www.elitecme.com | 2019 | INFECTIOUS DISEASE, DISASTER PLANNING & WOUND CARE 25 ops. The frequency of parotitis associated with the mumps ranges from 31-65%, although extremes are possible in different age groups. Incidences range from nine percent to 94%, as a function of age and state of immunity. Parotitis tends to occur in the first two days of symptom onset and may be initially described as an earache or jaw tenderness. Parotitis usu- ally resolves itself within 10 days. At this time, other symptoms are usually non-specific and include myalgias, anorexia, malaise, low-grade fever, and headache (CDC, 2016-1). SELF-ASSESSMENT QUESTION Answers are listed on the last page of the course. 5. Which of the following about mumps is TRUE? a) Prior to 1945, the incidence of mumps was rare. b) Parotitis is the most common symptom associated with mumps. c) Mumps was considered eradicated in the U.S. in 1987. d) Infection with the mumps virus is limited to the nasopharynx. COMPLICATIONS ASSOCIATED WITH MUMPS While a variety of issues occur in patients afflicted with mumps, they are rarely serious and typically self-resolve as the infection clears (NHS, 2015-1). Examples of common complications are discussed below: • Pain accompanied by swelling of the tes- ticle (orchitis) impacts about 25% of males who become afflicted with the mumps after puberty. In most cases, the swelling occurs suddenly and occurs in only one testicle. Additionally, the affected testicle may be ten- der and feel warm. In the majority of cases, testicular swelling occurs four to eight days after swelling is seen in the parotid gland. In some instances, however, it can appear up to six weeks later. These symptoms can usu- ally be addressed by over-the-counter (OTC) pain medications, cold or warm compresses, or supportive underwear. About one-half of males with mumps-related orchitis will note a shrinkage of their testicles; 10% suffer from a decreased sperm count. It should be noted that decrements of this magnitude generally self-resolve and are not adequate to impact fer- tility (NHS, 2015-1); • Oophoritis (swollen ovaries) are experi- enced by about five percent of post-pubertal females who are afflicted with mumps. This condition is associated with lower abdominal pain, high temperatures, and a general feeling of sickness. These symptoms typically resolve in parallel to clearing the underlying viral infection (NHS, 2015-1); • In about one in seven cases, the mumps virus is able to penetrate the meninges. This leads to viral meningitis. In contrast to bac- terial meningitis, which can present as a life-threatening emergency, this variety of viral meningitis is usually associated with milder flu-like symptoms and carries a low risk of serious complications. Common symp- toms of viral meningitis include stiffness of the neck, a sensitivity to light, and headaches. These discomforts generally dissipate within 14 days (NHS, 2015-1); • Approximately five percent of the time, mumps can lead to acute pancreatitis. The most common symptom associated with pan- creatitis is pain in the center of the abdomen. Additional symptoms include generalized ill- ness, diarrhea, anorexia, high fever, abdominal tenderness, and rarely, jaundice (NHS, 2015-1). In addition to common complications, the mumps can also lead to rare, but possibly serious complications. Examples include the following: • Encephalitis is understood to occur in approximately one in 1,000 cases of viral men- ingitis associated with mumps infection. This is a serious complication that generally neces- sitates admission to a hospital intensive care unit (NHS, 2015-1); • Permanent hearing loss is estimated to occur in about one in 20,000 cases of mumps. This condition is not to be confused with tem- porary hearing loss, which can affect about one in 20 mumps patients (NHS, 2015-1). During the period that spanned between 1966-1971, approximately two fatalities were recorded for every 10,000 cases of mumps. In the current post-vaccine period, there have been no U.S. deaths reported despite the occurrence of outbreaks (CDC, 2016-1). MUMPS DURING PREGNANCY As with any infectious process, mumps can theoretically lead to complications in pregnancy. A 1966 investigation (which occurred prior to the introduction of the mumps vaccine) detected an increased risk of spontaneous abortion or intrauterine fetal death when mothers suffered from mumps during the initial trimester of pregnancy. These findings were not replicated in a subsequent study. A third study showed the presence of congenital malformations associated with mumps during pregnancy. Methodological flaws in these investigations have required clinicians to view these find- ings with some discretion (CDC, 2017-5). Nonetheless, it is prudent that pregnant women should avoid close contact with infected people (NHS, 2015-1). Nursing Consideration: Although available data is not definitive, prudent practice sug- gests that women who are pregnant should make every effort to avoid contracting mumps. As a result, ANPs and nurses with pregnant patients should stress the need to avoid con- tact with people suffering from infectious diseases, which includes mumps, whenever possible. MUMPS AND BREASTFEEDING Although the mumps virus is able to pass through breast milk, a subsequent mumps infection in infants is unexpected as a result of the presence of antibodies that have been passively transferred through the placenta. It is recommended that mothers do not interrupt breastfeeding due to a mumps infection (Lamounier, et al. 2004). DIAGNOSIS AND LABORATORY TESTING FOR MUMPS Mumps should be suspected based on the clinical presentation of the patient, especially in those presenting with salivary gland swell- ing—or in males, with testicular swelling. Laboratory confirmation of mumps is strong- ly recommended in all suspected patients. Swab samples should be collected from the salivary glands of suspected patients as soon as possible upon initial presentation; blood, urine, and cerebrospinal fluid (CSF) samples can also be collected for analysis. Enzyme immunoassay (EIA) can analyze the levels of immune system markers IgM or IgG: EIA is the most commonly used test to diagnose mumps. IgM antibody levels can be measured in the first few days of symptom onset. These levels peak approx- |  CONTINUING EDUCATION