Complications
The most common complication of mumps infection in the adult male, occurring in up to 38% of infected post-pubertal males. Of these cases, 15% to 30% are bilateral. Symptoms include fever, severe testicular pain and swelling, and erythema of the scrotum. The mumps virus can damage testicular tissue, causing parenchymal oedema, congestion of the seminiferous tubules, and perivascular infiltration of lymphocytes.[49] Testicular atrophy later develops in half of affected men, and decreased sperm count or abnormal sperm morphology arises in 25% of patients. Sterility after mumps is rare.[2][49] There is no evidence for an association between mumps orchitis and testicular cancer.[2]
Conservative management includes bed rest, fluids, and scrotal elevation. Surgical interventions aimed at reducing intra-testicular pressure are rarely, if ever, recommended. Many authors advocate the use of broad-spectrum antibiotics in people with epididymo-orchitis when a bacterial cause cannot be excluded.
The subcutaneous administration of interferon alfa-2b has also been studied in the treatment of mumps orchitis. In a study of 21 patients with mumps orchitis, those treated with interferon alfa-2b had quicker resolution of symptoms (2-3 days versus 4-5 days with conservative management) and no testicular atrophy (versus 3 patients with atrophy in the conservative group).[49]
Mumps aseptic meningitis is usually benign, and almost all patients have complete recovery with no residual neurological deficits and no risk of mortality. Symptoms include neck stiffness, photophobia, and vomiting. Patients require supportive care with adequate analgesia/antipyretics, antiemetics if vomiting, and IV fluids if volume-depleted. Reported rates vary widely depending on assessment. Where CSF is routinely examined with lumbar puncture, the reported rate is over 50%; however the rate of clinical meningitis is between 1% and 10%.[2]
Occurs in approximately 5% of post-pubertal females. Infertility and premature menopause have been reported but are rare complications.[2] Oophoritis manifests as fever with loin, abdominal, or back pain.
Occurs in approximately 0.1% to 0.5% of people with mumps.[2][43] The presence of seizures, decreased level of consciousness, and focal neurological symptoms indicates mumps encephalitis. Abnormalities in EEG can also be seen and usually resolve in a few weeks. Mortality is 1% to 5% and long-term morbidity is rare.[2]
Mumps encephalitis is a medical emergency. Management consists of basic resuscitation measures ensuring adequacy of the airway, breathing, and circulation, and empirical antiviral therapy for other possible viral causes of encephalitis concurrently with diagnostic steps (most importantly aciclovir if HSV infection is suspected). Intravenous immunoglobulin does not have established efficacy as a mumps treatment. However, it has demonstrated efficacy in the treatment of mumps symptoms that are autoimmune-based, such as encephalitis.[2]
Occurs in 4% of mumps infections and usually has a very mild course.[2] Severe haemorrhagic pancreatitis and pseudocyst formation are rare. Mumps pancreatitis has been reported in both children and adults. The majority of patients with acute pancreatitis will improve within 3-7 days of conservative management.[52]
ECG changes, including ST segment depression, T wave inversion, and prolonged PR intervals, are seen in 15% of mumps infections.[53] Cases of fatal myocarditis with dilated cardiomyopathy have been reported but are extremely rare.
Can be mono-articular large joint involvement (knee or hip) or a migratory polyarticular involvement.[2] There has been no documented residual joint damage.
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