Mumps Virus

Mumps 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.

Tabs Content

Clinical Overview

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)
- Real-time polymerase chain reaction (RT-PCR) – buccal or oral 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
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 Lab Tests

Tests generally appear in the order most useful for common clinical situations. Click on number for test-specific information in the ARUP Laboratory Test Directory.

Mumps Virus Antibody, IgM 0099589
Method: Semi-Quantitative Enzyme-Linked Immunosorbent Assay

Recommended Use

Aid in the diagnosis of suspected mumps infection

Follow-up

If equivocal, repeat testing in 10-14 days may be helpful

Mumps Virus Antibody, IgG 0050390
Method: Semi-Quantitative Chemiluminescent Immunoassay

Recommended Use

Not recommended as a stand-alone test unless testing for evidence of antibody production from vaccination

Follow-up

If equivocal, repeat testing in 10-14 days may be helpful

Mumps Virus RNA Qualitative, Real-Time PCR 2009387
Method: Qualitative Real-Time Polymerase Chain Reaction

Recommended Use

Can be used for molecular confirmation of mumps infection

Mumps Virus Culture 0065056
Method: Cell Culture/Immunofluorescence

Recommended Use

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

Medical Reviewers

Couturier, Marc Roger, PhD, D(ABMM), Medical Director, Microbial Immunology, Parasitology and Fecal Testing, and Infectious Disease Antigen Testing at ARUP Laboratories; Associate Professor of Clinical Pathology, University of Utah

Hillyard, David R., MD, Medical Director, Molecular Infectious Diseases at ARUP Laboratories; Professor of Clinical Pathology, Adjunct Professor of Biology, University of Utah

Schlaberg, Robert, MD, MPH, Medical Director, Microbial Amplified Detection, Virology, and Fecal Chemistry; and Assistant Medical Director, Virology and Molecular Infectious Disease at ARUP Laboratories; Assistant Professor of Clinical Pathology, University of Utah

References

Guidelines

U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC). Recommended Immunization Schedule for Adults Aged 19 Years or Older. United States 2018. Center for Disease Control and Prevention. [Last updated: Apr 2018; Accessed: May 2018]

U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Manual for the Surveillance of Vaccine-Preventable Diseases. Centers for Disease Control and Prevention. Atlanta, GA [Last updated: Apr 2018; Accessed: Apr 2018]

U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Recommended Immunization Schedule for Children and Adolescents Aged 18 Years or Younger. United States, 2018. Centers for Disease Control and Prevention. Atlanta, GA [Last updated: Jan 2018; Accessed: Apr 2018]

General References

Andersen E. Mumps--new face on an old disease. AAOHN J. 2006; 54(10): 425-6. PubMed

Hviid A, Rubin S, Mühlemann K. Mumps. Lancet. 2008; 371(9616): 932-44. PubMed

Wilson KF, Meier JD, Ward D. Salivary gland disorders. Am Fam Physician. 2014; 89(11): 882-8. PubMed

References from the ARUP Institute for Clinical and Experimental Pathology^®

Shirts BH, Welch RJ, Couturier MR. Seropositivity rates for measles, mumps, and rubella IgG and costs associated with testing and revaccination. Clin Vaccine Immunol. 2013; 20(3): 443-5. PubMed

Last Update: April 2018


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	Mumps Virus. ARUP Consult^©. Retrieved May 14, 2018, from: https://arupconsult.com/content/mumps-virus

Mumps Virus

Diagnosis

Indications for Testing

Laboratory Testing

Differential Diagnosis

Background

Epidemiology

Organism

Clinical Presentation

ARUP Lab Tests

Medical Reviewers

References

Guidelines

General References

References from the ARUP Institute for Clinical and Experimental Pathology®

References from the ARUP Institute for Clinical and Experimental Pathology^®