You mean mumps? There are many clinical types, acute suppurative parotitis and sudden onset. Most patients have systemic symptoms, such as high fever, chills, general malaise and leukocytosis. Due to the exhaustion of physical conditions, the above systemic reactions may not be obvious in a few patients. Acute suppurative parotitis mostly occurs on one side. The parotid gland of the affected side is obviously red and swollen, the mandibular retrofovea disappears and the earlobe is upturned. Because the parotid gland capsule is dense, the swelling is suppressed, the internal pressure is increased, the pain is severe and the tenderness is obvious. There are different degrees of mouth opening restrictions. The opening of parotid duct on the affected side is red and swollen, and purulent secretion is discharged. Abscess is often multiple and scattered small pus foci due to fascia separation. Mumps is a common disease in children and an infectious disease caused by viruses. More common in children, with a history of contact infection, often bilateral. There is no purulent secretion at the opening of parotid duct. The total number of white blood cells is not high, and the proportion of lymphocytes in classification increases. I suggest you go to the clinic as soon as possible!
[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.
[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. orchitis
The incidence rate 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. Ovarian inflammation
The incidence rate is 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) pancreatitis
The incidence rate 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. Meningitis or meningoencephalitis
The incidence rate 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. Polyneuritis and myelitis
Mumps that occasionally occur after 1 ~ 3 weeks have a good prognosis. 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.
become deaf
Vomiting, dizziness and tinnitus are mainly caused by endolymphatic labyrinthitis and acoustic 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) Myocarditis
About 4 ~ 5% patients 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) nephritis
Mumps virus can be isolated from early urine, 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 performance as acute glomerulonephritis, and some severe cases may die of acute renal failure. But most of them have good prognosis.
(6) Others
About 5 ~ 10%, such as mastitis, osteomyelitis, hepatitis, pneumonia, prostatitis, vestibular adenitis, thyroiditis, thymitis, thrombocytopenia, urticaria, dacryocystitis, acute herpetic conjunctivitis, etc. 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.
[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
It is advisable to dispel wind and relieve exterior syndrome, and clear away heat and toxic materials. Decocting Radix Isatidis with 60-90g water or Yinqiao Powder with 15g water; Topical use can be made of purple gold ingot or indigo powder with vinegar, several times a day; Or use dandelion,; Patching 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.
note:
Mumps virus invades reproductive organs through blood circulation, which can cause male orchitis and female oophoritis, both of which will have harmful effects on future reproductive function.
According to statistics, about 20% of mumps patients aged 12 ~ 18 are complicated with orchitis. Once orchitis occurs, it can cause high fever, chills, testicular swelling, swelling and pain, accompanied by severe tenderness. Except testicular swelling, scrotal skin edema and hydrocele, about one third of patients have testicular atrophy. If only one testicle is affected, it will lead to oligozoospermia. If bilateral testicles are involved, azoospermia can be caused. Recently, some scholars have pointed out that the male infertility caused by mumps is not that the testis loses the ability to produce sperm, but that the sperm produced is killed by autoantibodies, which is called autoimmune infertility.
When girls are complicated with ovarian inflammation, they may have abdominal pain, low back pain and other symptoms, which may also lead to infertility. There are 5 ~ 7% adult female mumps patients complicated with oophoritis, which causes menstrual disorder and premature amenorrhea. Many infertile women, after examination, found ovarian dysfunction, unable to ovulate normally, and some of them also suffered from mumps.
Men and women in adolescence, if they suffer from mumps, complicated with orchitis or oophoritis, will have a great influence on their reproductive function in the future. Therefore, after suffering from mumps in adolescence, more attention should be paid to preventing orchitis or oophoritis.
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