JSC “ASTANA MEDICAL UNIVERSITY”

DEPARTMENT OF INFECTIOUS DISEASES

PERTUSSIS.
PARAPERTUSSIS.
MUMPS.
Nur-Sultan, 2019
 PERTUSSIS: WHAT IS
•
IT?
Pertussis, or whooping cough, is an acute
infectious disease caused by the bacterium
Bordetella pertussis. Outbreaks of pertussis
were first described in the 16th century, and the
organism was first isolated in 1906.
• The earliest clear account of whooping cough
was described in 1640 by Baillow, an
epidemiologist. The name ‘pertussis’ means
“violent cough”, and was first used to describe
the disease in 1679.
• In China, the disease is known as “Hundred Day
Cough”
 Classification
Type Severity Course
1.Typical form a) mild a) acute
2.Atypical: b) moderate b) protracted
a) abortive; c) severe c) mixed infection
b) suppressed;
c) subclinical.
Complications specific Non-specific
• Emphysema of the mediastinum, subcutaneous • pneumonia;
tissue, segmental atelectasis, pertussis bronchitis;
pneumonia, violation of the rhythm of sore throats;
breathing. lymphadenitis;
• Encephalopathy. otitis, etc.
• Bleeding (from the nasal cavity, posterior
pharyngeal space, bronchi, external auditory
canal).
• Hemorrhages (under the skin, in the mucous
membranes, sclera, retina, brain, subarachnoid
and intraventricular, epidural hematomas of
the spinal cord).
 Bordetella pertussis
• B. pertussis is a small,
aerobic gram-negative
rod. It is fastidious and
requires special media
for isolation
• Antigenic and biologically
active components:
 pertussis toxin (PT),
 filamentous
hemagglutinin (FHA),
 agglutinogens,
 adenylate cyclase,
 pertactin,
 tracheal cytotoxin
• Pertussis is a disease of worldwide importance,
with an estimated 285,000 deaths in 2001, with
most occurring in Africa and SE Asia
• According to the WHO, 2010 there are 1.29 lac
cases reported globally, with 95% occurring in
developing countries, and the DPT(3)
Immunisation rate was 85%.
• In India yr.1987 incidence was 1.63 lac cases, in
2011only 39,091 cases were reported (decline of
76%)
 PATHOGENESIS
• Penetration of the pathogen through the mucous membranes
of the upper respiratory tract -> bronchogenic spread to
bronchioles and alveoli -> excretion of exotoxin, causing
bronchospasm, increased peripheral blood vessels tone,
development of secondary immunodeficiency, various
metabolic products, causing prolonged irritation of the
receptors of afferent vagus nerve fibers, irritation
respiratory center of the medulla oblongata and reflex
convulsive cough
• Constant impulses from the receptors of the epithelium of
the respiratory tract into the medulla oblongata lead to the
formation of a stagnant dominant focus of excitation in it,
the main signs of which are:
 increased irritability of the respiratory center and the ability
to summarize irritations (sometimes a minor irritant is
enough for an attack of convulsive cough)
 the ability of a specific response to a non-specific stimulus:
any stimuli (pain, tactile, etc.) can lead to a convulsive cough
 PATHOGENESIS
• the possibility of irradiation of excitation to neighboring centers:
a)vomiting (the response is vomiting, which often ends in convulsive
coughing attacks);
b)vascular (the response is an increase in blood pressure, vasospasm
with the development of acute cerebrovascular accident and
cerebral edema)
c) the center of skeletal muscle (with a response in the form of tonic-
clonic seizures)
• resistance (activity remains for a long time)
• inertia (having formed, the focus periodically weakens and
intensifies)
• the possibility of the transition of the dominant focus to a state of
parabiosis (this explains the delay and stop breathing in patients
with whooping cough)
AGENT FACTORS
 B. pertussis is very contagious, and attack
rates among susceptible groups range from
50-100% depending on the nature of the
exposure.
 B. pertussis occurs in smooth and rough
phases, capsulated and non-capsulated
form,elaborates exotoxins and endotoxins
 B. pertussis is antigenically highly complex. It
carries 3 major agglutinogens-1,2,3 and
several minor ones
 Survives only for very short periods outside
the human body
• AGE: disease of infants and pre-school children;
however, children under the age of 5 years are at
the highest risk of developing more serious
symptoms.
Being in close contact with an infected person for
extended periods of time increases the risk of
becoming infected
• IMMUNITY: recovery from whooping cough or
adequate immunisation is followed by immunity
response formation. Infants are susceptible to
infection from birth because maternal antibody does
not appear to give them protection. No cross
immunity with B. Parapertussis.
• Reservoir
• Pertussis is a human disease. No animal or insect
source or vector is known to exist. Adolescents
and adults are an important reservoir for B.
pertussis and are often the source of infection for
infants.
• Transmission
• Transmission most commonly occurs by the
respiratory route through contact with
respiratory droplets, or by contact with airborne
droplets of respiratory secretions. Transmission
occurs less frequently by contact with freshly
contaminated articles of an infected person.
 Pertussis Clinical
Features
• Incubation period 7-10 days (range 4-21 days)
• Insidious onset, similar to the common cold
with nonspecific cough
• Fever usually minimal throughout course of
illness
Catarrhal stage
• ■ 1-2 weeks
Paroxysmal cough stage
• ■ 1-6 weeks
Convalescence
■ weeks to months
 Catarrhal Stage
• The first stage, the
catarrhal stage, is
characterized by the
insidious onset of coryza
(runny nose), sneezing,
low-grade fever, and a
mild, occasional cough,
similar to the common
cold.
• The cough gradually
becomes more severe, and
after 1–2 weeks, the
second, or paroxysmal
stage, begins. Fever is
generally minimal
throughout the course of
the illness.
 Paroxysmal Stage
• It is during the paroxysmal stage that the
diagnosis of pertussis is usually suspected.
Characteristically, the patient has bursts, or
paroxysms, of numerous, rapid coughs,
apparently due to difficulty expelling thick mucus
from the tracheobronchial tree. At the end of the
paroxysm, a long inspiratory effort is usually
accompanied by a characteristic high-pitched
whoop. During such an attack, the patient may
become cyanotic (turn blue). Children and young
infants, especially, appear very ill and distressed.
Vomiting and exhaustion commonly follow the
episode. The person does not appear to be ill
between attacks.
 Paroxysmal Stage
• Paroxysmal attacks occur more
frequently at night, with
an average of 15 attacks per 24 hours.
During the first 1
or 2 weeks of this stage, the attacks
increase in frequency, remain at the
same level for 2 to 3 weeks, and then
gradually decrease.
• The paroxysmal stage usually lasts 1 to
6 weeks but may persist for up to 10
weeks. Infants younger than 6 months
of age may not have the strength to
have a whoop, but they do have
paroxysms of coughing.
 Convalescent Stage
• In the convalescent stage, recovery is gradual.
The cough becomes less paroxysmal and
disappears in 2 to 3 weeks. However, paroxysms
often recur with subsequent respiratory
infections for many months after the onset of
pertussis.
• Adolescents, adults and children partially
protected by the vaccine may become infected
with B. pertussis but may have milder disease
than infants and young children. Pertussis
infection in these persons may be asymptomatic,
or present as illness ranging from a mild cough
illness to classic pertussis with persistent cough.
 in Children in Adolescents and Adults
Secondary bacterial Difficulty sleeping
pneumonia – most common
Neurologic complications – Urinary incontinence
seizures, encephalopathy
more common among infants
Otitis media Pneumonia
Anorexia Rib fracture
Dehydration
Epistaxis
Subdural hematomas
Hernias
Rectal prolapse
Pneumothorax
ANAMNESIS
Diagnostics
• gradual start;
• cyclical course of the disease;
• contact with a laboratory-confirmed case of pertussis 3–14 days
before the onset of symptoms of the disease or with a long coughing
child;
• dry, growing cough at normal or subfebrile body temperature, mild
and quickly stopping catarrhal phenomena;
• lack of effect of the therapy in the catarrhal period;
• the appearance of paroxysmal cough with reprise, after 1 - 2 weeks
from the onset of the disease;
• secretion of thick viscous sputum or vomiting after a coughing fit;
• lack of constant changes in the lungs during the period of spasmodic
cough;
• possible respiratory dysrhythmia and apnea attacks.
 Pertussis Laboratory
Diagnosis
• Culture – gold standard
• Polymerase Chain Reaction (PCR)
• can confirm pertussis in an outbreak
• highly sensitive
• high false-positive rate
• Serology
• can confirm illness late in the course of infection
• many tests have unproven or unknown clinical
accuracy
• Direct fluorescent antibody test
• low sensitivity
• variable specificity
• should not be used for laboratory confirmation
 Pertussis Laboratory Testing
Culture PCR DFA Serology
Specimen NP Swabs or NP Swabs or NP Swab Blood
aspirates aspirates
Advantages •Gold Results Rapid results
standard available
•100% quickly
Specific
Disadvantage •Relatively •Sensitivity & •Not •No
s insensitive specificity confirmatory standardized
•Difficult to varies test available
isolate •No use for
•Most •Calcium surveillance •No use for
successful alginate Surveillance
during the swabs cannot
catarrhal be used to
stage collect NP
•Takes 7-10 swabs for
days to get PCR
24
the result
Comments Use with Use with Use with
 DIFFERNTIAL
DIAGNOSIS
Pneumonia Tuberculosis of lungs
Reason: Coughing and rapid Reason: Coughing >30 days.
breathing. Examination: bacteriological
Examination: chest X-ray analysis of sputum on MT,
Exclusion criteria: Cough and chest x-ray.
rapid breathing: Exclusion criteria: chronic
•age <2 months ≥ 60 / min; cough (more than 30 days).
•age 2 - 12 months ≥ 50 / min; Poor development, weight
•age 1 - 5 years ≥ 40 / min; loss. Mantoux positive
•retraction of the lower chest; reaction. History of contact
•fever with a patient with
•fine crackles; tuberculosis. A chest x-ray
•bloating of the wings of the may reveal a primary complex
nose; or miliary tuberculosis.
•groaning breathing (in
infants)
 DIFFERNTIAL
DIAGNOSIS
Foreign body in the airways Bronchopulmonary form of cystic
fibrosis
Reason: Coughing. Reason: Coughing.
Examination: chest X-ray and Examination of sweat for the content
bronchoscopy. of sodium and chlorine ions; X-ray of
Exclusion criteria: sudden chest.
development of mechanical Exclusion criteria: An indication in the
obstruction of the airways. family history of a similar disease in
- Indication in history of the other children in the family;
first sudden attack of cough; • slow physical development;
the absence of a general • signs of long-lasting bronchial
infection syndrome in the obstruction;
disease; periodic recurrence of • signs of a pulmonary heart are
paroxysmal more often possible;
cough, due to a change in body • symptoms of pancreatic insufficiency,
position, the absence in the including steatorrhea;
peripheral blood of • persistent constipation in case of
leukocytosis with violation of the diet and inadequate
lymphocytosis; characteristic enzyme therapy;
 DIFFERNTIAL
Nosologi Pertussis
DIAGNOSIS
Parapert ARVI Measles
cal form ussis
Onset Gradual Gradual Acute Acute
Intoxicatio - - + +
n
Temperat N N increased increasing
ure
Cough Dry, intrusive, Dry, Dry or wet, Coarse,
growing day by gradually decreases by intensifies during
day, regardless increasin the 5-7th the catarrhal
of symptomatic g day of the period and
treatment disease decreases by the
end of the rash
period.
Rhinitis - - + +
Conjunctiv - - rare +
itis
Oral - - rare There are spots
 Pertussis treatment
• Etiotropic therapy is prescribed in the catarrhal period
and within 3-4 weeks of the period of spasmodic cough.
At a later date, antibacterial agents are prescribed to
patients with bacterial complications.
• Pathogenetic treatment:
• in order to reduce the number of coughing fits and their
duration diazepam is used;
• As an antitussive, butamirate is used
• oxygen therapy depending on the severity form
• in the presence of: coughing attacks with apnea, diffuse
cyanosis of the face with coughing attacks in children of the
first months of life and encephalic disorders, GCS - hormones
are prescribed - Hydrocortisone - 5 mg / kg / day or prednisone
at the rate of 1-2 mg / kg / day (intramuscularly) 3-7 days
 Pertussis treatment
• The regimen for patients with mild forms of
whooping cough is sparing (with a decrease in
negative psycho-emotional and physical stress).
Individual walks are required. Patient's stay in an
atmosphere of fresh, clean, cool and moist air is
favourable.
• Diet should include food rich in vitamins and be age-
appropriate. In severe forms of whooping cough, food
is given in small quantities and at shorter intervals,
preferably after a coughing attack. If vomiting occurs
after a meal, the food should be given in small
portions in 10-15 minutes after vomiting.
 Pertussis treatment
• paracetamol 10-15 mg / kg with an interval of at
least 4 hours, no more than three days per os or per
rectum or ibuprofen in a dose of 5-10 mg / kg no
more than 3 times a day is prescribed to stop the
hyperthermic syndrome over 38.5 ° C per os;
• with the goal of desensitizing therapy of
chloropyramine 1-2 mg / kg per day through the
parenteral route or twice a day for 5-7 days;
• etiotropic therapy – midecamycin 20-40 mg / kg
daily after 3 times a day for 7 days or azithromycin
on the first day 10 mg / kg, then another four days 5
mg / kg per os once a day or amoxicillin + clavulanic
acid 40 mg / kg per day per os 3 times a day within
7-10 days or ampicillin 100 mg / kg i / m, 3 times a
day for 7-10 days or cefuroxime 50-100 mg / kg i / m
3 times a day for 7-10 days;
 Pertussis treatment
• Infusion therapy is prescribed only in case of complicated
course of pertussis. An indication for its use is the
presence of toxicosis.
• For the purpose of detoxification therapy, intravenous
infusion at the rate of 30-50 ml / kg with the inclusion of
solutions: 10% dextrose (10-15 ml / kg), 0.9% sodium
chloride (10-15 ml / kg);
• In case of complications from the central nervous system
(encephalopathy) - dehydration therapy - furosemide 1% -
1-2 mg / kg per day with an interval of 12 hours for 2 to 3
days, then acetazolamide 0.25 g - 8 - 10 mg / kg per day
once a day according to the scheme: three days daily, one
day break, up to three to five courses in combination with
potassium preparations;
 Pertussis treatment
• pathogenetic therapy: to improve bronchial patency, as well
as to reduce venous pressure in the pulmonary circulation —
aminophylline per os or parenterally (with obstructive
syndrome) 4-5 mg / kg per day 3 times a day for 7 days;
• in order to reduce the number of coughing attacks and their
duration - neuroplegic drugs: diazepam 0.5% - 0.2-0.5 mg /
kg i / m; or i/ v; either rectally or orally, usually before night
and daytime sleep. The dose is selected individually:
sufficient if the child falls asleep after 10-15 minutes and the
daytime sleep lasts at least 2.5-3 hours, and the night sleep
6-8 hours, the duration of the course is 6-7 days. Butamirate
is used as an antitussive agent - from 2 months to 12
months - 10 drops, from 12 months to 3 years - 15 drops,
from 3 years and older - 20 drops every 6 hours for 7-10
days.
 Prevention
• Communicating with patient with pertussis, children under the
age of 18 years in the presence of a cough, regardless of the
vaccination history, shouldn’t be allowed to visit preschool
educational and general educational organizations. They are
allowed to visit them after receiving two negative results of
bacteriological and (or) one negative result of molecular
genetic research.
• In families where there are patients with whooping cough
children are under medical supervision for 14 days. All
coughing children and adults undergo a two-time
bacteriological (two consecutive days or with an interval of one
day) and (or) a single molecular genetic study.
 Prevention
• The most important way to prevent pertussis is
through complete immunisation. The vaccine for
pertussis is usually given in combination with
diphtheria and tetanus (often in combination also
with poliomyelitis, Haemophilus influenzae and
hepatitis B). A primary course of three doses of DTaP
(diphtheria, tetanus, acellular pertussis) vaccine or
DTwP (diphtheria, tetanus, whole-cell pertussis)
vaccine is usually given between two and twelve
months of age. A fourth dose is recommended at 11–
24 months of age and another dose between three
and six years of age.
• There is considerable variation between national
immunisation schedules in the timing of these doses.
Some countries recommend boosters for
adolescents, during pregnancy or soon after delivery.
 Parapertussis
• Parapertussis is an acute infectious disease
with an airborne transmission mechanism
caused by Bordetella parapertussis
belonging to the genus Bordetella, which
manifests itself as a persistent dry cough
with seizures that resembles the course of
pertussis in a mild form.
 Parapertussis symptoms
• The incubation period (from the moment of infection to
the appearance of the first signs of the disease) is from 4
to 14 days.
• The general condition of patients suffers slightly, body
temperature is often normal, it is possible to increase to
37-37.5 ° C during the catarrhal and spasmodic periods.
• Catarrhal period: slight nasal congestion, sore throat,
rare dry cough, duration - 3-5 days.
• Spasmodic period: no more than 14 days;
• Erased (atypical) form - occurs without coughing, there
is no sequential change in the periods of the disease, the
cough becomes wet, intrusive, sputum starts to go away;
 Parapertussis
• With a pertussis-like form of parapertussis, the
cough becomes paroxysmal, ending with a
whistling deep breath (reprise), and
sometimes vomiting, the frequency of attacks
is no more than 5-7 times a day. In comparison
with whooping cough, this form of
parapertussis in children is characterized by
more rare and shorter coughing attacks.
• The period of reverse development
(resolution): the cough weakens and quickly
disappears within a few days.
 Diagnostics
• Analysis of the history of the disease and
complaints: the gradual onset of the disease with
signs of a cold (runny nose, redness (hyperemia) of
the pharynx), cough, worsening every day before
the attacks.
• Epidemiological history (presence of contact with a
sick person, identification of cases of illness of
other people in the region of residence).
• Laboratory diagnosis: bacteriological method
(detection of the pathogen in the mucus from the
back wall of the pharynx).
• Serological method (determination of antibodies in
the blood).
 Treatment
• Treatment is carried out at home.
• A prolonged stay in the fresh air is recommended, since during
coughing attacks the patient experiences a lack of oxygen. The
optimum temperature for walks is from +10 to -5 ° C, duration
from 20 minutes to 2 hours.
• Diet: exclude products that cause irritation of the mucous
membrane of the throat - sour juices, dry cookies, crackers,
spicy, smoked, consume more vegetables and fruits.
• Sparing daily routine without physical exertion and stress.
• Mucolytic agents in the form of inhalations (diluting sputum and
facilitating its discharge).
• Antibiotics are prescribed in case of development of
complications - inflammation of the bronchi (bronchitis), lungs
(pneumonia).
 Mumps
• a viral infectious disease with an airborne
transmission mechanism, characterized by a
predominant lesion of the salivary glands, less
often other glandular organs (pancreas, testicles,
ovaries, etc.), as well as the central nervous
system (meningitis, meningoencephalitis),
accompanied by symptoms of moderate
intoxication and prone to epidemic spread.
41
 Classification
Type Severity Course
1.Typical a) Mild Acute
a) lesion of the b) Moderate By the nature of
glandular c) Severe the
organs; complications:
b) lesion of the • infertility,
nervous system; diabetes
c) mixed forms. mellitus,
2.Atypical: deafness,
a) erased; persistent
b) subclinical. paresis, or
paralysis of the
muscles of the
limbs, otitis
media,
 Mumps virus
• Mumps virus is a
paramyxovirus in the
same group as
parainfluenza and
Newcastle disease
virus. Parainfluenza and
Newcastle disease
viruses produce
antibodies that cross-
react with mumps virus.
The virus has a single-
stranded RNA genome.
• Mumps virus is rapidly
inactivated by formalin,
ether, chloroform, heat,
and ultraviolet light.
 Pathogenesis
• The virus is acquired by respiratory
droplets. It replicates in the nasopharynx
and regional lymph nodes. After 12 to 25
days a viremia occurs, which lasts from 3
to 5 days. During the viremia, the virus
spreads to multiple tissues, including the
meninges, and glands such as the salivary,
pancreas, testes, and ovaries.
Inflammation in infected tissues leads to
characteristic symptoms of parotitis and
aseptic meningitis
 Clinical Features
• The incubation period of mumps is 12 to 25 days, but
parotitis typically develops 16 to 18 days after exposure
to mumps virus.
• The prodromal symptoms are nonspecific, and include
myalgia, anorexia, malaise, headache, and low-grade
fever.
• Parotitis is the most common manifestation.
• Parotitis may be unilateral or bilateral, and any
combination of single or multiple salivary glands may be
affected. Parotitis tends to occur within the first 2 days
and may first be noted as earache and tenderness on
palpation of the angle of the jaw. Symptoms tend to
decrease after one week and usually resolve after 10 days.
 Symptoms
Early symptoms can
include:
•Sore throat
•Difficult swallowing
•Fever
•Tiredness
•Muscle and body aches
•Loss of appetite
•Chills
47
 Diagnostics
ANAMNESIS
• contact with a laboratory-confirmed case of mumps 11-21
days before the onset of symptoms of the disease;
• acute onset of the disease;
• painful enlargement of one or more salivary glands
(unilateral or bilateral);
• sharp pains in the epigastric region, nausea, tense
abdominal muscles;
• repeated vomiting;
• severe pain in the scrotum in boys (usually on the one side),
radiating to the lower abdomen, an increase in the size of
the testicle (orchitis);
• pain in the iliac region in girls (more often on the one
hand);
• severe headache;
• Not vaccinated.
 Diagnostics
• Glandular organ syndrome: parotitis
• by the end of 1-2 days from the onset of the disease, an increase in the
parotid glands appears. Usually the process begins on one side, and
then after 1-2 days the second gland is affected. At the same time, a
new increase of body temperature is noted. Inflammation of the
parotid salivary gland is accompanied by the appearance of soft tissue
edema located in front of the ear, at the apex of the angle formed by
the ascending branch of the lower jaw and upper 1/3 of the
sternocleidomastoid muscle. In the center, the swelling is resiliently
elastic, and to the periphery it is doughy, so in most cases there are no
clear boundaries. The skin above is not changed, palpation causes
moderate soreness. When examining the inner surface of the patient’s
cheek with mumps, hyperemia and swelling of the mouth of the
excretory duct of the parotid salivary gland can be detected - a
symptom of Moursou. The latter is not specific for mumps infection,
but in combination with other symptoms, it can be diagnosed, as it
appears already in the prodromal period. Salivation is reduced, saliva
viscosity is increased, but saliva is transparent.
 DIAGNOSTICS
• Intoxication syndrome: an increase in
temperature from subfebrile rate(mild severity)
to 38.0-40.0 ° C (moderate and severe). Fever
reaches its maximum severity for 1-2 days of
illness and lasts 4-7 days, the temperature
decreases lytically.
• Submaxillitis (single-sided lesion of the
submandibular salivary glands):
• In the submandibular region, a spindle-shaped
formation appears, of a test-like consistency,
moderately painful if palpated. Under the tongue,
you can observe hyperemia and swelling of the
excretory duct of the affected gland.
 DIAGNOSTICS
• Sublingvitis:
• swelling and soreness in the chin and under the tongue;
• reduction of salivation;
• development of swelling of the pharynx, larynx, and tongue is
possible with a marked increase in the submandibular, sublingual
salivary glands.
• Pancreatitis (lesion to the pancreas):
• increase in body temperature;
• nausea, vomiting;
• abdominal pain radiating to the back, right hypochondrium,
sometimes girdle;
• In young children, oily loose stools may appear, in older ones -
constipation.
• with palpation of the abdomen pain, positive symptoms of Mayo-
Robson and Voskresensky are noted.
 DIAGNOSTICS
• Orchitis (genital lesions):
• increase in body temperature;
• pain in the affected testicle with irradiation to the inguinal and femoral areas;
• an increase in the testis by 2-3 times;
• dense consistency; pain during palpation; the skin of the scrotum is hyperemic;
“primary” orchitis (precedes an increase in the parotid salivary glands); “concomitant”
orchitis (develops simultaneously with mumps);
• more often only the right testicle is affected, which is associated with the peculiarities
of blood supply. However, in 15% of patients, the process can be bilateral. In addition,
the development of epididymitis is possible;
• expressed pathological changes in the testicle persist for 5–7 days, then a slow
recovery begins. Signs of organ atrophy are observed after 1-2 months.
• manifestations of left-side orchitis are more persistent.
 DIAGNOSTICS
• Prostatitis (lesion of the prostate gland):
• increase in body temperature;
• pain in the perineum and anus;
• enlargement of the prostate gland.
• Oophoritis (lesion of the female genital
glands):
• increase in body temperature;
• weakness, malaise;
• pain in the iliac region.
 DIAGNOSTICS
Serous meningitis Mononeuritis
sudden deterioration of (lesion of the cranial
general condition; nerves), mainly lesions of
>a new increase of body the VII pair and VIII pair:
temperature up to 38-39 ° C; >lesion of the auditory
>lethargy, adynamia; nerve - dizziness,
>headache; nystagmus, tinnitus, hearing
>repeated vomiting; loss.
>meningeal signs: stiff neck,
>Myelitis and
symptoms of Brudzinsky and
encephalomyelitis appear
Kernig;
on the 10-12th day of the
>the presence of persistent
focal symptoms indicates the
disease, manifest as spastic
involvement of brain matter lower paraparesis, impaired
(meningoencephalitis) in the function of the pelvic organs
pathological process; (incontinence of stool,
>in rare cases the symptoms urine).
of serous meningitis appear
prior to these of the salivary
 DIAGNOSTICS
 CBC: Serological Molecular
leukopenia, blood test: genetic
lymphocytosi ELISA - method:
s, ESR is not detection of PCR -
changed. IgM for mumps detection of
 Biochemical virus; mumps RNA
analysis of CFT, HI-test - from a sample
blood: an increase in of blood or
increased antibody titer saliva or urine.
activity of by 4 times or
amylase, more in the
diastase. study of paired
sera (the first is
taken at the
beginning of
the disease, the
second after 2-
3 weeks).
 DIAGNOSTICS
CSF examination for Instrumental studies (according to
meningitis and indications):
meningoencephalitis: >spinal puncture – in case of
>color - colorless; appearance of cerebral symptoms,
>transparency - transparent or positive meningeal symptoms;
slightly opalescent; >Ultrasound of the abdominal
>pressure - the liquid flows organs - to determine the degree of
out in a form of stream or the pancreatic tissue lesion
frequent drops, the pressure (pancreatitis);
reaches 300-500 mm of H20; >Ultrasound of the scrotum, pelvis
>pleocytosis - lymphocytic organs;
around 300-700 cells, up to >ECG - for disorders of the
1000 in 1 μl; cardiovascular system, for early
>increase of protein quantity detection of heart lesion (severe);
up to 0.3-0.9 g / l (with the  Chest X-ray – in case of
development of inflammatory changes in the lungs
meningoencephalitis, (pneumonia);
indicators are higher);  EEG - in case of focal neurological
>glucose level is not changed symptoms, seizures, signs of
or is slightly increased; intracranial hypertension.
 Differential diagnosis
Purulent parotitis Infectious mononucleosis
Common symptoms: acute Common symptoms: acute
onset, severe intoxication onset, fever, intoxication
symptoms, fever, swelling in symptoms, swelling in the
the parotid region. parotid, submandibular areas.
Examination: consultation of Examination: Epstein-Barr
the maxillofacial surgeon. Virus IgM Blood Capsid
Exclusion criteria: fever Antigen
above 390C. Swelling and Exclusion criteria: enlarged
redness of the salivary gland, it cervical lymph nodes arranged
is sharply painful, dense with in chains along the
gradual softening and sternocleidomastoid muscles,
fluctuation. The defeat is tonsillitis, hepatosplenomegaly,
always one-sided. Isolation of rash, icteric syndrome is
pus from the mouth of the possible. Persistent prolonged
Stenon duct. fever.
In the CBC, leukocytosis with a In CBC, leukocytosis with a
neutrophilic left shift, neutrophilic shift, acceleration
increased ESR. of ESR.
The diagnosis is confirmed
 Differential diagnosis
Lymphogranulomatosis Salivary stone disease
Common symptoms: swelling Common symptoms: swelling in
in the parotid, submandibular the parotid region.
areas. Examination: consultation of the
Examination: consultation of an maxillofacial surgeon.
infectious disease specialist, Exclusion criteria: lack of fever
hematologist, oncologist. and intoxication. Recurrent
Exclusion criteria: lesion of the course of the disease. The
lymph nodes. In this case, the swelling then increases, then
latter is usually preceded by decreases, “salivary colic”
"causeless" weakness, asthenia, increases with food intake. No
a periodic increase in body damage to other organs.
temperature, and excessive There are no changes in the CBC.
sweating. The disease is
characterized by a long
progressive course. In CBC,
leukocytosis with a neutrophilic
shift, significant monocytosis,
acceleration of ESR.
 Differential diagnosis
• Mikulich syndrome
• Common symptoms: swelling in the parotid
region
• Examination: surgeon consultation
• Exclusion criteria: the onset of the disease is
gradual with a chronic process. Increase in body
temperature, lack of intoxication. The increase
in the salivary glands is bilateral, tuberous, less
painful. The lesion of other organs: an increase
of the lymph glands, liver, spleen, ptosis.
• In CBC - thrombocytopenia, anemia.
 Epidemiology
• Mumps is spread by coughing and
sneezing or touching something infected
with the mumps virus

• It can occur anytime, from a few days

prior to the onset of swelling of the
salivary glands to 9 days after the onset
of symptoms

• Once the virus enters the body, it

travels to the back of the throat, nose,
63

and lymph glands in the neck, where it

 Epidemiology
Reservoir human

asymptomatic infections
may transmit
Transmission airborne

direct contact with droplet

nuclei or saliva
Temporal pattern peak in late winter and
spring
Communicability several days before and
after onset of parotitis
 Treatment
• Hospitalization is necessary for children with
moderate and severe forms of the disease,
with complications, children from closed
institutions etc.
• The treatment is complex, depending on
form, severity and period of the disease, the
age of the patients and their individual
characteristics.
• Patients should have bed rest throughout the
acute period of the disease: up to 7 days -
with isolated mumps, at least 2 weeks - with
serous meningitis (meningoencephalitis), 7-
10 days - with inflammation of the testicles.
 Treatment
• Diet № 2
• dry heat on the area of ​the affected salivary glands;
• physiotherapy: light-heat therapy with a Sollux lamp in
the salivary gland area after normalization of body
temperature, exposure time 3-5 minutes (5-10
procedures);
• rinsing the mouth after eating (warm boiled water, 2%
sodium bicarbonate solution or furacillin solution 1:
5000) 4-6 times a day;
• local treatment of orchitis: elevated position of the
testicles with the help of a supporting dressing -
suspension. During the first 2-3 days - cold (lotions with
cold water or an ice bubble), then heat on the testicles
(dry warm cotton dressing).
 Treatment
• Etiotropic therapy: not performed.
• Symptomatic therapy:
• for resolution of hyperthermic syndrome over
38.5 ° C, paracetamol 10-15 mg / kg is
prescribed with an interval of at least 4 hours,
no more than three days per os or per rectum
or ibuprofen in a dose of 5-10 mg / kg no more
than 3 times day per os;
• for the purpose of desensitizing therapy,
chloropyramine 1 - 2 mg / kg per day per os or
parenterally twice a day for 5-7 days /
• Orchitis:
Treatment
 corticosteroid hormones at the rate of 2-3 mg / kg / day, followed
by a dose reduction during 7-10 days;
 detoxification therapy per os or parenteral (30-50 ml / kg);
 non-narcotic analgesics - diclofenac;
 Discharge of convalescents is carried out a week after the local
inflammation subsides. Over the next 2 weeks the use of a
suspensorium is indicated.
• Pancreatitis:
 detoxification therapy (heavy drinking or i/v infusion of glucose-
salt solutions 30-50 ml / kg);
 antisecretory treatment – pantoprazol 20 mg per os 2 times a day;
omeprazol 20 mg per os 2 times a day
 Protease inhibitors - aprotinine 10000 U i/v 5-7 days
 Exocrine function insufficiency treatment – pancreatine 10000 U
after meal.
 Treatment
Lesion of the nervous system:
>dehydration therapy - mannitol 15% at the rate of 0.5-1.5 g /
kg intravenously; furosemide 1% - 1-3 mg / kg per day with an
interval of 12 hours for 3-5 days, then acetazolamide 0.25gr -
8 - 10 mg / kg per day, once per day according to the scheme:
three days daily, one day break, up to five courses in
combination with potassium preparations;
>detoxification therapy with forced diuresis (parenteral);
>for patients with cerebral edema and encephalitis -
dexamethasone for the purpose of anti-inflammatory and
desensitizing therapy: for children under two years of age -
the first dose of 1 mg / kg, then 0.2 mg / kg every 6 hours,
older than two years - the first dose of 0.5 mg / kg, then 0.2
mg / kg every 6 hours. The course of treatment is 3-7 days,
oxygen therapy;
>for convulsions - diazepam - 0.5% 0.2-0.5 mg / kg i / m; i / v;
rectally or sodium oxybutyrate 20% solution - 50-150 mg / kg
(single dose i / m; i/v).
>Antibacterial drugs are prescribed in case of the
 Prevention
• MMR vaccine: helps prevent measles,
mumps, and rubella. Children 1 year of
age and older get 2 doses. These are
usually given between ages 15 and 18
months and again between ages 4 and
6 years

70
 Isolation Precautions

• S/S of mumps illness should be cared for using droplet

precautions
• These pathogens do not remain infectious over
long distances in a healthcare facility
• Special air handling and ventilation are not
71
required to prevent droplet transmission
THANK YOU FOR
ATTENTION!