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Case of the Week: Mumps

people_mumps

Clinical image from the CDC’s Public Health Image Library

Until this week, it had been a long time since I’d seen a case of the mumps. The last was in Central America over a decade ago. And until this week, I had never personally diagnosed a case.

I can’t go into clinical specifics, other than to say that despite the classic presentation of painful swelling of the salivary glands, mumps was not at the top of my list of possible diagnoses for my patient. After all, almost everyone is vaccinated nowadays, and we just don’t see it anymore.

But I sent the test anyways, and was shocked when the Health Department called: Positive.

So I’ve been reading up, and I’ve learned something: the mumps vaccine isn’t 100% protective. At best, two doses of the MMR (mumps, measles, and rubella) vaccine is 88% effective in preventing infection. This is, of course, better than nothing: an unvaccinated person is about nine times more likely to contract mumps than a vaccinated person. Still, outbreaks can and have occurred within highly vaccinated populations.

While mumps is rarely fatal, the complications that can occur are not pleasant: pancreatitis (inflammation of the pancreas causing abdominal pain, nausea and vomiting); orchitis (painful swelling of the testicle); mastitis (inflammation of the breasts); oophoritis (inflammation of the ovaries causing fever and pelvic pain); meningitis (inflammation of the spinal column causing fever, headache and a stiff neck); encephalitis (inflammation of the brain that can cause headaches and confusion, and can be quite serious).

I have to admit, until studying up on this case, I had never heard of oophoritis, and I know that most clinicians may not think of mumps at all when caring for a patient with acute pelvic pain. I wonder if some cases of mumps are simply missed.

So of course, now I’m sitting here wondering if I’ve seen mumps and missed the diagnosis, since it usually resolves on its own. And, I wonder if I’m percolating the mumps virus, and if I’m going to pass it on to my family…

The CDC has a very good, brief summary of mumps, as does the Mayo clinic. If you’re a nerd like me, you’ll enjoy reading and learning!

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4 replies »

  1. What Dr Mom said. Was this patient vaccinated? I haven’t seen mumps since the late 80s and then it was mostly older kids who started school before mumps vaccine was required for kindergarten in our area. 88% is generally good enough if everybody is vaccinating. If everybody is not, not so much. Those of us who grew up in the pre-vaccine era can tell you that even the uncomplicated variety is not much fun. Don’t know why anybody wouldn’t want to keep their kids from having it.

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