Epidemic parotitis (mumps) has no generally accepted classification. This is explained by different interpretations by specialists of the manifestations of the disease. A number of authors believe that the symptoms of mumps are a consequence of the defeat of the salivary glands, and the defeat of the nervous system and other glandular organs as complications or manifestations of the atypical course of the disease.
The position, according to which the lesions not only of the salivary glands but also other localization caused by the mumps virus, are pathogenetically justified as symptoms of mumps and not complications of the disease. Moreover, they can manifest themselves in isolation without lesion of salivary glands. At the same time, lesions of various organs as isolated manifestations of mumps infection are rarely observed (atypical form of the disease). On the other hand, the erased form of the disease, which was diagnosed before the scheduled vaccination, during almost every outbreak in the children's and adolescents' groups and during routine examinations, can not be considered atypical. Asymptomatic infection is not considered as a disease. The classification should also reflect the often unfavorable long-term consequences of mumps. The severity criteria in this table are not included, since they are completely different for different forms of the disease and do not have a nosological specificity. Complications of mumps are rare and do not have any characteristic features, so they are not considered in the classification.
The incubation period of mumps is between 11 and 23 days (usually 18-20). Often the unfolded picture of the disease is preceded by a prodromal period.
In some patients (usually in adults) 1-2 days before the development of a typical picture, prodromal symptoms of mumps are observed in the form of weakness, malaise, hyperemia of the oropharynx, muscle pain, headache, sleep and appetite disorders. Typically acute onset, chills and fever to 39-40 ° C. Early symptoms of mumps (mumps) - tenderness behind the ear lobe (symptom Filatova). The swelling of the parotid gland often appears towards the end of the day or on the second day of the illness first on one side, and after 1-2 days in 80-90% of patients on the other. In this case, usually notice a noise in the ears, pain in the ear, worse with chewing and talking, trismus is possible. The parotid gland is clearly visible. The gland fills a hole between the mastoid process and the lower jaw. With a significant increase in the parotid gland, the auricle protrudes and the earlobe rises to the top (hence the alternative name "mumps"). Edema spreads in three directions: anteriorly - on the cheek, down and behind - on the neck and upwards - on the region of the mastoid process. Puffiness is especially noticeable when examining the patient from the back of the head. The skin above the affected gland is strained, of ordinary color, with palpation of iron has a test consistency, moderately painful. The maximum degree of swelling reaches on the 3-5th day of the disease, then gradually decreases and disappears, as a rule, on the 6-9th day (in adults on the 10-16th day). During this period, salivation is reduced, the mucous membrane of the mouth is dry, the patients complain of thirst. The stenons of the duct are clearly visible on the mucous membrane of the cheek in the form of a hyperemic edematous ring (Mursu symptom). In most cases, not only the parotid but also the submandibular salivary glands are involved in the process, which are defined as weakly painful spindle-like swelling of the test consistency, in case of a hypoglossal lesion, swelling is noted in the chin and under the tongue. The defeat of only submandibular (submaxillitis) or sublingual glands is very rare. Internal organs with isolated parotite, as a rule, are not changed. In a number of cases, patients notice tachycardia, noise at the apex and muffling of heart sounds, hypotension. The defeat of the central nervous system manifests itself as a headache, insomnia, adynamia. The total duration of the febrile period is usually 3-4 days. In severe cases - up to 6-9 days.
A common symptom of mumps (mumps) in adolescents and adults is testicular damage (orchitis). The frequency of mumps orchitis directly depends on the severity of the disease. In severe and moderately severe forms, it occurs in approximately 50% of cases. Possible orchitis without lesion of salivary glands. Signs of orchitis noted on the 5-8th day of the disease against a background of decrease and normalization of temperature. The patient's condition deteriorates again: body temperature rises to 38-39 ° C, chills, headache, nausea and vomiting are possible. There are severe pain in the scrotal and testicles, sometimes radiating to the lower abdomen. The testicle increases 2-3 times (to the size of the goose egg), becomes painful and dense, the skin of the scrotum is hyperemic. Often with a cyanotic shade. More often one egg is affected. Expressed clinical manifestations of orchitis persist for 5-7 days. Then the pain disappears, the testicle gradually decreases in size. In the future, it can be noted signs of its atrophy. Almost 20% of patients have orchitis combined with epididymitis. The adherence of the testicle is palpated as an oblong painful swelling. This condition leads to a violation of spermatogenesis. Data were received on the erased form of orchitis, which can also be the cause of male infertility. In mumps orchitis, a mild infarct is described due to thrombosis of the prostate and pelvic organs. An even more rare complication of parotitic orchitis is priapism. Women can develop oophoritis, bartholinitis, mastitis. It is rarely found in female patients during the post-pubertal period with oophoritis. Not affecting fertility and not leading to sterility. It should be noted that mastitis can develop in men.
A common symptom of mumps is an acute pancreatitis, often asymptomatic and diagnosed only on the basis of increased activity of amylase and diastase in the blood and urine. The frequency of pancreatitis, according to various authors, varies widely - from 2 to 50%. It often develops in children and adolescents. Such a spread of data is associated with the use of various criteria for the diagnosis of pancreatitis. Pancreatitis usually develops on the 4th-7th day of the disease. They observe nausea, repeated vomiting, diarrhea, pains of the shingles in the middle part of the abdomen. With severe pain syndrome, sometimes stress the muscles of the abdomen and symptoms of irritation of the peritoneum. A significant increase in the activity of amylase (diastase) is characteristic. Which lasts up to one month, while other symptoms disappear within 5-10 days. The defeat of the pancreas can lead to atrophy of the islet apparatus and the development of diabetes.
In rare cases, it is possible to damage other glandular organs, usually in combination with salivary glands. Thyroiditis, parathyroiditis, dacryoadenitis, thymoiditis are described.
The defeat of the nervous system is one of the frequent and significant manifestations of parotitis infection. Most often observed serous meningitis. There are also meningoencephalitis, neuritis of the cranial nerves, polyradiculoneuritis. Symptoms of parotid meningitis are polymorphic, so the diagnostic criterion can only be the detection of inflammatory changes in the cerebrospinal fluid.
There are cases of epidemic mumps occurring with the syndrome of meningism, with the intactness of the cerebrospinal fluid. On the contrary, often without the presence of meningeal symptoms, inflammatory changes in the cerebrospinal fluid are noted, so data on the frequency of meningitis, according to various authors, vary from 2-3 to 30%. Meanwhile, timely diagnosis and treatment of meningitis and other CNS lesions significantly affects the long-term consequences of the disease.
Meningitis is more common in children aged 3-10 years. In most cases, it develops on the 4-9th day of the disease, i.e. In the midst of the defeat of the salivary glands or on the background of the subsidence of the disease. However, it is also possible the appearance of symptoms of meningitis simultaneously with the defeat of salivary glands and even earlier. Possible cases of meningitis without lesions of salivary glands, in rare cases, in combination with pancreatitis. The onset of meningitis is characterized by a rapid rise in body temperature to 38-39.5 ° C, accompanied by an intense headache of a diffuse nature, nausea and frequent vomiting, hyperesthesia of the skin. Children become lethargic, adynamic. Already on the first day of the disease, meningeal symptoms of mumps (mumps) are noted, which are moderately expressed, often not in full, for example, only a symptom of planting ("tripod"). In young children, cramps, loss of consciousness, in older children - psychomotor agitation, delirium, hallucinations. General cerebral symptoms usually regress within 1-2 days. Preservation for a longer time indicates the development of encephalitis. An important role in the development of meningeal and cerebral symptoms is played by intracranial hypertension with an increase in LD to 300-600 mm of water. Careful drop by evacuation of the cerebrospinal fluid during lumbar puncture to the normal level of LD (200 mm of water) is accompanied by a marked improvement in the patient's condition (cessation of emesis, clarification of consciousness, decrease in the intensity of the headache).
Spinal-cerebral fluid in mumps is transparent or opalescent, pleocytosis is 200-400 in 1 μl. The protein content is increased to 0.3-0, b / l, sometimes up to 1.0-1.5 / l. Rarely observe a reduced or normal level of protein. Cytosis, as a rule, lymphocytic (90% and above), in the 1-2 days of the disease can be mixed. The concentration of glucose in the blood plasma - within normal values or increased. The recovery of cerebrospinal fluid occurs after the regress of the meningeal syndrome, by the 3rd week of the disease, but can be prolonged, especially in older children, up to 1-1.5 months.
In meningoencephalitis, 2-4 days after the development of the meningitis pattern, on the background of the weakening of meningeal symptoms, general cerebral symptoms develop, focal symptoms appear: the flattening of the nasolabial fold, the deviation of the tongue, the revival of tendon reflexes, anisoreflexia, muscle hypertonia, pyramidal signs, oral automatism symptoms, ataxia, intentional tremor, nystagmus, transient hemiparesis. In young children, cerebellar disorders are possible. Parotite meningitis and meningoencephalitis proceed benignly. As a rule, full recovery of CNS functions occurs. But sometimes intracranial hypertension may persist. Asthenia, loss of memory, attention, hearing.
Against the background of meningitis, meningoencephalitis, sometimes in isolation, neuritis of the cranial nerves, most often of the VIII pair, is possible. In this case, they note dizziness, vomiting, worse when the body position changes, nystagmus. Patients try to lie motionless with their eyes closed. These symptoms are associated with a lesion of the vestibular apparatus, but cochlear neuritis is also possible, which is characterized by the appearance of noise in the ear, hearing loss, mainly in the high frequency zone. The process is usually one-sided, but often complete restoration of hearing does not occur. It should be borne in mind that with a pronounced parotitis, a short-term decrease in hearing is possible due to edema of the external auditory canal.
Polyradiculoneuritis develops against the background of meningitis or meningoencephalitis. It is always preceded by the defeat of the salivary glands. At the same time, the appearance of radicular pain and symmetrical paresis of predominantly distal parts of the extremities is typical, the process is usually reversible, and possibly the defeat of the respiratory muscles.
Sometimes, usually on the 10-14th day of the disease, more often in men, polyarthritis develops. In general, large joints (humeral, knee) are affected. Symptoms of mumps (mumps), as a rule, are reversible, result in complete recovery within 1-2 weeks.
Complications (sore throat, otitis, laryngitis, nephritis, myocarditis) are extremely rare. Changes in blood during epidemic parotitis are insignificant and characterized by leukopenia, relative lymphocytosis, monocytosis. An increase in ESR, in adults sometimes marked with leukocytosis.