Mumps (Mumps) is a common respiratory infectious disease in children and adolescents, and it also occurs in adults. The disease is caused by mumps virus, which mainly invades parotid gland, but it can also invade all kinds of glandular tissues and nervous system and almost all organs such as liver, kidney, heart and joints. Therefore, besides swelling and pain of parotid gland, it can often cause symptoms such as meningoencephalitis, orchitis, pancreatitis and oophoritis.
Mumps virus (paramyxovirus
Parotitis) belongs to paramyxovirus with parainfluenza, Xincheng, measles, respiratory syncytial virus and other viruses. It is RNA type and was isolated from the saliva of patients in 1934, and successfully infected monkeys and "volunteers". The diameter of the virus is about 85 ~ 300 nm, with an average of 140nm. They are all very sensitive to physical and chemical factors. 1% Lysol, ethanol, 0.2% formalin, etc. can inactivate them within 2 ~ 5 minutes, and die quickly when exposed to ultraviolet rays. Its vitality can be maintained for 2 months at 4℃, stored for 24 hours at 37℃, and heated to 55 ~ 60℃ after10 ~ 20. It can survive for months to years at -65℃. The virus is only found in humans, but it can proliferate in monkey, chicken embryo amniotic membrane and various human and monkey tissue cultures. Monkeys are most susceptible to this disease. The virus has only one serotype.
The nucleocapsid protein of mumps virus has soluble antigen (S antigen), and its outer surface contains neuraminidase and hemagglutinin glycoprotein.
Glycoprotein) has virus antigen (V antigen). S antigen and V antigen have their respective antibodies. S antibody appeared on the 7th day after onset, reached the peak within two weeks, and then decreased gradually, which can last for 6 ~12 months. It can be measured by complement fixation method, and S antibody is not protective. V antibody appears late, and can only be detected after 2 ~ 3 weeks of onset, and reaches the peak after1~ 2 weeks, but it exists for a long time. It can be detected by complement fixation, hemagglutination resistance and neutralizing antibody method, which is the best index to detect immune response, and V antibody has protective effect. After being infected with mumps virus, no matter whether it comes on or not, it can produce immune response, and it is rare to get infected again.
Mumps virus can be isolated from saliva, blood, cerebrospinal fluid, urine or thyroid at the early stage of the disease. The virus rarely mutates, and the antigenicity of each strain is very close.
It is believed that the virus first invades the oral mucosa and nasal mucosa, proliferates in epithelial tissues and then enters the blood circulation (first viremia), which involves parotid gland and some tissues through blood flow and proliferates in them. Re-enter the blood circulation (second viremia) and invade some organs that were not affected last time. Mumps virus can be isolated from oral cavity, respiratory secretions, blood, urine, milk, cerebrospinal fluid and other tissues in the early stage of the disease. Someone isolated this virus from human placenta and fetus respectively. According to the fact that patients with this disease can never have parotid gland swelling, but meningoencephalitis and orchitis can appear before parotid gland swelling, it also proves that mumps virus first invades the oral and nasal mucosa and involves various organs and tissues through blood flow. Some people think that the virus has special affinity for parotid gland, so it invades parotid gland through parotid duct after entering the mouth, proliferates in the gland and then enters the blood circulation, forming viremia involving other tissues.
Various glandular tissues such as testis, ovary, pancreas, serous enzyme-producing glands of intestine, thymus gland and thyroid gland may be invaded, and the brain, meninges, liver and myocardium are often involved, so the clinical manifestations of mumps are varied. Meningeal encephalitis is the result of virus directly invading the central nervous system, and the pathogen may be isolated from cerebrospinal fluid.
Non-suppurative inflammation of parotid gland is the main lesion of this disease, with swollen and red glands, exudates, hemorrhagic lesions and leukocyte infiltration. There is catarrhal inflammation in parotid duct, serous fibrin exudation and lymphocyte infiltration around the duct and glandular stroma, and the duct is filled with broken cell residues and a small amount of neutrophils. Edema and necrosis of glandular epithelium, congestion of blood vessels between acinus. There is obvious edema around parotid gland and congestion and swelling of nearby lymph nodes. There is little change in saliva composition, but the secretion is lower than normal.
Because the parotid duct is partially blocked, the discharge of saliva is hindered, so when eating acidic diet, it may cause swelling and pain due to increased saliva secretion and saliva retention. Amylase contained in saliva can enter the blood circulation through the lymphatic system, leading to the increase of amylase in blood and excretion from urine. Enzymatic content of pancreatic and intestinal serous fluid. The virus easily invades mature testicles, and orchitis rarely occurs in young patients. The epithelium of testicular seminiferous tubule is obviously congested, with bleeding spots and lymphocyte infiltration, edema and serous fibrin exudate in the stroma. The pancreas is hyperemia and edema, and the islets have slight degeneration and fatty necrosis.
Mumps is a common infectious disease all over the world. It can occur all year round, with the most in spring and winter and less in summer in temperate regions, but it can also occur. There is no seasonal difference in the tropics. Be popular or spread. It is easy to cause outbreaks in children's collective institutions, troops and crowded people with poor sanitary conditions. It has been mentioned in foreign literature that before the universal use of vaccines, this disease tends to have a periodic epidemic every 7-8 years, which is obviously the cumulative result of susceptible people. If we continue to improve living conditions and carry out preventive immunization for susceptible people in a planned way, this periodic epidemic can be prevented. Since the United States 19671February began to gradually expand the prevention of mumps, the incidence rate has dropped greatly. In particular, 1980 stipulates that all susceptible children, adolescents and adults should be immunized except for contraindications. However, the annual incidence rate of mumps in the United States 1986 and 1987 increased three times compared with the average incidence rate in the previous five years, and 1989 stipulated that children aged 4-6 should be strengthened with immunization. However, in the past ten years, China's bleeding cheeks have continued to rise steadily.
During the twelve-year period from 1982 1 month to 19931February, there were 38, 5 17 cases with severe illness (such as high body temperature, long heat course, etc.) or complications. The data also found that the epidemic peak lasted for1~ 3 years, and then there was a year of trough, and then quickly entered the next higher peak. /kloc-3 times in 0/2 years. The disease occurs all year round, and the epidemic peak is from April to July.
The incubation period is 8-30 days, with an average of 18 days. Most patients have no prodromal symptoms, but the first symptom is swelling of the lower ear. A few cases may have short-term nonspecific discomfort (several hours to two days), and may have symptoms such as muscle soreness, loss of appetite, burnout, headache, low fever, conjunctivitis and pharyngitis. In recent ten years, the condition of mumps in China has been worse than before, which is characterized by long heat course, increased complications, and the proportion of hospitalized children in outpatient children has also increased.
The onset is mostly acute, with fever, chill, headache, loss of appetite, nausea, vomiting and general pain. After several hours to1~ 2 days, the parotid gland becomes swollen. Fever varies from 38℃ to 40℃, and the severity of symptoms is also very inconsistent, and adult patients are generally more serious. The most characteristic side of parotid gland swelling is swollen first, but there are also two sides swelling at the same time; Generally, it takes the earlobe as the center, develops forward, backward and downward, and looks like a pear with a tough feeling and unclear edges. When the gland enlargement is obvious, there will be swelling pain and sensory process, especially when chewing with your mouth open and eating acidic diet. The local skin is tense and shiny, and the surface is hot, but it is not red, and it has a light touch pain. The cellulite around the parotid gland can also show edema, which can reach the temporal and zygomatic arch, down to the jaw and neck, and the sternocleidomastoid muscle can also be affected (occasionally edema can appear in front of the sternum), thus deforming the face.
Usually, after one parotid gland swells 1 ~ 4 days (occasionally1week), the opposite side is involved, and bilateral swelling accounts for about 75%. Submandibular gland or sublingual gland can also be affected at the same time. When submandibular gland is swollen, the neck is obviously swollen, and the flexible oval gland with light touch pain can be palpated under the submandibular gland. The sublingual gland can also be involved at the same time. When the sublingual gland is swollen, the tongue and neck can be swollen and dysphagia can occur.
The parotid orifice (located on the buccal mucosa of the maxillary second molar) is often red and swollen in the early stage. Saliva secretion increases at first, and then decreases due to retention, but dry mouth symptoms are generally absent.
Parotid swelling mostly reached its peak in1~ 3 days, and gradually subsided and returned to normal after 4 ~ 5 days. The whole course of the disease is about10 ~14 days.
Atypical cases may appear as symptoms of simple orchitis or meningoencephalitis without parotid gland swelling, or only submandibular gland or sublingual gland swelling.
Mumps is actually a systemic infection, and viruses often involve the central nervous system or other glands or organs to produce corresponding symptoms. Even some complications are not only common, but also can appear alone without parotid gland enlargement.
1. Neurological complications
⑴ Aseptic meningitis, meningoencephalitis and encephalitis: common complications, especially in children, more boys than girls.
The incidence of encephalitis in mumps is about 0.3% ~ 8.2%. It is difficult to calculate the exact incidence of parotitis because it is impossible to check cerebrospinal fluid in all patients with parotitis and some cases have never seen parotid gland enlargement. It is said that 30% ~ 50% or even 65% of mumps without complications have increased white blood cells in cerebrospinal fluid, which is caused by the direct invasion of the virus into the central nervous system. The symptoms of meningoencephalitis can appear as early as 6 days before parotid gland swelling or within 2 weeks after parotid gland swelling, usually within 1 week after parotid gland swelling. Cerebrospinal fluid and symptoms are similar to other viral encephalitis, such as headache and vomiting, and acute brain edema is more obvious. Electroencephalogram can be changed, but it is not as obvious as other viral encephalitis. Combined with clinic, meningeal involvement is the main reason. No matter how good the prognosis is, individual encephalitis cases can also lead to death. There have been serologically confirmed cases of mumps and encephalitis in China, and there is no parotid swelling and pain from beginning to end.
⑵ Occasionally after mumps1~ 3 weeks, polyneuritis and myelitis appear, and the prognosis is good. The swollen parotid gland may be compressed and the nerve may cause temporary facial paralysis. Sometimes there are imbalance, trigeminal neuritis, hemiplegia, paraplegia, ascending paralysis and so on. Occasionally, parotitis is complicated with positive brain after aqueduct stenosis.
Water bearer.
⑶ Deafness: It is caused by auditory nerve involvement. Although the incidence rate is not high (about115 000), it can become permanent and complete deafness. Fortunately, 75% is unilateral, so the impact is not great.
2. Reproductive system complications Mumps virus invades mature reproductive glands, so it is more common in patients after late adolescence, but rare in children.
⑴ orchitis: The incidence rate is14% ~ 35% in male adult patients, and it has been reported that 9-year-old children are complicated with this disease. Generally, the incidence rate increased significantly after13 ~14 years old. It often happens when parotid gland enlargement begins to subside around 1 week, and suddenly high fever, chills, testicular swelling and pain accompanied by severe tenderness, with different symptoms, which generally subside around 10 day. Scrotal skin edema is also significant, and there may be yellow effusion in the tunica vaginalis cavity. Most lesions invade one side, and testicular atrophy occurs in different degrees in about1/3 ~1/2 cases. Because lesions are often unilateral, even if both sides are only partially involved in seminiferous tubules, it rarely leads to infertility. Epididymitis often occurs in combination.
⑵ Ovaritis: It accounts for about 5% ~ 7% of adult female patients. Symptoms are mild, do not affect pregnancy, and may occasionally cause premature amenorrhea. Symptoms of oophoritis include pain in the lower waist, tenderness in the lower abdomen, and menstrual cycle disorder. In severe cases, swollen ovaries with tenderness can be palpated. So far, there has been no report of infertility caused by this.
⑶ Pancreatitis: 5% of adult patients are interviewed, which is rare among children. It often occurs from 3 or 4 days to 1 week after parotid gland swelling, with severe pain and tenderness in the middle and upper abdomen as the main symptoms. Accompanied by vomiting, fever, abdominal distension, diarrhea or constipation, sometimes swollen pancreas can be palpated. The symptoms of pancreatitis usually disappear within one week. Amylase in blood is not suitable for diagnosis, and the serum lipase value exceeds 1.5U/dl (normally 0.2 ~ 0.7u/dl), suggesting that pancreatitis has occurred recently. Lipase usually rises 72 hours after onset, so early diagnosis is of little value. In recent years, as the illness of children became more and more serious, the complications of pancreatitis also increased. In the Pediatric Hospital of Shanghai Medical University1982 ~1993, among the 763 children with mumps who were hospitalized due to complications, 43 cases were complicated with pancreatitis, ranking second only to meningoencephalitis.
⑷ Nephritis: Mumps virus can be isolated from the urine of most early cases, so it is considered that the virus can directly damage the kidney, and there is a small amount of protein in the urine of light cases. The urine routine and clinical manifestations of severe cases are similar to nephritis, and some serious cases may die of acute renal failure. But most of them have good prognosis.
5. Myocarditis: About 4% ~ 5% patients are complicated with myocarditis. It is more common in the course of 5 ~10 days, and can occur simultaneously with parotid gland swelling or in the recovery period. It is characterized by pale face, increased or decreased heart rate, dull heart sound, arrhythmia, temporary cardiac enlargement and systolic murmur. Electrocardiogram showed sinus arrest, atrioventricular block, ST segment depression, low or inverted T wave, premature beats and so on. In severe cases, it can be fatal. Most of them only have ECG changes (3% ~15%) without obvious clinical symptoms, and occasionally pericarditis.
(6) Others: mastitis (13 1% of female patients over 5 years old complicated with this disease), osteomyelitis, hepatitis, pneumonia, prostatitis, bartholinitis, thyroiditis, thymitis, thrombocytopenia, urticaria and acute follicular conjunctivitis are rare. The incidence of arthritis is about 0.44%, mainly involving big joints such as elbows and knees, which can last for 2 days to 3 months and can be completely recovered. Most cases occurred within1~ 2 weeks after parotid gland swelling, and some cases had parotid gland swelling or not.
There is no specific treatment for mumps, and general antibiotics and sulfonamides are ineffective. Give plenty of water, eat enough, stay in bed and take aspirin to control infection. Interferon can be tried, which has an effect on the virus. The combination of traditional Chinese and western medicine is often used to treat symptoms.
(a) general nursing isolation patients to bed rest until the parotid gland swelling completely subsided. Pay attention to oral hygiene. It is advisable to eat liquid or soft food, avoid acidic food and ensure liquid intake.
(2) Symptomatic treatment should dispel wind and relieve exterior syndrome, and clear away heat and toxic materials. Decoct radix Isatidis with 60-90g of water, or decoct folium Isatidis15g of water with Yinchi powder; Topical application can be made of purple gold ingot or indigo naturalis powder with vinegar, and topical application can be made several times a day; Or use Bo Gongying,; Patches of Commelina communis, daffodil root and purslane can relieve local swelling and pain. If necessary, take antipyretic and analgesic drugs such as painkillers and aspirin orally.
Adrenal cortical hormone can be used for a short time when severe meningoencephalitis, severe orchitis and myocarditis are complicated. Such as hydrocortisone, 200 ~ 300mg/day for adults, or 40 ~ 60mg/day for prednisone for 3 ~ 5 consecutive days, and children should reduce it at their discretion.
Treatment of orchitis: In the early stage of this disease, adult patients should apply diethylstilbestrol, once 1mg, three times a day, which can relieve the swelling and pain.
Meningeal encephalitis can be treated according to Japanese encephalitis therapy. When high fever, headache and vomiting occur, appropriate diuretics are given for dehydration.
Treatment of pancreatitis: diet, infusion, repeated injection of atropine or anisodamine, and early application of corticosteroids.
Isolate the patient as early as possible until the parotid gland swelling completely subsides. Contacts are generally not necessarily quarantined, but they should be kept in collective children's institutions (including hospitals, schools) and military units for 3 weeks, and suspicious patients should be temporarily isolated immediately.
Live attenuated mumps vaccine: live attenuated chicken embryo cell culture vaccine has been widely used abroad since 1966, and its effect of preventing infection can reach 97% in children and 93% in adults. Live mumps vaccine, measles vaccine and rubella vaccine are used together at the same time, with satisfactory results and no interference among them. After immunization, the neutralizing antibody of mumps virus can be maintained for at least 9.5 years.
Besides intradermal injection and subcutaneous injection, the immunization route of mumps live vaccine can also be nasal spray or aerosol inhalation (in the aerosol room), and the effect is also good.
According to Chinese materials, after six months of immunization (nasal spray and aerosol inhalation combined), the incidence rate of children immunized group (7.4%) was significantly lower than that of the corresponding control group (78.5%), and the incidence rate of adult immunized group (0.33%) was also lower than that of the corresponding control group (4.6%), and there were no adverse reactions. In view of the high incidence and serious condition of this disease in China, the use of mumps vaccine (including adults) should be arranged in a planned way. Especially for the new kindergarten classes, universal immunization can significantly reduce the incidence. At present, the application of this vaccine has been gradually popularized in China.
Live mumps vaccine can't be used for pregnant women (to prevent the virus from infecting the fetus through the placenta), people with congenital or acquired immunodeficiency and those who are allergic to egg protein (because live mumps vaccine is obtained from chicken embryos).
General immunoglobulin, adult blood or placental globulin have no preventive effect on this disease. The blood of convalescent patients and their immunoglobulins or specific high-valent immunoglobulins may be useful, but the source is difficult and difficult to obtain, and the protection time after use is short, only 2 ~ 3 weeks, so it is not used much, and its effect needs further study.
How good, individual with serious complications. Such as severe meningoencephalitis, myocarditis, nephritis, etc., must be carefully handled and actively rescued.
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