Parotid virus infection causes swelling and pain of salivary glands in cheeks and neck. Rare complications include meningitis, meningoencephalitis, encephalitis and encephalomyelitis, as well as deafness, arthritis, orchitis, oophoritis, pancreatitis and inflammation of kidney, liver and thyroid. Although anyone can be infected, unvaccinated school-age children are the most susceptible to infection, with a high incidence in winter and spring.
[etiology]
Mumps virus belongs to paramyxovirus family, which is spherical and about 80 ~ 300 nm in size. It is a single-stranded ribonucleic acid virus (SSRNA). The virus has hemagglutinin antigen (V) in its outer membrane and soluble antigen (S) in its nuclear shell. Both S antigen and V antigen have their own corresponding antibodies. Whether S antibody has protective effect is still controversial, while V antibody has protective effect. Hemagglutinin in the outer membrane of the virus can agglutinate chicken and guinea pig red blood cells and produce hemagglutination inhibition antibodies. It grows well on Hela cells, human embryonic kidney and monkey kidney primary cells. The virus is cold-resistant, and can survive for more than 1 year at -50 ~-70℃. Its vitality can be stored at 4℃ for 2 months, 37℃ for 24 hours, and 55 ~ 60℃ for 20 minutes to die. There is considerable resistance to low temperature. Sensitive to ultraviolet rays and general disinfectants. It only survived for half a minute under strong ultraviolet rays, and was inactivated after contacting with formaldehyde solution, 30% Lysol and 75% ethanol for 2 ~ 5 minutes. There is only one serotype of this virus. Humans are the only virus hosts in nature.
[epidemiology]
It is mainly spread by droplets. Direct contact with saliva infection of patients.
(a) the source of infection early patients and recessive infection. The virus exists in the saliva of patients for a long time, and can be isolated from the saliva of patients from 6 days before cheek swelling to 9 days after cheek swelling, so it is highly contagious in these two weeks. After being infected with mumps virus, there is no mumps, but if there are symptoms in other organs such as the brain or testicles, the virus can also be detected in saliva and urine. During the epidemic period, about 30 ~ 40% patients only had subclinical infection of upper respiratory tract infection, which was an important source of infection.
Need to be quarantined. Patients are not allowed to go to school or work for 9 days after symptoms appear. The infection period is from one week before symptoms appear to nine days after symptoms appear. Patients are most contagious within 48 hours after symptoms appear.
(2) Mode of transmission: The virus spreads through droplets in saliva (saliva and contaminated clothes can also spread), and its infectivity is weaker than measles and chickenpox. Pregnant women infected with this disease can infect the fetus through the placenta, leading to fetal malformation or death, and the incidence of abortion will also increase.
(3) Susceptibility is generally susceptibility, and its susceptibility decreases with age. 90% of the cases occurred in children aged 1 ~ 15, especially children aged 5-9. /kloc-Babies under 0/year old can have maternal immunity and rarely get sick. 80% of adults have suffered from dominant or recessive infection. There is no gender difference among children, and there are more men than women after puberty. Can have lasting immunity after illness.
(4) Epidemiological features: The disease is distributed all over the world, and can occur all year round, but mainly in winter and spring. It can be popular or distributed. It is easy to cause outbreaks in children's collective institutions, military units and crowded people with poor sanitary conditions. Its epidemic law is that with the accumulation of infectious sources and the increase of susceptible population, the epidemic periodicity is formed, and the epidemic duration can fluctuate between 2-7 months. In unvaccinated areas, there is a trend of transmission every 7-8 years.
[Pathogenesis and pathological changes]
Mumps virus first invades the upper respiratory tract and conjunctiva of eyes, then proliferates in local mucosal epithelial tissues and then enters the blood circulation (primary viremia), then involves parotid gland and some tissues through blood flow, then proliferates in these organs, and then enters the blood (secondary viremia) and spreads to salivary glands, testicles, ovaries, pancreas, liver and central nervous system. The virus has a special affinity for parotid gland, so the non-suppurative inflammation of parotid gland is the main lesion. Its glands are red and swollen, exudation, hemorrhagic lesions and leukocyte infiltration. The glandular epithelium is edematous and necrotic, and the blood vessels between acinus are congested. The parotid duct is catarrhal inflammation, with serous cellulose exudation and lymphocyte infiltration around the duct and glandular interstitium, which often causes gland duct tissue blockage and internal pressure increase, leading to gland enlargement. Salivary glands, testes, ovaries and pancreas can also have similar inflammatory changes. When the parotid duct is partially blocked, the amylase retained in saliva can enter the blood circulation through the lymphatic system and be discharged from the urine, resulting in the increase of serum and urine amylase. Brain tissue lesions can be acute viral meningitis, including nerve cell degeneration, necrosis and inflammatory infiltration; Occasionally, the cells in the ventricles are necrotic, and the scar narrows the aqueduct of the brain, resulting in intracranial effusion. Adolescent patients are prone to orchitis. The epithelium of seminiferous tubules in testis is obviously hyperemia, with bleeding spots and lymphocyte infiltration. Edema and serous cellulose exudate can be seen in the stroma.
[Clinical manifestations]
The clinical manifestations are fever, parotid gland swelling, pain and fear of eating sour food. Including fever, swelling and pain of salivary glands in the neck, submandibular and ears. After puberty, 25% of male patients will develop testicular swelling, and one-third of infected people will be asymptomatic.
The incubation period is 8 ~ 30 days, with an average of 18 days. The onset is mostly acute, and there are no prodromal symptoms. There are fever, chills, headache, sore throat, loss of appetite, nausea, vomiting, general pain and so on. After a few hours, the swelling and pain of parotid gland gradually become obvious, and the body temperature can reach above 39℃, which is generally more serious in adult patients. Parotid gland enlargement is the most characteristic. Generally, it takes the earlobe as the center, develops forward, backward and downward, and looks like a pear with unclear edges; Local skin is tense, shiny but not red, tough and elastic to the touch, and painful to touch; Speaking and chewing (especially when eating acidic diet) stimulate saliva secretion, leading to increased pain; Usually, after swelling 1 ~ 4 days, one parotid gland involves the opposite side, and bilateral swelling accounts for about 75%. Submandibular gland or sublingual gland can also be involved. In severe cases, the tissues around the parotid gland are highly edematous, which distorts the appearance and may cause dysphagia. The opening of parotid duct can be red and swollen in the early stage, and no purulent secretion overflows from the opening when the parotid gland is squeezed. Parotid swelling mostly reached its peak in 1 ~ 3 days, and gradually subsided and returned to normal after 4 ~ 5 days. The whole journey takes about 10 ~ 14 days. Submandibular gland and sublingual gland can also be involved at the same time, or appear alone. The submandibular gland is swollen, indicating that the anterior cervical mandible is swollen, and the swollen gland can be felt. The swelling of sublingual gland can be seen in the swelling of tongue and floor of mouth, which makes it difficult to swallow.
Mumps infection in the first trimester of pregnancy often leads to fetal death and abortion, and may cause congenital endocardial elastic fiber hyperplasia.
[Laboratory inspection]
(1) The white blood cell count of hemogram is normal or slightly lower, and the lymphocytes are relatively increased in the later stage. When there are complications, the white blood cell count will increase.
(2) Determination of serum and urine amylase. 90% of patients have mild or moderate increase in serum amylase, which is helpful for diagnosis. The increase of amylase is often directly proportional to parotid gland enlargement. Urinary amylase can also be increased in meningitis patients without parotid gland enlargement. In addition to detecting amylase, serum lipase is helpful to make a clear diagnosis when pancreatitis is suspected.
(3) Serological examination
1. The low titer of neutralizing antibody test, such as 1: 2, indicates a specific immune response. Neutralizing antibody has strong specificity, but it is not commonly used.
2. Complement binding and hemagglutination inhibition tests detected complement binding and hemagglutination inhibition antibodies in early and convalescent serum. If there is a significant increase (titer more than 4 times), diagnosis can be made. Detection of IgM antibody by enzyme-linked immunosorbent assay and indirect fluorescence immunoassay abroad can be used for early diagnosis.
3. Virus can be isolated from saliva, urine, blood and cerebrospinal fluid in the early stage of virus isolation.
4. Urine protein, red blood cells and white blood cells. When urine and kidneys are affected, urine changes similar to nephritis may occur.
[complications]
(1) Mumps virus, a complication of reproductive system, invades mature gonads, so it is more common in adult patients in late adolescence than in children.
1. The incidence of orchitis accounts for 14 ~ 35% of male adult patients. Generally, the incidence rate increased significantly after 13 ~ 14 years old. It is common about a week after gilloma, with sudden high fever, chills, testicular swelling and pain, accompanied by severe tenderness. In severe cases, the scrotal skin is obviously edema, and there is yellow effusion in the tunica vaginalis. Most lesions invade one side. Acute symptoms last about 3 ~ 5 days, and the whole course of disease is about 10 days. Testicular atrophy occurred in about 1/3 ~ 1/2 cases. Because the lesions are usually unilateral, even bilateral ones only partially involve seminiferous tubules. So it rarely leads to infertility.
2. The incidence of ovarian inflammation accounts for about 5 ~ 7% of adult female patients. Symptoms are mild and do not affect pregnancy. The main manifestations are sudden chills, fever, abdominal pain or lumbosacral pain, menstrual cycle disorder, and severe cases can touch swollen ovaries and have tenderness. Does not affect fertility.
(2) The incidence of pancreatitis is about 5%, which is rare in children. It often occurs after parotid gland enlargement 1 week, with severe pain, tenderness and muscle tension in the middle and upper abdomen as the main symptoms. Accompanied by vomiting, fever, abdominal distension, constipation, and sometimes pancreatic swelling. Symptoms of pancreatitis usually disappear within a week. The increase of serum amylase activity can not be used as the only basis for diagnosis, and the serum lipase value exceeds 1.5μ% (the normal value is 0.2 ~ 0.7 μ%), which indicates the recent existence of pancreatitis.
Neurological complications
1. The incidence of meningitis or meningoencephalitis is 5-25%, and it can reach 35% in some areas. It is generally believed that the virus directly invades the central nervous system. It occurs 6 days before parotid gland enlargement or within 2 weeks after parotid gland enlargement, usually within 1 week. The clinical manifestations are acute high fever with severe headache, vomiting, lethargy or disturbance of consciousness, and positive meningeal irritation sign. Cerebrospinal fluid examination showed changes in viral encephalitis or meningitis. The general prognosis is good, and individual severe cases can lead to death.
2. After mumps 1 ~ 3 weeks, polyneuritis and myelitis occasionally occur, and the prognosis is good. The swollen parotid gland may compress the facial nerve, resulting in temporary facial paralysis. Sometimes there are imbalance, trigeminal neuritis, hemiplegia, paraplegia, ascending paralysis and so on. Occasionally, hydrocephalus is caused by aqueduct stenosis after meningoencephalitis.
3. Deafness is manifested as vomiting, dizziness, tinnitus and other symptoms, mainly caused by endolymphatic labyrinthitis and auditory neuritis. Although the incidence rate is very low (about115000), it can become permanent complete deafness. Fortunately, it mostly happens on one side (75%), so I can still keep some hearing.
(4) About 4 ~ 5% of patients with myocarditis have myocarditis, which is more common in the course of 5 ~ 10 days. It is characterized by pale face, increased or decreased heart rate, dim heart sound, arrhythmia and temporary enlargement of the heart. Systolic murmur. Electrocardiogram showed sinus arrest, atrioventricular block, st segment depression, low T wave or inversion. In severe cases, it can be fatal. But most of them only have ECG changes without obvious clinical symptoms. Occasionally there is pericarditis.
(5) Mumps virus can be isolated from urine at the early stage of nephritis, so it is considered that mumps virus can directly damage the kidney, and there is a small amount of protein in urine. Severe cases have the same manifestations as acute glomerulonephritis, and some severe cases may die of acute renal failure. But most of them have good prognosis.
(6) Others account for about 5 ~ 10%, such as mastitis, osteomyelitis, hepatitis, pneumonia, prostatitis, bartholinitis, thyroiditis, thymitis, thrombocytopenia, urticaria, dacryocystitis and acute herpetic conjunctivitis. Arthritis mostly occurs in parotid gland enlargement 1 ~ 2 weeks, mainly involving elbow, knee and other big joints, which can last for 2 days to 3 months and can be completely recovered.
[diagnosis]
(1) The clinical diagnosis is not difficult according to the epidemic situation, contact history and the characteristics of parotid swelling and pain during typical acute attack. For atypical suspicious cases, further diagnosis can be made by the following laboratory examination methods.
(2) Laboratory diagnosis For cases without parotid gland enlargement or recurrence and atypical suspicious cases, the diagnosis depends on serological and virological methods.
1. Complement fixation test can be diagnosed when the titer of two sera reaches 4 times or more, or the titer of one serum reaches 1: 64, which is of diagnostic significance. When necessary, S antibody and V antibody can be determined simultaneously. An increase in S antibody indicates a recent infection, and an increase in V antibody but no increase in S antibody indicates a previous infection.
2. In the recovery period of hemagglutination inhibition test, the patient's serum can inhibit the agglutination of mumps virus to chicken red blood cells, but the inhibitory effect of early serum is weak. If the inhibitory titer is increased by more than 4 times, it will be positive.
3. When it is necessary to isolate the virus, the saliva, blood, cerebrospinal fluid or urine of the patient can be inoculated into the culture tube of human embryonic kidney or monkey kidney cells for identification. Because the program is complicated, it is rarely used.
[Differential diagnosis]
(a) suppurative parotitis is often unilateral, with obvious local redness and tenderness, limited mass and a sense of fluctuation in the late stage. The parotid gland is red and swollen, and pus can be squeezed out. Purulent bacteria can be found in secretion smear and culture. The total number of white blood cells and neutrophils in hemogram increased significantly.
(2) Lymphadenitis in the neck and preauricular region is not centered on the earlobe, but confined to the neck or preauricular region. Nucleosomes are hard, with clear edges, obvious tenderness and superficial mobility. Inflammation, such as angina pectoris and ear furuncle, can be found in lymph node-related tissues in the neck or preauricular area. The total number of white blood cells and neutrophils increased significantly.
(3) Symptomatic parotid gland enlargement In diabetes, malnutrition and chronic liver disease, some drugs such as iodide, oxybutazone and isoproterenol can cause parotid gland enlargement. It is characterized by symmetry, no swelling and pain, soft touch, and no fatty degeneration in tissue examination.
(4) Mumps caused by other viruses, such as herpes simplex virus, parainfluenza virus type 3, coxsackievirus A and B, influenza A virus, etc., can all cause mumps. The diagnosis needs the help of serological examination and virological separation.
[therapy]
There is no specific medicine for mumps, and general antibiotics and sulfonamides are ineffective. Drink plenty of water, eat enough, stay in bed and take aspirin to control infection. You can try interferon, which is effective for the virus. The symptoms are often treated by combining traditional Chinese and western medicine.
(a) general nursing isolation patients stay in bed until the parotid gland swelling completely subsided. Pay attention to oral hygiene. It is advisable to eat liquid or soft food and avoid acidic food to ensure liquid intake.
(2) Symptomatic treatment should dispel wind and relieve exterior syndrome, and clear away heat and toxic materials. Decocting Radix Isatidis with 60-90g water or Radix Isatidis with 15g water; Topical use can be made of purple gold ingot or indigo powder with vinegar, several times a day; Or use Bo Gongying; The application of Commelina communis, Narcissus root and Portulaca oleracea can relieve local swelling and pain. If necessary, take painkillers, aspirin and other antipyretic and analgesic drugs orally.
When severe meningoencephalitis, severe orchitis and myocarditis are complicated, adrenocortical hormone can be used for a short time. For example, hydrocortisone, 200 ~ 300mg/ day for adults, or prednisone, 40 ~ 60mg/ day for 3 ~ 5 consecutive days, and children should reduce the dosage as appropriate.
Treatment of orchitis: Adult patients are treated with diethylstilbestrol at the initial stage of onset, with a dose of 1mg each time, three times a day, which has the effect of relieving swelling and pain.
Meningeal encephalitis can be treated according to Japanese encephalitis therapy. When high fever, headache and vomiting occur, appropriate diuretics are given to dehydrate.
Treatment of pancreatitis: diet, infusion, repeated injection of atropine or anisodamine, early application of corticosteroids.
[Prognosis]
No re-infection, lifelong immunity after illness.
[prevention]
(1) Management of the source of infection Isolate patients at an early stage until the parotid gland swelling completely subsides. Contacts are generally not necessarily isolated, but they should be kept in collective children's institutions and troops for three weeks, and those who are suspicious should be temporarily isolated immediately.
(2) Passive immunization with general immunoglobulin, adult blood or placental globulin has no preventive effect on this disease. The blood and immunoglobulin or specific high-valent immunoglobulin of convalescent patients can play a certain role, but the source is difficult and it is not easy to popularize.
(3) Active live attenuated mumps vaccine has a good immune effect. The immunization route is intradermal injection and subcutaneous injection, and nasal spray or atomized inhalation can also be used. The vaccine cannot be used for pregnant women, people with congenital or acquired immunodeficiency and people who are allergic to egg white. In recent years, it has been reported abroad that the incidence of mumps has obviously decreased after the use of mumps vaccines (measles, mumps and rubella vaccines), but the mumps virus infection caused by vaccines should be highly valued.
There is a preventive vaccine. 12- 15 months old measles, mumps and rubella vaccines include mumps vaccine.
The best prevention is vaccination at an appropriate age. Whether pregnant women and people with egg allergy can be vaccinated is up to the doctor.
(4) Drug prevention: decoct Radix Isatidis 30g or Flos Lonicerae 9g, daily 1 dose for 6 days.
2.
This is a single and compound drug.
1. Prunella vulgaris 30g, decocted in place of tea.
2. Boil 30g of honeysuckle and 30g of isatis root in water. 1 dose 3-4 days a day.
3. Dandelion and Viola each 30g, decocted in water. 1 dose 3-4 days a day.
4. 50 grams of gypsum, 65438 00 grams of Scutellaria baicalensis Georgi, 65438 00 grams of Fructus Forsythiae and 65438 00 grams of Prunella vulgaris, decocted in water. Daily 1 dose, 3-4 times in a row.
The above four directions are used for mild parotitis.
5. Cormorant prescription: 6 grams of Bupleurum, 6 grams of Rhizoma Osmundae, 3 grams of Radix Puerariae, 3 grams of bamboo shavings, 3 grams of Pinellia Fermentata, 2. 1 g of Rhizoma Coptidis, 2. 1 g of Fructus Aurantii, and 0. 2 grams of Glycyrrhiza uralensis Fisch. 1.2 g of decoction, daily. It is suitable for mumps with swollen cheeks, nausea and fever, upset in the afternoon, bitter taste, sleepless nights and heavy pulse.
6. Indigo decoction: Indigo 1.5g, licorice 6g, honeysuckle 15g, Fructus Trichosanthis 1/2, 50ml of wine, decocted in water and taken warm, daily 1 dose. Suitable for puffiness and swelling of cheeks.
This is a cure for mumps.
Therapeutic prescription: the main therapeutic methods are clearing away heat and toxic materials, reducing swelling and resolving hard mass. It is advisable to treat both inside and outside. 1, internal treatment: Yinqiao powder is used for mild symptoms. Flos Lonicerae, Fructus Forsythiae, Herba Schizonepetae, Herba Menthae, Radix Platycodi, Oxalis, Radix Isatidis, Radix Bupleuri, Prunellae Spica, Bombyx Batryticatus, Radix Glycyrrhizae, etc. Jiawei Puji Disinfection Drink in Treating Severe Diseases. Flos Lonicerae, Fructus Forsythiae, Radix Isatidis, Scutellariae Radix, Radix Scrophulariae, Cimicifugae Rhizoma, Bombyx Batryticatus, puffball, seaweed, Fritillaria thunbergii, Bupleuri Radix, etc. If the condition is serious and there are complications such as coma, convulsion or testicular swelling and pain, it is appropriate to be hospitalized. 2, external treatment: (1) a fresh cactus, deburring, slicing or mashing, external application to the affected area, air drying and immediate replacement, use for many days; (2) Realgar 10, Indigo Naturalis 15, Natrii Sulfas 15, Borneolum Syntheticum 2, and * * * * are ground into powder, mixed with wine and vinegar to make paste, externally applied to the affected part, and replaced after drying and healing (choose one of the above two parties).
Preventive nursing: 1, patients should be treated in isolation until 3-5 days after complete recovery; 2. Stay in bed during the onset, eat liquid or semi-liquid food, drink plenty of water, and avoid greasy, spicy and indigestible food; 3, keep your mouth clean, you can rinse your mouth with light tea, light salt water or honeysuckle licorice water; 4. During the epidemic period, susceptible children with contact history should take honeysuckle 15, Radix Isatidis 15 and Radix Glycyrrhizae 5 in water as tea, or take Radix Isatidis granules 1 bag each time for 3-5 days to prevent infection.