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FeedbackMumps is an acute, contagious disease of short duration, usually self-limiting, and characterized by swelling of the parotid gland. It has become rare in the U.S. due to vaccination programs. Diagnosis is usually clinical and not based on laboratory testing. Serology samples can be collected as soon as diagnosis is suspected. IgM antibody response normally appears 1-2 weeks after disease onset.
Diagnosis
Indications for Testing
- Atypical presentation of secondary complications in patients with apparent mumps
- Suspected outbreak – test patients for epidemiologic evidence
Laboratory Testing
- Limited role for laboratory testing – usually a clinical diagnosis
- Mumps case definition (CDC, 2012)
- Mumps information for healthcare providers (CDC, 2016)
- CDC mumps laboratory testing recommendations (CDC, 2017)
- CDC recommends buccal or oral swab and blood specimens be collected for all suspected mumps cases
- Serology
- Collect initial sample as soon as diagnosis is suspected; collect second sample 5-10 days after symptom onset if initial sample is negative – IgM response may not be detectable until 5 days after onset
- IgM antibody response normally appears 7-14 days after disease onset
- IgM antibody response may be delayed or absent in previously vaccinated patients and the period of viral excretion may be shorter
- IgG assays associated with cross-reactions
- Cross-reactivity can occur with parainfluenza 1, 2, and 3, Epstein-Barr virus, adenovirus, and human herpesvirus 6
- IgG antibody levels induced by vaccine are lower than those from natural infection
- Laboratory confirmation of mumps serology (CDC, 2017)
- Polymerase chain reaction (PCR) – buccal swab
- Negative test does not rule out mumps – vaccinated individuals typically shed virus in smaller amounts for shorter time
- Best if collected in first 3 days of illness – greater sensitivity
- May show positivity during first or recurrent (contralateral) parotitis episode
- Culture
- Gold standard
- Buccal and oral swab specimens preferred
- Culture growth often necessary for viral sequencing
- Allows for genotyping, which may be useful in outbreaks
- Limitation – may take days to weeks to complete
Differential Diagnosis
- Viral
- Parainfluenza virus
- Influenza virus
- Coxsackievirus
- Epstein-Barr virus
- Adenovirus
- Herpesvirus 6
- HIV
- Unilateral disease
- Bacterial parotitis
- Benign parotid gland neoplasms (eg, hemangioma, adenoma)
- Salivary stones
- Malignancy
- Metabolic disorders
- Diabetes mellitus
- Cirrhosis
- Uremia
- Sjögren syndrome
- Sarcoidosis
Background
Epidemiology
- Prevalence – between 229 (2012) and 6,366 (2016) reported cases in U.S. annually (CDC, 2017)
- Age – highest incidence, 16-24 years, often due to close-contact settings (school, college dormitories)
- Transmission – highly contagious and transmitted by droplets spread from the upper respiratory tract
Organism
- Paramyxoviridae family; Rubulavirus genus
- Single-stranded RNA virus
- 12 genotypes based on sequence of SH gene coding for short hydrophobic protein
- Immunity after infection appears to be lifelong
- 88% immunity after two-dose immunization (CDC, 2017)
Clinical Presentation
- Incubation period – 12-25 days (average, 16-18 days) (CDC, 2017)
- 25-30% of all infections are silent
- Most common clinical feature is bilateral or unilateral parotitis
- Secondary complications
- Orchitis – particularly in teenagers, can lead to decreased fertility or infertility
- Oophoritis
- Aseptic meningitis, encephalitis
- Rarely, pancreatitis, peripheral neuritis, uveitis, otitis, myocarditis
ARUP Laboratory Tests
Aid in the diagnosis of suspected mumps infection
If equivocal, repeat testing in 10-14 days may be helpful
Semi-Quantitative Enzyme-Linked Immunosorbent Assay
Not recommended as a stand-alone test unless testing for evidence of antibody production from vaccination
If equivocal, repeat testing in 10-14 days may be helpful
Semi-Quantitative Chemiluminescent Immunoassay
Detect mumps virus in buccal swab specimens
Qualitative Polymerase Chain Reaction
Culture test for detecting mumps virus in specimens other than cerebrospinal fluid (CSF)
Collect during first 3 days of illness; if collecting urine, collect first morning void
Cell Culture/Immunofluorescence
Not recommended
Semi-Quantitative Enzyme-Linked Immunosorbent Assay
Semi-Quantitative Chemiluminescent Immunoassay
Detect common respiratory viruses; molecular methods may offer improved sensitivity
Respiratory viruses rapid culture offers faster turnaround time
Viruses that can be isolated: adenovirus; cytomegalovirus; enterovirus; herpes simplex virus; influenza A and B; parainfluenza types 1, 2, and 3; respiratory syncytial virus; and varicella-zoster virus
Virus-specific tests are recommended
Cell Culture
Semi-Quantitative Enzyme-Linked Immunosorbent Assay/Semi-Quantitative Chemiluminescent Immunoassay
Semi-Quantitative Enzyme-Linked Immunosorbent Assay/Semi-Quantitative Chemiluminescent Immunoassay
Medical Experts
Couturier
Hillyard
Schlaberg
References
17059159
CDC - Manual for the Surveillance of Vaccine-Preventable Diseases - Chapters
U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Manual for the surveillance of vaccine-preventable diseases. [Updated: Jun 2020; Accessed: Mar 2021]
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CDC - Recommended Immunization Schedules for Children and Adolescents Aged 18 Years or Younger
U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Advisory Committee on Immunization Practices recommended immunization schedule for children and adolescents aged 18 years or younger – United States, 2019. [Last updated: Feb 2019; Accessed: Sep 2020]
CDC - Adult Immunization Schedule
U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Recommended adult immunization schedule for ages 19 years or older, United States, 2020. [Last updated: Feb 2019; Accessed: Sep 2020]