Facial Swelling

1/ Hey #IDFellows and #IDTwitter! Here is some #IDBoards review: 19M p/w fever, ear pain and right facial swelling x 3 days. VS: T 100.4F; HR 101; BP NL; RR 17. Exam demonstrates right facial swelling with tenderness on palpation. No adenopathy. Dentition and ear exam WNL.

2/ Lives in Midwest; attended local wedding three weeks ago – no other travel. No recent outdoor exposure or tick bites. No PMH. Up to date on all vaccinations. Labs demonstrate mild leukopenia with elevated lymphocytes. Which of the following is the most appropriate therapy?

3/ This is a case of #Mumps! Mumps is a viral disease that affects young children and adolescents. It causes inflammation of glandular tissue, particularly the salivary (parotid) glands. However, it can also result in orchitis, pancreatitis and meningitis.

4/ The Mumps virus is a member of the Paramyxoviridae family. It is an enveloped particle with external glycoproteins possessing hemagglutinin, neuraminidase and cell fusion proteins. It has a single, linear RNA genome. Source:

https://phil.cdc.gov/details.aspx?pid=8758

5/ Transmission is via resp droplets, contact with saliva or fomites. The incubation can range from 12-25 days with a median around 2.5 wks. It is highly contagious with virus being isolated in saliva prior to onset of symptoms. How long should this patient isolate?

6/ Mumps is very contagious with the highest rates of virus shedding occurring just prior to the onset of symptoms. Current best practices suggest droplet precautions should continue for 5 days after parotitis onset. PMID: 20455692 PMID: 18846033

7/ Treatment of mumps is symptomatic care and can include NSAIDs, acetaminophen, and warm compress. Unfortunately, there are no antiviral treatments at this time. Diagnosis is via serology for IgM antibodies or RT-PCR of serum or buccal swab.

8/ Mumps virus is prevented with the MMR vaccine which includes a live-attenuated virus. In 1967 the US started a vaccination program which decreased the case incidence by > 99%. However, there have been increasing outbreaks in the US.

https://www.cdc.gov/mumps/outbreaks.html

9/ Interestingly, there have been documented outbreaks among immunized individuals. A recently described outbreak occurred in 62 people after an outbreak related to a wedding – 41 of which had received ≥2 doses of MMR vaccine

http://dx.doi.org/10.15585/mmwr.mm6922a2

10/ Mumps outbreaks (along with influenza and varicella) have also been recently described in US migrant detention centers, where waning adult immunity combined with under-vaccination of immigrant children can promote spread. doi:10.1001/jama.2020.20539

11/ With the recognition of waning immunity and rising case outbreaks, it is now recommended by ACIP that in outbreak situations a third, booster dose of the MMR vaccine be given to those at risk. http://dx.doi.org/10.15585/mmwr.mm6701a7; doi: 10.1056/NEJMoa1703309

12/ Thanks for joining in! Feedback about content is always welcome. This was more of board review and we plan to mix this with learning from real cases. #IDFellows #IDTwitter #MedEd #IDBoards
P.S. Bonus points if you know who the image source is

@WuidQ @BIDMC_IDFellows @Tufs_ID @IUIDfellowship @UAB_ID @YaleIDFellows @ID_MUSC @TempleID1 @VUMC_IC @MayoClinicINFD @mgh_id @UCLA_ID @MontefioreID @UNMC_ID @UVA_ID @OhioState_ID @UTSWInfDis @BrownIDprogram @RushCCH_ID @OHSU_ID

@TAEscmid @BCMIDFellowship @BCMPedIDFellows @DartmouthID

Originally tweeted by Infectious Diseases Fellows Network (@ID_fellows) on 13 November, 2020.

Leave a Reply