What is mumps disease in adults. Mumps (mumps): infection, vaccination, signs, how to treat, complications. Infectious parotitis - symptoms

Epidemic parotitis (Parotitis epidemica) is an acute infectious disease caused by a virus mumps transmitted by airborne droplets and characterized by intoxication syndrome, damage salivary glands, the central nervous system, frequent involvement in the pathological process of other organs and systems.

historical data. Mumps (EP) was first described and singled out as an independent nosological form in 400 BC. e. Hippocrates. In 1849, A. D. Romanovsky, analyzing the epidemic of mumps in the Aleutian Islands, described the defeat of the central nervous system. N. F. Filatov, I. V. Troitsky pointed to inflammation of the gonads in both men and women.

Etiology. The causative agent of mumps is a virus belonging to the Paramyxoviridae family. The causative agent was discovered in 1934 by N. Johnson and E. Goodpasture, contains RNA, is unstable in the external environment, is sensitive to heat, drying, chemical, disinfectants(at a temperature of 60 ° C dies within 5-10 minutes, at ultraviolet irradiation- immediately, in disinfectant solutions - within a few minutes). The virus is not sensitive to chemotherapy and antibiotics, resistant to low temperatures(at -20°C it lasts 6-8 months); non-volatile - infection occurs only within a room or ward through direct contact. The antigenic structure is homogeneous. The mumps virus can be detected in saliva, blood, CSF taken from a patient in last days incubation period and in the first 3-4 days from the onset of the disease.

Epidemiology. Epidemic parotitis (mumps, mumps, mumps infection) is a typical anthroponotic infection. With artificial infection of animals, experimental infection was induced in monkeys.

The source of infection is a sick person who is contagious from the end of the incubation period (1-2 days before the onset of clinical manifestations) and, especially, during the first 3-5 days. illness. The contagiousness of patients with mumps ceases after the 9th day of illness. in the spread of infection great importance have patients with atypical forms. The existence of healthy virus carriers is assumed.

The transmission mechanism is drip.

The route of transmission is airborne. The virus is released into the external environment with droplets of saliva, where it is found in all children, regardless of localization pathological process.

The contact-household route of transmission is unlikely and is possible only with the direct transfer of infected objects from a sick person to a healthy one (for example, toys).

Contagiousness index - 50-85%.

The incidence is recorded in all countries of the world both in the form of sporadic cases and epidemic outbreaks (in children's groups, barracks for recruits). Outbreaks are characterized by a gradual spread over 2.5-3.5 months, an undulating course.

Age structure. Epidemic parotitis occurs at any age. Children 7-14 years old are most often ill; in children under the age of 1 year, especially the first 6 months. life, EP is extremely rare. Males are more commonly affected.

Seasonality. Cases of EP are recorded throughout the year, but in cold period(autumn-winter and early spring), their number increases. This is due to the activation of the drip transmission mechanism due to changes in the way of life of people and the formation of new teams.

Periodicity. Increasing incidence occurs after 3-5 years and is due to an increase in the number of susceptible individuals.

Immunity is stable, it is developed both after manifest forms and after atypical ones. Recurrence occurs in less than 3% of cases.

Pathogenesis. The entrance gates are the mucous membranes of the oral cavity, nose and pharynx. The place of primary localization of the EP virus is the salivary glands, possibly other glandular organs, the central nervous system. The virus penetrates into the salivary glands with blood flow, through the lymphatic tract, and also through the excretory ducts: parotid (stenon), etc. The virus multiplies in the glandular epithelium, after which it enters the blood again; with saliva, the virus is released into the external environment.

The virus infects glands of exoepithelial origin, different in function, but united by the identity of the anatomical and histological structure: salivary (parotid, submandibular, sublingual), pancreas (external secretory part), male sex (testicles, prostate), female genital (ovaries, Bartholin glands), milk, thyroid, lacrimal. Consequently, the virus in the process of evolution has adapted to the epithelium of the glands, which have an alveolar, alveolar-tubular and follicular structure.

Prolonged circulation of the pathogen in the blood contributes to its penetration through the blood-brain barrier. CSF study data indicate that in most cases there is CNS damage (even in the absence of clinical manifestations).

Pathomorphology. In the salivary glands, hyperemia and edema, expansion of the excretory ducts are noted. With mumps orchitis, multiple hemorrhages, swelling of the interstitial tissue and destruction of the germinal epithelium are observed, in the seminiferous tubules - fibrin, leukocytes, and remnants of epithelial cells. Degenerative changes spermatogenic epithelium is also detected in men without clinical signs of testicular involvement in the pathological process. Inflamed in the epididymis connective tissue the epithelium remains intact. Meningitis has a serous character, development of focal and diffuse encephalitis is possible.

Classification of mumps

Typical:

isolated (mumps);

Combined (mumps + submandibulitis; mumps + orchitis; mumps + serous meningitis, etc.).

Atypical:

· isolated;

Combined (pancreatitis + sublinguitis; pancreatitis + encephalitis, etc.);

erased;

asymptomatic.

By gravity:

1. Easy form.

2. Moderate form.

3. Severe form.

Severity Criteria:

the severity of the fever syndrome;

The severity of the syndrome of intoxication;

The severity of local changes.

Downstream (by nature):

1. Smooth.

2. Unsmooth:

With complications

With a layer of secondary infection;

with exacerbation of chronic diseases.

clinical picture. The incubation period for mumps varies from 11 to 21 days. (usually 15-19 days).

Typical forms (with an increase in the size of the parotid salivary glands) can be isolated, when there is only parotitis, and combined - a combined lesion of the parotid salivary gland and other glandular organs (submandibular and sublingual salivary glands, pancreas, sex glands, etc.); damage to the parotid salivary gland and central nervous system; damage to the parotid salivary gland and other organs and systems of the body.

The defeat of the parotid salivary glands (parotitis) is a typical, isolated form.

Initial period: in some cases, malaise, lethargy, headache, sleep disturbance (within 1-2 days). However, more often the disease begins acutely with an increase in body temperature.

During the peak period, children complain of pain when opening their mouths, chewing, less often - in the area of ​​the earlobe, neck. An increase in the size of the parotid salivary gland is detected, and after 1-2 days, as a rule, another parotid salivary gland. On the side of the lesion, swelling occurs in front of the ear (along the ascending branch mandible), under the earlobe, behind the auricle, so that the earlobe is also the center of the "tumor". Swelling of doughy or elastic consistency; the skin is tense, its color is not changed. The enlarged parotid salivary gland is painless or moderately painful on palpation.

With a significant increase in the size of the parotid salivary gland Auricle pushes up and forward. The configuration of the retromandibular fossa is smoothed out - between the branch of the lower jaw and the mastoid process. The degree of increase in the size of the parotid salivary glands is different: from imperceptible on examination (determined by palpation) to significant, with a change in the configuration of the face and neck. At sharp increase the size of the parotid salivary glands, edema may develop subcutaneous tissue extending to the neck, supraclavicular and subclavian regions.

In patients with EP, "Filatov's pain points" are determined: soreness with pressure on the tragus, mastoid process, and in the region of the retromandibular fossa. They also reveal characteristic changes in the oral mucosa: swelling and hyperemia around the external opening. excretory duct parotid salivary gland (Murson's symptom).

An increase in the size of the affected salivary glands is usually noted within 5-7 days, but sometimes disappears after 2-3 days or persists up to 10 days. from the onset of the disease.

During the period of convalescence, the body temperature is normal, the patient's well-being improves, functional activity salivary glands (by the end of the 3-4th week).

In patients with a typical form of EP, other glandular organs may be affected: submandibular and sublingual salivary glands, pancreas, gonads (typical, combined form).

The defeat of the submandibular salivary glands (submandibulitis) is more often bilateral. It occurs, as a rule, in combination with damage to the parotid salivary glands, but sometimes it can be the only manifestation of mumps infection. With submandibulitis, a "tumor" in the form of an oblong or rounded formation is determined medially from the edge of the lower jaw. The gland has a doughy consistency, somewhat painful on palpation: swelling of the subcutaneous tissue is possible.

The defeat of the sublingual salivary glands (sublingitis) in an isolated form is rare, usually combined with parotitis or submandibulitis. Swelling and soreness are determined in the chin area and under the tongue: a “tumor” of a doughy consistency. With a pronounced increase in the submandibular and sublingual salivary glands, edema of the pharynx, larynx, and tongue may develop.

Damage to the pancreas (pancreatitis) occurs in half of the patients. In most children, it develops simultaneously with the defeat of the parotid salivary glands, less often - on the 1st week of the disease and in isolated cases - on the 2nd week. Perhaps the development of pancreatitis to increase the size of the parotid salivary glands; extremely rarely, pancreatic damage is the only symptom of the disease. Clinically, pancreatitis is manifested by sharp cramping pains in the left hypochondrium, often of a girdle character. The body temperature rises with possible fluctuations up to 1-1.5 ° C (lasts up to 7 days or more). Nausea, repeated vomiting, loss of appetite, hiccups, constipation are almost always noted, in rare cases- diarrhea. In children of the first 2 years of life, the nature of the stool changes - liquid, poorly digested, with the presence of white lumps. Tongue coated, dryish. At severe forms there is repeated vomiting; pulse quickened, arterial pressure reduced, the development of a collaptoid state is possible.

Lesions of the male gonads (orchitis, prostatitis). Inflammation of the testicles (orchitis). The incidence of orchitis in men reaches 68%, in boys before school age- 2%. With the onset of puberty, orchitis occurs more often: in the age group of 11-15 years - in 17% of patients; at 16-17 years old - in 34% of patients.

Cases of the development of mumps orchitis in infants are described.

Orchitis develops acutely, more often on the 3-10th day of illness. Orchitis may occur on the 14-19th day of EP and even after 2-5 weeks. Orchitis may precede an increase in the size of the parotid salivary glands ("primary" orchitis), develop simultaneously with mumps ("associated" orchitis) and be the only manifestation of the disease ("autonomous" orchitis). However, most often, along with the defeat of the testicles, other organs and systems of the body (salivary glands, pancreas, central nervous system) are involved in the pathological process. Orchitis can be combined with lesions of the epididymis (orchiepididymitis). In EP, a predominantly unilateral lesion of the seminal glands is observed. Right testicle is involved in the process more often than the left one, which is due to the peculiarities of its blood circulation.

When orchitis occurs, the general condition of patients deteriorates sharply - body temperature rises to 39-41 ° C. The temperature curve acquires a "double-humped" character, and with the sequential involvement of both testicles in the pathological process, a third peak of body temperature increase is also observed. At the same time, pain in the testicles appears, radiating to the lower back, perineum, aggravated by getting out of bed, movements. In some cases, headache and vomiting are observed. Along with the symptoms of intoxication develop local signs orchitis - an increase in the volume of the testicle, its soreness, hyperemia, thinning or swelling of the skin of the scrotum. Signs of orchitis are most pronounced for 3-5 days, then gradually decrease and disappear.

Damage to the prostate gland (prostatitis) occurs mainly in adolescents and adults. The patient notes discomfort, pain in the perineum, especially during bowel movements and urination. Enlargement of the prostate gland is detected using finger research rectum.

The defeat of the female sex glands. Oophoritis occurs in girls during puberty. Inflammation of the ovaries is characterized by the severity of the process, sharp pain in iliac region, high body temperature. The reverse dynamics is usually fast (5-7 days). Outcomes of oophoritis are often favorable.

Mastitis of mumps etiology occurs in women and men. There is an increase in body temperature, soreness, compaction of the mammary glands. The process is liquidated quickly - in 3-4 days; suppuration of the glands is not observed.

Defeat thyroid gland(thyroiditis) is extremely rare. The disease proceeds with high body temperature, pain in the neck, sweating, exophthalmos.

Damage to the lacrimal gland (dacryoadenitis) is characterized by severe pain in the eyes, swelling of the eyelids, their pain on palpation.

In patients with a typical form of EP, the central nervous system is often affected (typical, combined form).

Serous meningitis occurs, as a rule, before the 6th day of illness and may be the only manifestation of mumps infection. Most often mumps meningitis occurs in children aged 3 to 9 years.

The onset is acute, sometimes sudden. Celebrate sharp rise body temperature, repeated vomiting that is not associated with food intake and does not bring relief; convulsions, delirium, loss of consciousness are possible. Patients complain of headache, lethargy, drowsiness, bad dream, loss of appetite. are revealed meningeal symptoms- neck stiffness, Brudzinsky's symptoms I, II, III, Kernig's symptom (moderately or weakly expressed for 5-7 days). Helps with diagnosis spinal tap; CSF pressure is increased, the fluid is clear or opalescent, moderate pleocytosis (up to 500-1000 cells/µl) of a lymphocytic nature (96-98% of lymphocytes). In most patients, the protein content is normal or moderately elevated (0.6 g / l), the concentration of chlorides, as a rule, is within the normal range.

There are asymptomatic CSF-positive meningitis, which are extremely difficult to diagnose.

Meningoencephalitis is rare. In typical cases, it develops on the 6-10th day of the disease, more often in children under 6 years of age. The pathological process involves cranial nerves, the pyramidal and vestibular systems, and the cerebellum.

The condition of the patients is extremely severe, high body temperature, severe headache, repeated vomiting, lethargy, drowsiness, impaired consciousness, delirium, tonic and clonic convulsions, paresis of cranial nerves, limbs by hemitype, cerebellar ataxia.

Cranial nerve lesions (mononeuritis) are rare, predominantly in older children. The most common lesions are VII couples on peripheral type and VIII couples. With damage to the auditory nerve, dizziness, nystagmus, tinnitus, hearing loss up to deafness are noted.

Myelitis and encephalomyelitis appear more often on the 10-12th day of illness. They are manifested by spastic lower paraparesis (increased muscle tone and tendon reflexes lower extremities, foot clonus, abnormal foot signs, decreased abdominal reflexes), fecal and urinary incontinence.

Severe damage to the nervous system in the form of polyradiculoneuritis occurs on the 5-7th day of the disease. It is manifested by distal flaccid paralysis and paresis in combination with radicular pain syndrome and loss of sensitivity in the distal-peripheral type.

Along with inflammation of the parotid salivary gland, other organs and systems of the body may be affected (typical, combined form).

Defeats respiratory system. With mumps infection, physical changes in the lungs are scarce.

However, in all patients, X-ray examination reveals circulatory-vascular changes (expansion of the roots of the lungs, increased pulmonary pattern), peribronchial seals lung tissue. They occur from the 1st to the 15th day of the disease and persist for a long time.

Lesions of the urinary system (urethritis, hemorrhagic cystitis). Changes in the urine are more often determined in preschool children, in half of the cases - at the 1st week of illness. They occur acutely and are manifested by proteinuria, hematuria, leukocyturia. Patients complain of frequent painful urination, macrohematuria is often observed. Total duration lesions of the urinary system no more than 1 week.

Defeat of cardio-vascular system manifests itself in the form of myocardial dystrophy and less often - myocarditis. Signs of myocarditis are detected by the end of the 1st week of illness, after 1.5-2 weeks. noted an improvement in electrocardiographic parameters.

The pathological process may involve: liver, spleen, organ of hearing (labyrinthitis, cochleitis), organ of vision (conjunctivitis, scleritis, keratitis, neuritis or paralysis optic nerve), serous membranes joints.

Isolated damage to organs and systems of the body is observed only in 15% of cases, in 85% of patients the lesions are combined or multiple.

BUT typical shapes proceed without an increase in the size of the parotid salivary glands. They can be isolated (one organ/system is affected) and combined (two or more organs/systems are affected).

Erased form - with an ephemeral lesion of the parotid salivary gland (an increase in the size of the gland is determined by palpation, quickly disappears).

Asymptomatic form - no clinical signs; is diagnosed in the foci of infection by increasing the titer of specific antibodies in the dynamics of the study.

According to severity, mild, moderate and severe forms of EP are distinguished. An isolated lesion of the parotid salivary glands (mumps) occurs, as a rule, in a mild to moderate form. Severe forms of the disease are due to the involvement in the pathological process of other organs and systems of the body (CNS, pancreas, gonads).

At mild form disease symptoms of intoxication are expressed slightly. General state remains satisfactory, body temperature rises to 37.5-38.5 °C. The increase in the size of the parotid salivary glands is expressed moderately, there is no edema of the subcutaneous tissue.

Moderate, the form is characterized severe symptoms intoxication (lethargy, sleep disturbance, headache, vomiting), an increase in body temperature up to 38.6-39.5 ° C. An increase in the size of the parotid salivary glands is expressed, in some cases there is a slight pastiness of the subcutaneous tissue of the neck.

In severe form, the symptoms of intoxication are pronounced: severe headache, repeated vomiting, delirium, hallucinations, anxiety, sometimes convulsions: body temperature reaches high numbers (39.6 ° C or more). The parotid salivary glands are significantly enlarged, painful on palpation; there is swelling of the subcutaneous tissue of the neck.

The course of EP (by nature) can be smooth and uneven (with complications, layering of secondary infection, exacerbation of chronic diseases).

Outcomes. After the defeat of the male gonads, the following adverse outcomes are possible: testicular atrophy, testicular tumors, "chronic orchitis", hypogonadism, prialism (prolonged painful erection of the penis, not associated with sexual arousal), infertility, impotence; gynecomastia.

Violation of spermatogenesis, up to azoospermia, can develop not only as a result of mumps orchitis, but also after mumps, which proceeded without clinical symptoms testicular inflammation.

After oophoritis, infertility may develop, early menopause(premature ovarian failure), ovarian carcinomas, ovarian atrophy, disorders menstrual cycle, juvenile uterine bleeding.

In some cases, after damage to the pancreas, chronic pancreatitis, diabetes mellitus, and obesity occur.

In 70% of convalescents nervous forms EP, various disorders of the general condition are noted ( fatigue, headaches, tearfulness, aggressiveness, night terrors, sleep disturbance, poor academic performance). The phenomena of cerebrosthenia and neuroses persist from 3 months. up to 2 years or more. In some cases, a pronounced asthenovegetative or hypertensive syndrome, enuresis develop, rarely - epilepsy, deafness, blindness.

Complications are caused by the layering of the secondary microbial flora (pneumonia, otitis, tonsillitis, lymphadenitis).

Features of epidemic parotitis in children of early age. Children of the first year of life practically do not get sick, at the age of 2-3 years, EP is rare. The disease is not severe, usually in the form of an isolated lesion of the parotid salivary glands and less often - submandibular and sublingual. Other glandular organs and the nervous system, as a rule, are not affected.

In women who undergo EN during pregnancy, spontaneous abortions, the birth of children with malformations, in particular with primary myocardial fibroelastosis, are possible. The EP virus can cause the development of hydrocephalus in the fetus.

Diagnostics

Supporting and diagnostic signs of mumps:

Contact with a patient with EP;

Increase in body temperature;

Complaints of pain when chewing;

Swelling in the area of ​​the parotid salivary glands;

Painful points of Filatov;

Murson's symptom;

Multiple organ damage (parotitis, submandibulitis, sublinguitis, pancreatitis, orchitis, serous meningitis, etc.).

Laboratory diagnostics. Virological and serological methods are used. Isolation of the virus from blood, saliva and CSF is an indisputable confirmation of the diagnosis. In the reaction of hemagglutination inhibition, antibodies (antihemagglutinins) to the EP virus are detected. Complement-fixing antibodies appear on the 2-5th day of the disease and remain in the blood serum for a long time, which allows the use of CSC for both early and retrospective diagnosis. diagnostic sign is an increase in the titer of specific antibodies by 4 times or more. With a single serological examination in the period of convalescence, a titer of 1:80 or more is considered diagnostic.

Differential diagnosis. The defeat of the parotid salivary glands in EP must be differentiated from acute purulent parotitis that occurs against the background of any severe common disease (typhoid fever, septicemia), or with local purulent infection (necrotizing or gangrenous stomatitis). With purulent parotitis, an increase in the size of the parotid salivary glands is accompanied by severe pain and a significant density of the gland. The skin in the area of ​​the affected gland quickly becomes hyperemic, then fluctuation appears. In the blood, neutrophilic leukocytosis is observed, in contrast to leukopenia and lymphocytosis in EP.

Toxic parotitis is rare, usually in adults, and is occupational diseases(for acute poisoning with iodine, mercury, lead). They are characterized by slow development, while, along with parotitis, other lesions typical of poisoning are detected (for example, a dark border on the mucous membrane of the gums and teeth). Possibly kidney damage digestive tract, CNS.

Salivary stone disease develops as a result of blockage of the excretory ducts of the salivary glands, occurs more often in adults and children over 13 years of age, is characterized by a gradual development at normal body temperature, and has a relapsing course. Depending on the degree of obstruction of the excretory duct, the size of the salivary gland changes - the swelling periodically increases and decreases, intermittent pain ("salivary colic") is noted. The pain is aggravated by eating. The process is often one-sided, damage to other organs and body systems is not typical. The diagnosis is confirmed by sialography with a contrast agent.

In rare cases, EP must be differentiated from a foreign body in the ducts of the salivary glands, actinomycosis of the salivary glands, cytomegalovirus infection, Mikulich's syndrome (observed with leukemia, chloroma; in adults it develops gradually, with normal temperature bodies, bilateral).

Submandibulitis must be differentiated from lymphadenitis that occurs with tonsillitis, periodontitis. In patients with regional lymphadenitis (submandibular, anterior cervical), separate enlarged lymph nodes are determined, painful on palpation. Possible suppuration lymph nodes. Body temperature is elevated. In the peripheral blood, neutrophilic leukocytosis and elevated ESR are detected.

In some cases it is difficult differential diagnosis EP and periostitis, in which there is a subperiosteal accumulation of pus, resulting in swelling and infiltration in the lower jaw. The diagnosis of periostitis is confirmed by finding a painful carious tooth, swelling of the gums at the root of the tooth.

Epidemic parotitis sometimes has to be differentiated from toxic diphtheria of the pharynx. Swelling in toxic diphtheria of the pharynx is painless, jelly-like consistency; the skin over the edema is not changed. The retromandibular fossa remains free; when examining the pharynx, edema is determined soft palate, palatine tonsils, uvula, widespread fibrinous raids.

The defeat of the sublingual salivary gland in some cases must be differentiated from the phlegmon of the floor of the mouth (Ludwig's angina). Patients complain of sore throat, aggravated by swallowing and talking, weakness, malaise, fever up to 38.0-39.5 °C. An infiltrate appears in the chin area, spreading to the anterior, sometimes side surface neck. The skin over the infiltrate is hyperemic. Opening the mouth is sharply difficult, the tongue is raised, an unpleasant putrid odor from the mouth appears, swallowing is almost impossible. On examination, moderate hyperemia and swelling of the oral mucosa and palatine tonsils are noted, usually with. one side; language is shifted. On palpation of the soft tissues of the bottom of the mouth, their compaction is determined. The general condition of the children is extremely difficult. High lethality is noted. The cause of death is the spread of infection through the interfascial fissures into the mediastinum and cranial cavity.

Great difficulties are presented by the differential diagnosis of an isolated serous meningitis mumps etiology and serous meningitis of a different nature (see "Meningitis").

Treatment of patients with mumps infection is complex, taking into account the form, severity and period of the disease, the age of patients and their individual characteristics.

At home, the treatment of patients is shown only with an isolated lesion of the parotid salivary glands, occurring in a mild or moderate form. Children with a severe form of mumps, damage to the central nervous system, gonads, combined damage to organs and systems are subject to mandatory hospitalization. In order to prevent the development of mumps orchitis, it is recommended to hospitalize all boys older than 12 years. If bed rest is observed, the incidence of orchitis decreases sharply (by 3 times or more).

Bed rest is mandatory throughout acute period illness: up to 7 days. - with isolated mumps, at least 2 weeks. - with serous meningitis (meningoencephalitis), 7-10 days. - with inflammation of the testicles.

The nutrition of the child is determined by his age, the severity of local changes and possible emergence pancreatitis. The patient should be fed warm liquid or semi-liquid food if the usual causes pain when chewing. Pureed soups, liquid cereals are recommended, mashed potatoes, applesauce, steam cutlets, chicken meat, vegetable puddings, fruits, fish. Excluded products that have a pronounced juice effect (juices, raw vegetables), as well as sour, spicy and fatty foods.

To prevent gingivitis and purulent inflammation parotid salivary glands, it is necessary to rinse your mouth after eating with boiled water or a weak solution of potassium permanganate, furacilin.

Dry heat is applied locally to the area of ​​the salivary glands. They use wool (woolen scarf, scarf), heated sand or heated salt, gray cotton wool, electric heating pad, blue light, solux lamp, paraffin applications. Local therapy is carried out until the disappearance of the tumor. Compresses are contraindicated.

With mild and moderate forms isolated lesions of the parotid salivary glands are prescribed: bed rest, diet, dry heat (locally). Antipyretic drugs are used: ibuprofen (the drug "Nurofen for children" in the form of a suspension is used in children aged 3 months to 12 years, "Nurofen" in tablets - older than 6 years) is used in a single dose of 7.5-10 mg / kg 3-4 times a day, paracetamol is prescribed in a single dose of 15 mg / kg no more than 4 times a day with an interval of at least 4 hours. According to indications, desensitizing agents are prescribed (loratidin, suprastin, tavegil). In moderate and severe forms, viferon is used.

Treatment of patients with severe EP is carried out with the use of etiotropic agents. For meningitis, meningoencephalitis, orchitis, ribonuclease, recombinant interferons (reaferon, viferon) are used. Patients with CNS lesions are also given dehydration therapy (lasix, diacarb); prescribe drugs that improve brain trophism (pantogam, encephabol, nootropil, trental, instenon), and absorbable (aloe, lidase) therapy. According to indications, glucocorticoids are used (prednisolone at a dose of 1-2 mg/kg/day).

In mumps orchitis, along with etiotropic therapy, antipyretics are used, detoxification therapy is carried out (intravenous drip of 10% glucose solution with ascorbic acid, rheopolyglucin), glucocorticoids are prescribed (prednisolone at the rate of 2-3 mg / kg / day).

Local treatment of orchitis: the elevated position of the testicles is achieved using a supporting bandage - a suspensor. In the first 2-3 days positive effect renders cold (lotions with cold water or an ice pack), then heat on the testicles (dry warm cotton bandage, bandage with Vishnevsky ointment). Surgery(incision or puncture of the albuginea of ​​the testicle) is used for severe forms of orchitis, especially bilateral, in the absence of effect from conservative therapy. Surgical intervention promotes quick withdrawal pain and prevents the development of testicular atrophy.

In pancreatitis, antispasmodics (papaverine, no-shpa), inhibitors of proteolytic enzymes (trasilol, contrical, aniprol), detoxification therapy, glucocorticoids, enzymes (creon) are prescribed.

Antibiotics are prescribed when secondary bacterial microflora is attached.

In the period of convalescence, the use of drugs that increase the level of nonspecific reactivity of the body is indicated: immunal is prescribed in a single dose: for children from 1 to 6 years old - 1.0 ml; 6-12 years - 1.5 ml; over 12 years old - 2.5 ml (children over 4 years old can use a tablet form) 1-3 times a day for a course of 1 to 8 weeks. Vitamin-mineral complexes are prescribed as general strengthening agents: multitabs, asset complivit (for children over 7 years old, 1 tablet 1 time per day for 1 month).

Dispensary supervision. All EP convalescents should be under dispensary observation for 1 month. in a children's clinic. Convalescents of nervous forms of EP for at least 2 years are observed by a neuropathologist and pediatric infectious disease specialist. Boys who have had mumps orchitis are observed by an endocrinologist and urologist for at least 2 years. Pancreatitis convalescents are under the supervision of an endocrinologist for 1 year. Children who have had cystitis are observed by a nephrologist for 1 year.

Prevention. The patient with EP is isolated until the disappearance of clinical signs (at least 9 days from the onset of the disease).

Disinfection after isolation of the patient is not required; enough wet cleaning, ventilation.

The children's institution announces quarantine for 21 days. Children who have not had EP before and are not immunized against this infection are subject to quarantine. With a precisely established period of contact with a patient with EP, those who contacted can visit children's institutions for the first 9 days. Children under the age of 10 who had family contact in children's institution are not allowed from the 10th to the 21st day from the moment of isolation of the patient. From the 10th day of contact, a systematic medical supervision for early detection illness.

In the focus, emergency vaccination of the ZhPV is carried out for all contact, unvaccinated and not sick with mumps persons (after the first case of the disease is registered).

Mumps (mumps, mumps) is traditionally classified as a "children's" infection, since the causative agent of the disease, which has a fairly high contagiousness index, is capable of rapidly spreading mainly among the children's contingent. However, this fact does not exclude the possibility of developing the disease in adults. Insufficient attention of doctors to the features of the course this disease in adults is fraught with serious danger due to the possibility of damage, in particular, to the nervous system and reproductive apparatus of men.

Mumps (EP) is an acute systemic viral infection, registered more often in children of school age and characterized by predominant lesion salivary glands, as well as other glandular organs and the nervous system.

The causative agent of mumps (EP) is a virus belonging to the family paramyxovirus, which is characterized by pronounced polymorphism: its dimensions can vary from 100 to 600 nm, and in shape represent rounded, spherical or irregular elements. The virus genome is a single-stranded helical RNA surrounded by a nucleocapsid. The antigenic structure of the virus is stable, and today only one of its serotypes is known. The virus has neurominidase, hemolytic and hemagglutinating activity, which are associated with HN and F glycoproteins.

In vitro, the EP virus is cultivated on various cell cultures of mammals and chicken embryos.

The EP virus is unstable in the external environment and exhibits exceptional sensitivity to high temperature, ultraviolet radiation, drying and disinfectants.

Despite the fact that under experimental conditions it is possible to reproduce the disease in some mammalian species (primarily on monkeys), it is believed that the “natural host” of the EP virus is only a person with clinically manifest, erased or subclinical forms of the disease. Isolation of the virus by infected patients begins already at the end of the incubation period (five to seven days before the onset of the disease) and continues until the ninth day from the appearance of the first clinical signs of the disease. Thus, the average period of contagiousness of the patient for others is about two weeks. The most active release of the virus into the external environment occurs in the first three to five days of the disease. In the acute period of the disease, the EP virus is found in saliva, and in the case of meningitis, in the cerebrospinal fluid. In addition, it was found that the virus can be found in other biological secrets of patients: blood, urine, breast milk and in the affected glandular tissue.

A person's susceptibility to mumps infection is estimated to be quite high (about 100%) and remains at this level throughout life if the patient has not previously suffered from EN or was not vaccinated against it (see Figure 1). Cases of the disease are extremely rare in children under six months of age and in people over 50 years of age.

The primary localization of the pathogen on the upper mucosa respiratory tract with subsequent damage to the salivary glands, the airborne route of infection is determined. In addition, the possibility of transmission of the pathogen by direct contact with toys or utensils contaminated with infected saliva, however, it should be remembered that such a transmission route can only be implemented in a children's team, since the EP virus is unstable in the external environment. One of the factors accelerating the spread of the EP virus is the presence of concomitant acute respiratory infections- due to a significant increase in the release of the pathogen into the external environment.

EP refers to "preventable" infections, the incidence of which depends on vaccination. But to date, only 38% of the countries of the world have vaccination against EPO included in their national vaccination calendars(Galazka A. M. et al., 1999). Vaccination against EP significantly affected the incidence rates. Prior to the introduction of mandatory vaccination, EP had an epidemic distribution mainly among children of primary school age. The rise in incidence was typical of the autumn and winter months, and epidemics recurred every two to five years. Due to the constant circulation of the virus among the children, by the age of 15, antibodies to the EP virus in the blood serum were detected in more than 90% of children. The introduction of mandatory vaccination contributed to a significant (tens of times) decrease in the incidence of EP. At the same time, there was a trend towards a change in the age structure of patients: against the background of a decrease in the incidence of children, the proportion of the incidence of adult patients increased. Under the conditions of mandatory vaccination, cases of the epidemic spread of the EP virus began to be recorded in organized groups of the older age group (military contingent, college students, etc.) (Caspall K. et al., 1987).

After the disease, patients develop intense lifelong immunity. There are only a few descriptions in the literature repeated cases EP diseases. Although the duration of post-vaccination immunity is not well understood, most researchers also point to its sufficient duration.

A special group consists of children under one year of age, whose protection from the disease of EP is provided by the presence of transplacental specific antibodies (IgG) to the EP virus. Active transplacental transport of class G immunoglobulins begins as early as six months of pregnancy and increases rapidly towards its end. In the blood serum of the fetus, the concentration of IgG exceeds maternal levels in the ratio of 1.2-1.8: 1. During the first year of life, IgG titers to the EP virus slowly decrease and at the age of nine to 12 months are detected only in 5.2% of the observed ( C. Nicoara et al., 1999).

Many researchers point out that although, in general, the incidence of EP is decreasing, the risk of nosocomial forms of the disease is increasing, which is explained by the late detection of patients in whom the disease occurs with the development of serous meningitis, orchitis, oophoritis, and other complications (C. Aitken, D. J. Jeffries, 2001).

The airborne spread of the EP virus determines the entrance gate of infection: the mucous membrane of the oropharynx and nasopharynx. It has been experimentally established that inoculation of the EP virus on the mucous membrane of the nose or cheek leads to the development of the disease. Primary viral replication occurs in the epithelial cells of the upper respiratory tract and is accompanied by the spread of the virus to the nasopharyngeal and regional lymph nodes, followed by viremia and systemic dissemination of the virus. The phase of viremia is short and does not exceed three to five days. During this period, the virus spreads to various organs and tissues (salivary, genital, pancreas, central nervous system and etc.), inflammatory response in which and defines clinical manifestations diseases.

Although the character pathological changes in the affected organs is still insufficiently studied, in recent times Special attention researchers turn to the defeat of glandular cells, whereas previously the leading pathomorphological substrate of the lesion was considered developing in the organs of interstitial edema and lymphohistiocytic infiltration. Studies show that although the development of edema and lymphocytic infiltration of the interstitial space of the glandular tissue is typical for the acute period, the EP virus can simultaneously affect the glandular tissue itself. So, the study of J. Aiman ​​et al. (1980) showed that, in addition to edema, orchitis also affects the testicular parenchyma (Leydig cells), which causes a decrease in androgen production and impaired spermatogenesis (R. Le Goffic et al., 2003). A similar nature of the lesion is also described in the case when the islet apparatus of the pancreas was affected, which may result in its atrophy with the development of diabetes.

In the process of the development of the disease in the body, specific antiviral antibodies are produced that neutralize the virus and prevent its penetration into cells. There are observations that the imbalance of the emerging cellular-humoral immunity in EP is more often observed in individuals with more severe and complicated forms of the disease.

The incubation period for EN, on average, is 18-20 days, although it can be both shortened (up to 7-11 days) and longer (up to 23-25 ​​days).

Numerous observations show that the clinical manifestations of EN can vary widely. Thus, typical forms of EP (with lesions of the salivary glands) are recorded only in 30-40% of infected people, while about 40-50% of patients carry EP into atypical form with a predominance of non-specific respiratory signs disease, and in 20% of patients it proceeds generally subclinically. Some authors point out that the percentage of subclinical forms among recovered patients can reach 30%. With age, the frequency of erased forms of the disease increases in patients, and the ratio of typical and erased forms among children aged 7–9 years is 1:1; 10-14 years old - 1: 3; and 15-19 years old - 1:11 (V. A. Postovit, 1997). A clear explanation of this phenomenon does not yet exist, if we do not take into account the traditional one - the presence in patients varying degrees expressiveness of specific antimumps immunity.

For EP, an acute onset of the disease is typical, although in 15% of adults and 5% of children the disease can manifest from a short (up to one day) prodromal period, which extremely rarely can be extended up to two or three days. It is characterized by non-specific manifestations in the form general malaise, headache, myalgia, feelings of chilling, subfebrile temperature, anorexia and catarrhal phenomena.

A typical form of EP is characterized by lesions of the salivary glands, which are registered already on the first day of the disease. Although any salivary glands can be affected in EP, involvement of the parotid salivary glands is nevertheless more specific for this disease, which in 70-80% of patients has a bilateral localization. At the same time, it should be remembered that the synchronism of damage to the parotid salivary glands is not typical, and the time interval between the defeat of one and the other gland can be from one to three days.

In most cases, patients have a combined nature of the lesion with the involvement of not only the parotid, but also the submandibular and sublingual salivary glands. Isolated lesions of the submandibular and sublingual salivary glands, although possible, are very rare.

The development of inflammation in the salivary glands, as a rule, is accompanied by fever, although there are cases when EP occurred without an increase in body temperature or with subfebrile condition. Almost simultaneously with an increase in temperature to 39-40 ° C, patients notice pain in the area of ​​the parotid salivary glands, especially when chewing and opening the mouth. Pain in the projection area of ​​the parotid salivary glands, they precede the development of edema of the gland in the vast majority of patients (over 90%). Among the early clinical signs of EP is Filatov's symptom (detection pain points). Already during the first day, patients in the projection area of ​​the parotid salivary gland have a slight swelling. Quite quickly (within a few hours) edema develops, which can spread to the area of ​​the mastoid process, anteriorly to the cheek and to the neck area. As the parotid salivary gland enlarges, the earlobe on the side of the lesion rises upward, giving the patient's face a typical "pear" shape. Edema parotid gland from the onset of the disease increases within three to five days. The skin in the projection area of ​​the inflamed salivary gland is tense, shiny, but its color is not changed. Patients have moderate soreness on palpation of the affected gland.

During this period, patients often complain of noise and pain in the ear (on the side of the lesion), which is due to compression of the edematous gland eustachian tube they have trouble swallowing and speaking. Mursu's symptom described in EP (small hyperemia and swelling of the mucosa in the area of ​​the orifice of the excretory duct of the stenon) can be detected, according to different authors, from 5 to 80 or more percent of cases.

Studies show recent years, the lymphatic apparatus is also involved in the process during EP, however, an increase in regional lymph nodes in patients is detected quite rarely (from 3 to 12%), which can partly be explained by the fact that it is camouflaged developing edema on the affected side. The development of hepatolienal syndrome for EP is also not typical.

The febrile reaction in patients with EP persists during the entire period of the peak of the disease, which corresponds to developing edema affected salivary gland. Observations show that in children the resolution of edema occurs already by the ninth day of illness, while in adults it may occur somewhat later. The prolongation of the febrile reaction in patients with EP may be due to the sequential involvement of other salivary glands in the pathological process or other localization of the process (orchitis, CNS, etc.). Although a single-wave course of the disease is typical for EP, cases are described when two or even three waves of the disease were recorded in patients.

According to traditional concepts, a different localization of the pathological process in EP (except for the salivary glands) is considered as a complication of the disease. Although these lesions do register in more late dates, Nonetheless modern research allow us to consider them as more severe variants of the course of the disease (V. I. Pokrovsky, S. G. Pak, 2003), since they are due to the specific tropism of the EP virus (see table 1).

Orchitis. They are among the most common lesions (excluding salivary glands) in EP in male patients in the post-pubertal period and reach 50%. In most cases, testicular involvement is preceded by involvement of the salivary glands, although cases have been described in which EP was manifested only by the development of orchitis. More often recorded unilateral testicular lesions, although in 20-25% of patients it may be bilateral.

Orchitis, as a rule, develops by the end of the first week from the onset of the disease, when patients have a decrease and normalization of temperature. Patients suddenly notice a deterioration in their condition, the body temperature rises again to high numbers, a headache appears or intensifies, patients may vomit. The most important clinical sign is the appearance of aching pain and swelling of the testicles. The process lasts about a week, but the swelling of the testicles can last much longer. Different degrees of testicular atrophy are recorded in approximately 50% of patients, however, sterility in patients develops quite rarely and only with a bilateral process.

Oophoritis. Refers to the number of infrequent manifestations of EP in female patients in the post-pubertal period. Moreover, oophoritis does not affect fertility and does not lead to sterility. In some cases, the development of oophoritis can clinically mimic acute appendicitis.

Mastitis. More often develop at the height of the disease on the third to fifth day of EP. A feature of the development of mastitis is that they can develop not only in women, but also in girls and men. Clinically, this is manifested by compaction and soreness in the area of ​​​​the mammary glands.

Pancreatitis. The described incidence of pancreatitis in patients with EP, according to various authors, varies over a very wide range: from 1-2% to more than 50%. Such an incredibly wide range is explained, first of all, by the use of various diagnostic criteria. The level of urine amylase cannot be a reliable criterion for diagnosing pancreatitis, since parotitis is also characterized by an increase in its level. Many authors point to the latent course of pancreatitis in EP.

The defeat of the central nervous system can be manifested by the development of serous meningitis and encephalitis.

Meningitis. Prior to the introduction of vaccination, the EP virus was one of the most common causes of serous meningitis. Observations show that serous meningitis in EP is very often asymptomatic. The study of liquor shows that 50-60% of patients with EP develop pleocytosis, while clinical signs of meningitis (meningeal signs) are detected only in 5-20% of patients. Adults are at a higher risk of developing serous meningitis than children. Meningitis can develop not only in the period of peak or convalescence of epilepsy, but even in the absence of lesions of the salivary glands in patients. Meningitis, as a rule, has a favorable course, and the normalization of cerebrospinal fluid occurs within 3-10 days.

Despite the fact that in patients with EP it is extremely rare (1:20,000) that such a neurological disorder as deafness can be recorded, transient sensorineural hearing loss occurs more often, for which, in particular, the development of vestibular disorders in the form of dizziness, static and coordination disorders is typical, nausea and even vomiting.

Encephalitis. They are among the rare manifestations in EP (less than two cases per 100 thousand) (K. L. Davison et al., 2003). In the conducted in 1995-1998. in a four-state study of unexplained deaths and severe illnesses possibly associated with infectious agents in previously healthy individuals aged one to 49 years, it was found that the EP virus can cause a previously unidentified etiological damage to the nervous system (R. A. Hajjeh et al., 2002).

Encephalitis in EP can develop both in parallel with the defeat of the salivary glands, and after one to two weeks from the onset of the disease, which indicates different mechanisms of its development. The clinical picture is characterized by: high temperature, severe condition of patients, lethargy, impaired consciousness, agitation, clonic-tonic convulsions, focal symptoms. Despite the severity of the lesion, mortality in mumps encephalitis ranges from 0.5 to 2.3%.

In some patients, after suffering encephalitis, prolonged asthenic syndrome and neurological disorders may persist.

Diagnosis of EP is based on clinical and epidemiological data and in typical cases does not present great difficulties.

Laboratory confirmation of EP includes both isolation of the virus itself (from saliva, urine, cerebrospinal fluid) and serological tests of blood serum for the detection of specific anti-mumps antibodies (IgM and IgG), which is of particular importance in cases of atypical and subclinical course of the disease.

In recent years, PCR methods for diagnosing EP have been developed, which allow not only to significantly speed up the analysis time, but also to qualitatively improve the laboratory verification of the disease (G. P. Poggio et al., 2000).

Differential Diagnosis

The range of differential diagnostic search is determined by the variant of the course of EP. First of all, a differential diagnosis should be made in patients with unilateral lesions of the parotid salivary glands, in whom it is necessary to exclude a different etiology of mumps or establish a cause that mimics swelling of the parotid (or other) salivary gland. An increase in the parotid salivary glands can be recorded in viral diseases caused by Coxsackie A viruses and lymphocytic choriomeningitis, with bacterial parotitis caused by Staphylococcus aureus, sialolithiasis, Sjogren's syndrome, sarcoidosis, and tumors. A special group consists of diseases in which a pseudo-enlargement of the parotid salivary glands can be detected due to swelling of the subcutaneous tissue or developing lymphadenitis: a toxic form of diphtheria, infectious mononucleosis, herpes virus infection (M. D. Witt et al., 2002).

Despite the contagiousness of EP, treatment of patients is allowed both on an outpatient and inpatient basis. Patients should be hospitalized according to epidemiological and clinical indications. In order to reduce the risk of complications, regardless of the severity of the course of the disease, patients should remain in bed for the entire febrile period. In the acute period of the disease, during the first three to four days, patients should receive only liquid and semi-liquid food. Given the violation of salivation, much attention in the acute period of the disease should be given to oral care (rinsing, brushing teeth, regular fluid intake), and during the period of convalescence it is necessary to stimulate the secretion of saliva, using, in particular, lemon juice.

There are no specific treatments for patients with EP, although in vitro experimental studies have established an inhibitory effect of ribavirin on viral replication. Unlike some other childhood infections, immunoglobulins are not used for prophylaxis or treatment in EP.

The basis of pharmacological treatment is pathogenetic therapy aimed at reducing the severity of the inflammatory response in the affected organs, which is achieved by prescribing non-steroidal anti-inflammatory drugs and detoxification therapy. In patients with severe disease with an anti-inflammatory purpose, corticosteroid drugs (prednisolone) at a daily dose of 40-60 mg for several days can be used, but it should be remembered that their administration does not prevent the development of orchitis or other localizations of the process. Reduction of general intoxication is facilitated by sufficient consumption of liquids in the form of compotes, juices, fruit drinks during the day. If necessary, crystalloid (5% glucose solution) and colloid (Hemodez, reopoliglyukin) solutions are administered intravenously to patients. It is also advisable to prescribe desensitizing therapy (suprastin, diphenhydramine, etc.). Some relief comes from the application of cold compresses or an ice pack to the area of ​​the affected gland.

Anti-epidemic measures are aimed at isolating the patient in order to limit the spread of infection, which is of particular importance for children attending kindergartens and schools. Patients are subject to isolation until clinical recovery for at least nine days from the onset of the disease. If the exact date of contact of a child who has not been ill before EP with a sick child has been established, then during the first 10 days from the moment of the supposed start of the incubation period, they can visit children's groups, and from the 11th to the 21st days they are subject to mandatory isolation.

For specific prophylaxis of EP, a live mumps vaccine is used, which is administered routinely.

Literature.

V. A. Malov, doctor of medical sciences, professor
A. N. Gorobchenko, Candidate of Medical Sciences, Associate Professor
MMA them. I. M. Sechenov, Moscow

Most often, mumps affects children aged 5-15 years, but adults can also get sick.

As a rule, the disease is not very severe. However, parotitis has a number of dangerous complications. To insure against an unfavorable course of the disease, it is necessary to prevent the very possibility of developing mumps. For this, there is from mumps, which is included in the list of mandatory vaccinations in all countries of the world.

Causes of the disease

Infection occurs by airborne droplets (when coughing, sneezing, talking) from a sick person. A sick mumps is contagious 1-2 days before the onset of the first signs of the disease and within 9 days after its onset (the maximum isolation of the virus is from the third to the fifth day).

After entering the body, the virus multiplies in the glandular tissue and can affect almost all glands of the body - genital, salivary, pancreas, thyroid. Changes in the functioning of most glands rarely reach the level at which specific complaints and symptoms begin to arise, but the salivary glands are affected first and most severely.

Symptoms of mumps (mumps)

The disease usually begins acutely. The temperature can rise to 40 degrees, there is pain in the ear or in front of it, especially when chewing and swallowing, increased salivation. Especially sharp pain occurs when food is ingested, causing profuse salivation (for example, sour). Inflammation of the parotid salivary gland causes an increase in the cheek - a rapidly spreading swelling appears in front of the auricle, which increases to the maximum by the 5-6th day. The earlobe protrudes upward and forward, which gives the patient a characteristic appearance. Feeling this place is painful. Elevated body temperature persists for 5-7 days.

Complications

Of the complications of mumps, the most common are inflammation of the pancreas () and gonads. Perhaps inflammation of the thyroid and other internal glands of the body, as well as damage to the nervous system in the form of meningitis or encephalitis.

Pancreatitis begins with sharp pains in the abdomen (often girdle), loss of appetite, and stool disorders. If you notice the appearance of such symptoms, you should immediately consult a doctor.

The defeat of the gonads can be in both boys and girls. If in boys the inflammation of the testicles is quite noticeable, due to their anatomical location and a rather vivid clinical picture (a new rise in temperature, soreness of the testicle, discoloration of the skin above it), then in girls the diagnosis of ovarian damage is difficult. The consequence of such inflammation may subsequently be testicular atrophy in men, ovarian atrophy, infertility, menstrual dysfunction in women.

What can you do

There is no specific therapy for mumps. The disease is most dangerous in boys during puberty, due to possible damage to the testicles. Treatment is aimed at preventing the development of complications. Do not self-medicate. Only a doctor can correctly diagnose and check whether other glands are affected.

What can a doctor do

In typical cases, the diagnosis does not cause difficulties and the doctor immediately prescribes treatment. In doubtful cases, the doctor may prescribe additional diagnostic methods. Patients are advised to stay in bed for 7-10 days. It is known that in boys who did not comply with bed rest during the 1st week, (testicular inflammation) develops about 3 times more often. It is necessary to monitor the cleanliness of the oral cavity. To do this, prescribe daily rinsing with a 2% solution of soda or other disinfectants.

A dry warm bandage is applied to the affected salivary gland. Patients are prescribed liquid or crushed food. To prevent inflammation of the pancreas, in addition, it is necessary to follow a certain diet: avoid overeating, reduce the amount of white bread, pasta, fats, cabbage. The diet should be dairy-vegetarian. From cereals it is better to use rice, brown bread, potatoes are allowed.

Prevention of mumps (mumps)

The danger of complications of mumps is beyond doubt. That is why methods of preventing this disease are so common in the form of establishing quarantine in children's groups and preventive vaccinations. The patient is isolated until the 9th day of illness; children who have been in contact with the patient are not allowed to visit children's institutions (nurseries, kindergartens, schools) for 21 days. However, the problem is that in 30-40% of those infected with the virus, no signs of the disease occur (asymptomatic forms). Therefore, avoiding mumps, hiding from patients, is not always possible. Accordingly, the only acceptable way of prevention is vaccination. According to the preventive vaccination calendar in Russia, vaccination against mumps is carried out at 12 months and at 6 years.

Mumps (or mumps) is an acute viral disease that occurs against the background of exposure to paramyxovirus. Parotitis, the symptoms of which are manifested in the form of fever, a general type of intoxication, as well as an increase in the salivary glands (one or more), often affects other organs, as well as the central nervous system.

general description

The source of the disease is exclusively a person, that is, patients in whom the disease occurs in a manifest or inapparent form. Patients become contagious within the first 1-2 days from the moment of infection until the first symptoms indicating the disease appear in them. In addition, they are contagious in the first five days of the course of the disease. From the moment the patient's symptoms characteristic of mumps disappear, he also ceases to be contagious.

The transmission of the virus occurs by airborne droplets, but the possibility of its transmission through contaminated objects (for example, through toys, etc.) is not excluded. As for susceptibility to infection, it is quite high.

Children are predominantly affected. Regarding gender, it is noted that the incidence of parotitis among men occurs one and a half times more often than among women. In addition, the disease is characterized by high seasonality, with the maximum incidence in March-April, and the minimum in August-September.

In the adult population (about 80-90%), the presence of antibodies to the infection is detected in the blood, which, in turn, indicates the significance of its spread.

Features of the course of mumps

The mucosa of the upper respiratory tract acts as a gateway for infection, which also does not exclude the tonsils in this context. Penetration of the pathogen occurs to the salivary glands in a hematogenous way, and not through the stenons (that is, the ear) duct. The spread of the virus occurs throughout the body, in the process of which it chooses the most favorable conditions for itself, in which its reproduction will become possible - in particular, these are the glandular organs and the nervous system.

The nervous system, as well as other glandular organs, is affected not only after the salivary glands have been affected, but also at the same time or before this. In some cases, this type of lesion may not be present.

The localization of the pathogen, as well as the severity of changes accompanying certain organs, determines the widest variety that characterizes the symptoms of the disease. During the course of parotitis, the body begins to produce antibodies, which are subsequently detected over several years, in addition to this, an allergic restructuring in the body also occurs, which persists for a long period of time (perhaps even throughout life).

In determining the mechanisms of neutralization of the virus we are considering, it is important to note that a significant role is determined for virucidal bodies that inhibit the activity of the virus, as well as the process of its penetration into cells.

Classification of clinical forms of parotitis

The course of mumps can take place in various clinical forms, which is especially important in the process of diagnosing the disease. To date, there is no generally accepted version of the classification of the forms of the disease, but the following, most successful variation is applicable.

• Manifest forms:
• Uncomplicated forms: only the salivary glands (one or several) are affected;
• Complicated forms: the salivary glands are affected, as well as some other types of organs, which manifests itself in the form of meningitis, nephritis, orchitis, arthritis, mastitis, meningoencephalitis, etc.;
• Depending on the inherent severity of the course of the form:
• Light (atypical, erased) forms;
• Moderate forms;
• Forms are heavy.
• Inapparent form of a variety of infection;
• Phenomena of the residual type that occur against the background of mumps:
• Diabetes;
• Infertility;
• testicular atrophy;
• Violations in the functions of the central nervous system;
• Deafness.

The classification regarding the manifest forms of the disease implies two additional criteria: complications (their presence or absence), as well as the severity of the disease. Then the possibility of the infection in an inapparent form (that is, in the form of an asymptomatic) is indicated, in addition, residual phenomena are also identified that persist for a long time (mainly throughout life) from the moment of elimination of the mumps virus from the patient's body. The severity of the consequences of the disease (deafness, infertility, etc.) determines the need for this section, because in practice, experts often lose sight of them.

As for uncomplicated forms of the disease, these include those variants of the course of the disease in which only the salivary glands in any number are affected. In the case of complicated forms, damage to the salivary glands is considered an obligatory component of the clinical picture, while, however, the development of damage to other types of organs (mainly glands: mammary, genital, etc.), nervous system, kidneys, joints, myocardium is not excluded.

With regard to determining the severity criteria corresponding to the course of mumps, they start from the severity of fever and signs characteristic of intoxication, in addition to which complications (their absence or presence) are also taken into account. The course of uncomplicated mumps, as a rule, is characterized by its own ease, somewhat less often there is a correspondence of moderate severity, while severe forms in any case proceed with complications (often multiple).

Peculiarities mild forms of parotitis consist in the course of the disease in combination with subfebrile temperature, mild or absent intoxication, with the exception of the possibility of complications.

Medium-heavy forms characterized by the occurrence of febrile temperature (within 38-39 degrees), as well as a prolonged form of fever with severe symptoms of intoxication (headache, chills, myalgia, arthralgia). The salivary glands reach a considerable size, bilateral parotitis is often possible in combination with complications.

severe forms diseases occur at high body temperature (from 40 degrees or more), and its increase is characterized by a significant duration (within two or more weeks). In addition, the symptoms characteristic of intoxication are pronounced (severe weakness, lowering blood pressure, sleep disturbances, tachycardia, anorexia, etc.). In this case, mumps is almost always bilateral, and its complications are multiple. Fever in combination with toxicosis proceeds in waves, and each individual wave is directly related to the appearance of an additional complication. In some cases, a severe course is not determined from the first days of the onset of the disease.

Parotitis: symptoms in children

Mumps, like any other infection, has several stages that are relevant to itself, of which the first is the incubation period, its duration is about 12-21 days.

Following the penetration of the virus into the child's body through the mucous membranes of the respiratory tract, it enters the bloodstream, after which it spreads throughout the body. The virus mainly concentrates in the glandular organs (pancreas, salivary glands, thyroid gland, testicles, prostate), as well as in the central nervous system. It is in these organs that the accumulation and reproduction of the virus occurs, which, by the end of the incubation period, again appears in the blood - this already determines the second wave of viremia. The duration of the presence of viruses in the blood is about 7 days, during which it becomes possible to detect them using specialized research techniques.

This is followed by such a stage of parotitis as the stage of the appearance of clinical symptoms. The classic course of mumps in children is characterized by the appearance of temperature (about 38 degrees). Within a day or two, swelling occurs in combination with soreness, localized from the side of the parotid salivary gland. Inflammation of the salivary gland, respectively, leads to a violation of its functions, which, in turn, causes dry mouth.

Given that saliva itself has antibacterial as well as digestive properties, the resulting violation provokes the appearance of dyspeptic disorders (abdominal pain, nausea, stool disorders) and the appearance of bacterial infections (stomatitis) in the oral cavity. Parotitis in children can occur both in the bilateral form of lesions of the salivary gland, and in the form of bilateral.

In addition to the parotid gland, the sublingual and submandibular salivary glands can also be affected by mumps. Due to this, the face becomes puffy, especially this manifestation is expressed in the parotid and chin areas. Based on the manifestations characteristic of the disease, the people call it mumps - because of the similarity with the pig's "muzzle".

With the involvement of other organs in the inflammatory process, the development of complicated mumps occurs. In children in this case, there is heaviness in the abdomen and stool disorders, nausea and vomiting.

Older children (school age) with this disease may experience damage to the testicles (orchitis), as well as damage to the prostate gland (that is, prostatitis). Basically, in children, only one testicle is affected, in which edema forms. In addition, the skin on the scrotum becomes red, warm to the touch.

In the case of prostatitis, the localization of pain is concentrated in the perineum. Rectal examination determines the presence of a tumor formation, the presence of which is also accompanied by the manifestation of pain. As for girls, in this case, ovarian damage becomes possible, which is accompanied by symptoms in the form of nausea and abdominal pain.

The course of parotitis in children is possible not only in the classical form of its manifestation, but also in an erased and asymptomatic form. The erased form occurs with a slight increase in temperature (up to 37.5 degrees), there is no characteristic lesion of the salivary glands (or it is insignificant and disappears after a few days). Accordingly, the asymptomatic form of parotitis in children proceeds without any symptoms, without disturbing them. At the same time, it is precisely these forms that are the most dangerous for the environment of the child - in this case, he is a spreader of the disease, which, in turn, does not always manifest itself accordingly, making it impossible to carry out timely quarantine measures.

Parotitis: symptoms in adults

Mumps also occurs in adults. Its course and symptoms in most of its manifestations are similar to the course of parotitis in children.

The duration of the incubation period is about 11-23 days (mainly within 15-19). Some patients experience prodromal symptoms one to two days before the onset of the disease. It manifests itself in the form of chills, pain in the joints and muscles, headaches. Dryness appears in the mouth, in the region of the parotid salivary glands discomfort.

Basically, the onset of the disease is accompanied by a gradual transition from subfebrile temperature to high temperature, the duration of fever is about a week. Meanwhile, it often happens that the course of the disease proceeds without fever. In combination with fever, headache, malaise and weakness are noted, patients may also be disturbed by insomnia.

The main manifestation of parotitis in adults, as in children, is inflammation of the parotid glands, and possibly also the glands of the sublingual and submandibular. The projection of these glands determines swelling and pain on palpation. The pronounced increase to which the parotid salivary gland is subject leads to the fact that the patient's face becomes pear-shaped in shape, the earlobe also rises somewhat from the side of the lesion. In the area of ​​swelling, the skin is visibly stretched, it is also shiny and difficult to gather into folds. There are no changes in color.

In adults, parotitis is mainly manifested in a bilateral form of the lesion, although, as in children, the possibility of a unilateral lesion is not excluded. The patient experiences pain and a feeling of tension in the parotid region, which is especially acute at night. Squeezing of the tumor in the area of ​​the Eustachian tube can lead to the appearance of noise in the ears, as well as pain in them. Pressure behind the earlobe indicates a pronounced manifestation of soreness, and this symptom is one of the most important among the early manifestations of the disease.

In some cases, the patient experiences difficulty when trying to chew food, more severe manifestations of this symptom are expressed in the development of functional trismus that occurs in the masticatory muscles. Also relevant symptoms are the appearance of dry mouth with a simultaneous decrease in salivation. The duration of the pain is about 3-4 days, in some cases they radiate to the neck or ear with a gradual subsidence by the end of the week. At about the same time, the puffiness that arose in the projection of the salivary glands also disappears.

The prodromal period is a feature of the course of the disease in adults. It is characterized by the presence of severe clinical symptoms. In addition to the already noted general toxic manifestations, the phenomena of dyspeptic and catarrhal scale are becoming relevant. Lesions of the salivary glands (submandibular and sublingual) are observed in adults much more often than in children.

Epidemic parotitis: complications

Epidemic parotitis is most often accompanied by complications in the form of damage to the central nervous system and glandular organs. In the event that we are talking about childhood morbidity, then most often the complication becomes serous meningitis. Notably, males are three times more likely to develop meningitis as a complication of mumps. Mostly, symptoms indicating damage to the central nervous system appear after inflammation of the salivary glands has occurred. Meanwhile, simultaneous damage to the central nervous system in combination with the salivary glands is not excluded.

In about 10% of cases of parotitis, the development of meningitis occurs earlier than inflammation of the salivary glands, and in some cases, meningeal symptoms in patients appear without pronounced changes affecting the salivary glands.

The onset of meningitis is characterized by its own acuteness, in frequent cases it is described as violent (often by 4-7 days of illness). In addition, chills occur, body temperature reaches 39 degrees or more. The patient is worried about severe headache and vomiting. The meningeal syndrome begins to develop quite quickly, which manifests itself in the stiffness of the neck muscles, as well as in the symptoms of Kering-Brudzinsky. Symptoms characteristic of meningitis and fever disappear after 10-12 days.

Some patients, in addition to the listed meningeal symptoms, also experience the development of signs characteristic of meningoencephalitis or encephalomyelitis. In this case, there is a violation of consciousness, drowsiness and lethargy appear, periosteal and tendon reflexes are characterized by their own unevenness. Actual paresis in the area of ​​the facial nerve, hemiparesis and lethargy, noted in the pupillary reflexes.

Such a complication of parotitis, as orchitis, in varying degrees of its manifestation, mainly occurs in adults. The frequency of occurrence of this complication is determined by the severity of the disease. So, if we are talking about moderate and severe forms of mumps, then orchitis becomes a complication in about 50% of cases.

Symptoms characteristic of orchitis appear by 5-7 days from the onset of the disease, while they are characterized by another wave of fever at a temperature of about 39-40 degrees. Severe pains appear in the area of ​​the testicle and scrotum, in some cases their irradiation (spread) to the lower abdomen is possible. The enlargement of the testicle reaches the size corresponding to the goose egg.

The duration of fever is about 3 to 7 days, the duration of testicular enlargement is about 5-8 days. After that, the pain disappears, and the testicle undergoes a gradual decrease. Already later, after one or two months, manifestations are possible that indicate its atrophy, which becomes quite a common occurrence in patients who have had orchitis - in 50% of cases.

In the case of mumps orchitis, as a rare complication, pulmonary infarction is also noted, which occurs due to thrombosis that occurs in the veins of the prostate and in the pelvic organs. Another complication, which is much rarer in cases of its own occurrence, is priapism. Priapism is the appearance of a painful and prolonged erection of the penis, which occurs when the cavernous bodies are filled with blood. Note that this phenomenon is not associated with sexual arousal.

The development of complications such as acute pancreatitis, observed by 4-7 days of illness. Acute pancreatitis manifests itself in the form of sharp pains that occur in the epigastric region, as well as in the form of nausea, fever, and repeated vomiting. Inspection allows you to determine among some patients the presence of tension in the abdominal muscles, as well as symptoms indicating irritation of the peritoneum. The activity of amylase in the urine increases, which can last up to a month, while the remaining symptoms of acute pancreatitis are relevant for a period of 7-10 days.

In some cases, complications such as hearing loss causes total deafness. The main symptom of this lesion is ringing in the ears and the appearance of noise in them. Vomiting, dizziness, disturbances in coordination of movements indicate labyrinthitis. Predominantly deafness develops unilaterally, from the side of the lesion of the corresponding salivary gland. The convalescence period excludes the possibility of hearing restoration.

Such a complication arthritis occurs in about 0.5% of patients. Most often, adults are affected, and men with mumps arthritis are much more likely than women. This complication is noted during the first two weeks from the moment of damage to the salivary glands. Meanwhile, their appearance is also possible before the glands have undergone corresponding changes. Large joints (ankle, knee, shoulder, etc.) are mainly affected - they swell and acquire significant soreness, in addition, a serous effusion can form in them. As for the duration of the manifestations of arthritis, most often it is about 1-2 weeks, in some cases the symptoms can persist up to 3 months.

To date, it has been established that parotitis in pregnant women usually causes damage to the fetus. So, later in children, the presence of peculiar changes in the heart can be noted, which is defined as the primary form of myocardial fibroelastosis.

Regarding other possible complications in the form of oophoritis, prostatitis, nephritis, mastitis and others, it can be noted that they appear quite rarely.

Parotitis treatment

There is no specific treatment for parotitis. So, the treatment of this disease can be carried out at home. As for hospitalization, it is provided only for severe and complicated forms of parotitis, including on the basis of epidemiological indications. Patients are isolated at home for 9 days. In those institutions where a case of mumps is detected, quarantine is established for a period of 3 weeks.

Focusing on the features of treatment, it should be noted that the main task in it is to prevent (prevent) complications. In particular, bed rest should be observed for at least 10 days. It is noteworthy that men who excluded bed rest during the first week of compulsory treatment experienced the development of orchitis three times more often than those men who were hospitalized in this way during the first three days of the onset of the disease.

Prevention of pancreatitis is provided by following a certain diet. In particular, you should avoid excessive glut, reduce the consumption of cabbage, fats, pasta and white bread. The basis of the diet for the diet should consist of dairy and vegetable components. Of the cereals, rice is recommended, in addition, potatoes and black bread are allowed.

If orchitis develops, prednisolone (up to 7 days) or another type of corticosteroid is prescribed. Meningitis also implies the need for corticosteroids.

As for the general forecast, it is generally favorable. The probability of lethal cases is 1:100,000. Meanwhile, it is important to take into account the possibility of developing testicular atrophy and, as a result, azoospermia. After the transfer of meningoencephalitis and mumps meningitis, asthenia is noted for a long time.

If you or your child develop symptoms that are characteristic of mumps, you should contact your pediatrician / general practitioner or infectious disease specialist as soon as possible.

Mumps is an inflammation of one or both parotid glands (large salivary glands located on both sides of the face in humans). The causes can be different and are divided into infectious (caused by bacteria or viruses) and non-infectious (injuries, dehydration, hypothermia, blockage of the gland). Parotitis can also develop against the background of other diseases, including some autoimmune diseases, sialadenosis, sarcoidosis, pneumopathitis, or be nonspecific, i.e. not have a specific reason.

Parotitis(in the common people - mumps, mumps) is an infectious disease of viral etiology, characterized by non-purulent lesions and an increase in one or more groups of salivary glands, proceeds with pronounced manifestations of intoxication and fever. The causative agent is a virus of the genus Rubulavirus, belonging to the Paramyxovirus family. Its virion (mature viral particle) was first isolated and studied in 1943 by scientists E. Goodpasture and C. Johnson.

At non-infectious form damage to the salivary glands occurs due to trauma to the salivary gland and the penetration of a pathogen into it from the oral cavity (for example, after surgery). Often also dehydration, which can occur in the elderly or after surgery, can also be the cause. In rare cases, non-epidemic mumps can develop as a complication of pneumonia, typhoid or influenza.

Routes of transmission and incubation period

The virus is unstable in the external environment, however, it is easily transmitted from a sick person to a healthy person by airborne droplets (when talking, coughing, sneezing). The first symptoms of the lesion do not appear immediately: the incubation (hidden) period lasts two, sometimes three weeks.

According to studies, after the transfer of mumps, there remains a stable lifelong immunity. Only in rare cases, repeated infections with the virus are recorded.

Many are interested in: "Why is the disease called mumps?". The fact is that swollen lymph nodes change the face beyond recognition. At the same time, the neck merges with the face and, apparently, this was the reason for the high resemblance to a piglet, that is, a pig.

Characteristic symptoms

It is generally accepted that parotitis is a childhood disease. Indeed, mumps is diagnosed most often in children from three to fifteen years. However, due to its high contagiousness, the disease sometimes occurs in adults, especially in those who do not have immunity to the pathogen (the Rubulavirus virus).

Symptoms in adults are often more pronounced than in children. The main symptoms characteristic of mumps in adults:

• swelling and inflammation of the parotid gland (lasting 5-10 days);
• painful inflammation of the testicles develops in 15-40% of adult men (past puberty). This inflammation of the testicles is usually unilateral (both testicles swell in 15-30% of cases of mumps) and usually occurs about 10 days after inflammation of the parotid gland, although in rare cases much later (up to 6 weeks). Reduced fertility (the chance of conception) is an uncommon consequence of testicular inflammation from mumps, and infertility is even rarer.
• inflammation of the ovaries occurs in about five percent of adolescents and adult women;
• hearing loss, which can be unilateral or bilateral;
• an increase in body temperature (lasts about a week, the peak (38-39, sometimes 40 degrees) is observed in the first days);
• on palpation behind the ears and in the chin area, pain occurs (especially at the point of the mastoid process, in front and behind the earlobe - Filatov's symptom);
• acute inflammation of the pancreas (about 4% of cases), manifested as abdominal pain and vomiting;
• impaired salivation, dryness in the oral cavity;
• pain in the tongue, especially on the side of the lesion;
• enlarged inguinal lymph nodes;
• loss of appetite, drowsiness, migraine.

If the patient has a non-epidemic form of mumps, then often there is a release of pus from the salivary glands into the oral cavity.

The disease can sometimes proceed in an erased form, with mild symptoms (without fever and local pain).

It should be noted that the virus, penetrating into the body, affects all glandular organs. In addition to the salivary glands, these can be the testicles in men and the ovaries in women, the pancreas and the pia mater (vascular) of the brain. In this regard, certain complications may occur, which are described below.

Photo of the faces of sick adults

Diagnostics

In many cases, the diagnosis is determined already during an internal examination. The doctor conducts a thorough examination of the patient (the neck, tongue, lymph nodes are palpated) and asks if there has been contact with the patient in the last few weeks, suffering from mumps. If all the facts agree, then additional diagnostics in a particular case may not be needed.

However, sometimes it is important for the doctor to determine the accuracy of the presence of the disease. For example, with erased symptoms, a specialist can suggest a diagnosis and, in order to exclude a number of other dangerous pathologies, the patient is recommended to undergo a series of research activities.

The therapist, suspecting parotitis, is obliged to refer the patient to an infectious disease specialist. In some cases, additional consultation with a dentist and even a surgeon will be required (open an abscess if it is a non-epidemic form).

Treatment

Patients with mumps are usually treated at home. The exceptions are cases when the infection occurs in a particularly complex form. Home isolation is recommended (up to nine days). Disinfection in the outbreak area is not necessary.

There is no specific treatment for parotitis. All measures should be aimed at preventing complications. Recommendations and appointments for the patient are as follows:

1. Take antipyretic drugs if the body temperature has reached 38 degrees or more.
2. Observe bed rest, do not burden yourself with home physical work.
3. Due to the fact that the pancreas is under attack, it is recommended not to overload it. Try to eat easily digestible food, do not eat flour products, as well as spicy, smoked and sour dishes.
4. If there is an assumption about the development of orchitis (inflammation of the testicles in men), then it is recommended to start a course of treatment with Prednisolone (the initial dose should be 40-60 mg, followed by a daily decrease of 5 mg). The duration of treatment is a week.
5. Observe a plentiful drinking regimen.
6. A dry heat compress can be applied to the site of swelling.
7. In the case when there is a complication on the soft tissues of the brain, a spinal puncture is prescribed to extract a small amount of cerebrospinal fluid.
8. With the development of acute pancreatitis, drugs that inhibit enzymes are prescribed (for example, intravenously Kontrikal). The duration of treatment is five days.

Antibacterial drugs must be included in the treatment regimen for non-epidemic parotitis. With a large accumulation of pus, an opening and drainage of the salivary gland is prescribed. In this case, antibiotics are injected directly into the glandular organ.

It is important to treat non-epidemic parotitis correctly, otherwise the disease will become chronic (relapses can occur two to eight times a year).

Complications

Despite the fact that mumps is not among the serious diseases, in some rare cases it can provoke serious and sometimes irreversible consequences. One commonly discussed complication is orchitis. This pathology can lead to a deterioration in the quality of sperm, which leads to male infertility.

Viral "attack" of the soft membranes of the brain in some cases also leaves negative consequences. This can lead to the development of encephalitis and meningitis.

Studies have come to different conclusions as to whether the occurrence of viral mumps during pregnancy affects the increase in the frequency of spontaneous abortions.

Prevention

Today, active mumps prevention is carried out, which consists in vaccination of the population. The first vaccination is given to the child (regardless of gender) at the age of one, the subsequent revaccination - at the age of six. At the age of 14, a monovaccine against mumps is carried out exclusively for boys. The effectiveness of the vaccine depends on the strain of the virus, but, as a rule, it is able to protect against the disease in 80% of cases.

As you know, the disease is easier to prevent than to treat and deal with complications later. Today, many parents refuse to vaccinate their child, believing that they are harmful or even deadly. In fact, vaccination will help strengthen the immune system, and even if a child or an adult suddenly gets sick with mumps, there is a better chance of avoiding complications.