April
17
23:01
Paediatrics

Parotitis

Mumps

Mumps photo Mumps - This is common infectious disease that develops from the virus in the paramyxovirus family in the human body.The virus tends to defeat the glandular tissue, so the first target are the parotid gland.With more operating time of the amount of virus mumps, there is defeat and submandibular gland, testes and ovaries, sometimes pancreatic cancer.In special cases, mumps and reaches the nervous system, affecting nerves and meninges.All phenomena mumps, above, against the backdrop of intoxication processes and high temperature.

Mumps lives in places where children, with a maximum frequency of occurrence in the three and six years of age.Sensitivity to the highest rank of mumps (from about 8 to 10 people ill).

reasons

mumps Mumps is caused by a virus, containing the RNA in the cell nucleus, and relating to the class of paramyxoviruses.The structure of antigens hemagglutinin and neuraminidase are included.Origin of the antigens responsible for adherence to isotropic bodies and the

introduction into the cells, and second, acting in the blood causes clumping of erythrocytes and their gemolizirovanie.Picture of the antigenic structure of the virus is constant, therefore, the immune system, to turn out at the meeting with the mumps virus lifelong.The virus has sufficient resistance and at relatively low temperatures may exist for months.Application of conducting disinfection, acts detrimental to the mumps virus.

Mumps is an infection which persists between people (usually airborne, but occasionally marked by transmission through objects).Sick man mumps is considered contagious until the ninth day of the clinic.But the virus can still stand and two days prior to the deployment of clinical disease (incubation).It is extremely important epidemiologically.Mumps virus acts priority to the oral mucosa, in which he introduced and multiplied.The first introduction of mumps virus in the blood may not manifest clinically, but it certainly will be shown by laboratory tests.The second release of mumps virus in the blood lead to a new upsurge of the disease and lead to complications.The virus persists in a relatively short body - about 7 days.Find it in the body over time is not possible.You can only determine the high titers of IgM, which indicates the disease.

Signs and symptoms of mumps

for mumps is characterized by the duration of the incubation of 12-26 days.Manifestations depend on the form of mumps.If this is a typical manifestation of the disease, the pathology can occur with damage to the glands, with damage to the nervous system, in the form of a mixed (glandular organs and nerve tissue).Thus mumps can occur both in the form of light, and in moderate or severe.There is also the atypical manifestation of the disease, which plays a major role in the spread of infection (since clinically mumps itself practically does not show).These include erased (with implicit clinical signs) and subclinical (without clinic, but the presence of the pathogen in the blood) forms.

defeat of the parotid glands found in most cases (as the name suggests infection).Mumps begins with a temperature rise to high numbers and the deterioration of health.In the future, the temperature rises in case of defeat new and is characterized by an undulating bodies.Parotid glands occurs on day 2 (first one iron, and after a few hours of each).They are enlarged, painful, soft to the touch.There is a dry mouth.The process takes typically about 7 days, but may last longer.Following the defeat of the parotid glands may be affected and the submandibular and sublingual glands.Separate defeat these glands are extremely rare.

The second of affection mumps infection are sexual organs.This is estimated as a complication of the disease.There is usually 2 weeks after disease of the salivary glands (the case of isolated lesions of the sex glands are more correlated with the occurrence of imperceptible infection in the salivary glands).Usually affects the testicles in boys (up to a third of all cases), sometimes the ovaries in girls.In exceptional cases, penetration of the virus occurs in prostate and breast cancer.The defeat of the testicles (orchitis) has very dangerous consequences in the form of violation of spermatogenesis (up to half of all lesions) or infertility (in a third of cases).So important is corticosteroids at the beginning of this complication.Mumps begins a second rise in temperature and degradation.There swelling and edema of the testes and scrotum, often with one hand.Process takes about a week, after which the symptoms begin to regress.

third bodies involved in the infectious process, is the nervous system.Evidence suggests varying the frequency of this complication (10 to 80%).It may be implicated as the brain (meningitis, meningoencephalitis) and peripheral nervous system (neuritis, polyradiculoneuritis).Meningitis having serous character, the most common manifestation.It appears at the moment subsided process (second week).Manifested meningitis following a rise in temperature to 39-40 ° C, headache, multiple, not relieves vomiting.Accompanied by either lethargy, excitation or vice versa.Characterized by neck stiffness (the inability to reach the sternum chin yes) Kernig (difficulty in straightening the knees), a symptom Brudzinskogo (at an inclination of the head, there is a bending of the knee joint).The current meningitis may be different.In mild form of mumps meningitis the temperature may rise significantly, meningeal symptoms are not pronounced.Sometimes single vomiting, slight fever, general condition is satisfactory.Defines the diagnosis of meningitis lumbar puncture.Discover transparent liquor flowing under pressure, lymphocytosis, a slight increase in protein, normal levels of chlorides and sugar.

sometimes joins brain damage.Vomiting and headache worse, there are seizures, confusion, abnormal reflexes.All the symptoms of meningitis and encephalitis are beginning to take place a few days later from the beginning, and a week later and did subside.But this does not apply to the spinal liquor, changes that do not go up to a month.It is worth mentioning that the symptoms of nerve disorders are often not fully tested.Can be: fatigue, memory disorders, recurrent headaches.As for neuritis and polyradiculoneuritis, these symptoms are extremely rare.There may be a loss of the facial nerve in the parotid gland rapidly increasing.This will lead to violations in the area of ​​the facial muscles and pain in the nerves.A rarity is also a loss of hearing in the defeat of the cochlear nerve, paralysis of the lower limbs.

incidence of mumps pancreatitis ranges from 5 to 80%.The fact that the presence of amylase in the blood taken for pancreatitis.But this is not quite correct.Only clinic will testify in favor of mumps pancreatitis.It is manifested in the second week of illness pains vary in severity.Girdle pain, radiating to the back and right upper quadrant.There is an increase in blood cancer enzymes.In the analysis of stool - the presence of fatty acids and starch.Symptoms of mumps pancreatitis do not last more than a week, and laboratory changes take place a month later.

Mumps in adults

Mumps - a disease of childhood, but rarely found in adults.Like many childhood infections, affecting adults, it takes quite seriously.The danger is not so much the mumps as the severity of the process, so there is a greater possibility of complications.

Mumps is developing quickly and sharply.Temperatures can reach 40 ° C, appears sharp pain around the ear lobe.Hard swallowing, increased salivation.Especially dangerous is the defeat of mumps in the case of genitals.Men may come testicular atrophy in women menstrual cycle.Studies show that mumps is the cause of one-third of infertility cases.Often without mumps clinics it passes unnoticed in childhood, but it leads to infertility.The rest of the proceeds mumps in adults as children.

Diagnostics mumps

In the case of a typical course of mumps with lesions of the parotid gland, the diagnosis is not difficult.Suffice it to build a complete epidemiological history, contact information and inspect.On examination is palpable parotid gland testovatoy soft consistency, hard and painful.

Blood test material does not matter.Leukopenia may occur.

basis of diagnosis is virus isolation (virological methods) and the detection of antibodies to the virus (serological methods).

isolate the virus may be one of those body fluids where it persists.This is especially saliva, then blood and cerebrospinal fluid.Fence material must be carried out until the fifth day.This material is usually infect chicken embryos.Also used human embryos, cell culture.Then begins the long road waiting multiplication of the virus in these cultures.Method difficult and not economical.Implementing it requires good laboratory time.Allocate mumps virus immunofluorescence, which provides the ability to detect the virus in the cultures after 2 days.This method is applied to any material to glass, stained added thereto and labeled serum or monoclonal antibody.Then determine the presence of mumps virus in the material, its morphology.The lack of subjectivity of the information provided, since the nature of light is difficult to say about the virus.The method relates to the rapid methods.

For serological methods include RAC, response inhibition gemagglyutsinatsii, RN, ELISA.Detected antibodies in the sera of growth, combined with an interval of 2-3 weeks.In favor of the presence of the virus in a material increase in titer says 4 or more times.However, these methods are also quite complicated in practice, as on a par with virological methods require a lot of time to result.An exception is the enzyme immunoassay, which at this stage is the first of its kind in the information content and the time setting.Use appropriate antibody labeled with an enzyme, which is added to the material taken.In the case of viral antigens, it will bind to these antibodies.The substrate is cleaved by the enzyme and stained reaction products.Consequently, it will be possible to detect not only the presence of the pathogen in the material, but the amount thereof.This is different from the rest of the method of classical methods of serological immunology.Additionally, detection of different classes of antibodies (IgG, IgA, IgM), which is crucial in determining the period of development of the disease.These antibodies help to detect and atypical form of the disease, almost clinically manifest, but give the immunological reaction.In the case of mumps it is essential for the subsequent prevention of infertility in men.

There also allergological methods.For this intradermally administered mumps diagnosticum.But this method is now practically not used.

need to differentiate mumps gland inflammation with non-infectious nature, such as diseases of the oral cavity (caries).In this case, the inflammation will always be one-sided, characteristic swelling and painless.Purulent mumps are rare, which has all the classic signs of inflammation: pain, redness, swelling, change in the function.This disease initially as infectious mononucleosis may also masquerade as mumps, since lymph node enlargement may experience swelling of the face.The hallmark of mononucleosis Buda defeat all the lymphoid tissues of the body and specific body in the blood.

nervous system lesions must be differentiated from it in other viral infections.Make it can only laboratory immunoassays.

Treatment of mumps

All patients with symptoms of mumps are isolated for a period of 10 days.Specifically mumps is not treated primarily symptomatic therapy.In the case of uncomplicated forms of treatment is carried out at home.Mode the first week of the disease to be bed to prevent the development of complications (orchitis in particular).Further treatment may be extended.Dieting is also important, especially in the early days.Feed should not be less than 4-5 times per day, the breaks should be small.Limitation As for carbohydrates and fats.Moderately encourage drinking coffee, strong tea.It excludes all spicy, fried, carbonated beverages, smoking, alcohol.It should remove all allergenic foods.The diet should be a sufficient amount of fruits and vegetables, a variety of cereals.

Since the causative agent of the disease are viruses, no harm will be the appointment of:

- antivirals: Arpetol 100 and 200 mg in a dose of 50 mg / day for children (3-6 years) to 200 mg / day for adults.Isoprinosine (Groprinosin, Immunovir) 500 mg in a dose of 50 mg per kg body weight in 3 divided doses.Antiviral treatment lasts 7-14 days.

- interferon preparations: Leukocytic human interferon is dissolved in 2 ml of water and instilled into the nasal passages 2-4 cap.several times a day.Grippferon vial 50 and 100 ml in the form of droplets into the nasal passages.Viferon and Genferon in rectal suppositories of 2 candles in a day with an interval of 12 hours.

- interferon inducers (drugs that stimulate the production of endogenous interferon) TSikloferon 150 mg tablets.Anaferon tablets of 300 mg.Amiksin in tablets of 60 and 125 mg.and others.

- plant immunostimulants: preparations based on echinacea, ginseng, lemongrass, St. John's wort, rose hips, thyme, lemon balm.For example the drug Immunal (echinacea), a drop of 100 ml.

- bacterial immunostimulyatorv: Ribomunil in tablets of 250 and 750 mg.Bronhomunal capsules of 3.5 mg and 7.0 mg.Imudon in tablets of 50 mg.These preparations contain separate components of different bacteria as a stimulant of the immune response.

At a temperature of 38 ° C and above are assigned antipyretics, often nonspecific antiinflammatory: Paracetamol 10-15 mg / kg body weight per day in the form of tablets of 200 or 500 mg or syrup.Ibuprofen 5-10 mg / kg body weight per day in the form of 200 mg tablets or suspensions.Aspirin is contraindicated, especially in children (due to the danger of Raynaud's syndrome).In the case of high temperatures and the lack of effect of the use of fever-reducing Analgin injected intramuscularly with papaverine at the rate of 0.1 ml per year of life for children.

As for the topical treatment of enlarged or swelling of the parotid gland, the prescribed warm compresses.In the case of a large swelling solution using 6 drops of atropine.In the case of attachment of a bacterial infection antibiotics are administered intramuscularly and duct cancer.It is important to oral treatment (rinsing with antiseptic solutions after a meal).

all complicated forms require hospital treatment due to dangerous long-term effects on the body.If it affects the genitals necessarily required bed rest for a time the most active process, lacto-vegetarian diet.For the prevention of infertility prednisolone or other similar steroids.A dose of 2-3 mg / kg per day for seven days, with a gradual reduction of the dose from the fifth day.Observation is a surgeon in the case of too much edema produces dissection surgery shell eggs.

When joining the symptoms of brain damage, patients hospitalized with the obligatory clock surveillance.Strict bed rest.The main thing - the removal of cerebral edema.To do this, carry out detoxification and drug Furosemide degidrotatsii with potassium supplements.It is important to exercise lumbar puncture to reduce the pressure by allocating a certain amount of liquor.Perhaps the appointment of a large group of drugs that stimulate brain activity (Piracetam), as well as drugs that improve cerebral blood flow (Aktovegin).

Development mumps pancreatitis requires a strict regimen and diet.The first 2 days of nutrients administered only parenterally, then move on to a light meal.The diet must be followed for a year.