When discussing the differntial diagnosis of meningitis you must always consider entities other than bacterial. Please see below for a review of a more unusual cause of meningitis: MUMPS.Mumps is a single stranded RNA virus which is a member of the paramyxovirus genus. The incidence of Mumps infection has dramatically reduced since the introduction of the live attenuated vaccine in 1967. Despite this, there continue to be sporadic outbreaks.
The transmission of the virus is viral respiratory droplet, direct contact and fomites. The incubation period is 14-18 days from exposure to onset of symptoms. The peak of contagion is just before the onset of parotitis.
Clinical features of mumps include a non-specific viral prodrome of low grade fever, malaise, headache, myalgias and anorexia. Within 48 hours the onset of the classic parotitis begins. This is present in 95% of cases due to direct infection of ductal epithelium. The swelling can last up to 10 days.
Complications:
Some of the more serious complications of mumps include meningitis, encephalitis, orchitis. The orchitis is the most common complication in adult men appearing in close to 1/3 of cases. Symptoms include testicular pain, swelling, erythma of the scrotum. Oophoritis occurs in approximately 7% of post-pubertal females.
Aseptic meningitis is the most frequent extrasalivary complication. An assymptomatic pleocytosis can be seen in >50% of patients with clinical mumps. Clinical aseptic meningitis is seen in 4-6% of patients. This most frequently manifests as headache, low grade fever and nuchal rigidity. CSF has 10-2000 WBC (mostly lymphocytes), elevated total protein and mildly depressed glucose.
Other complications include encephalitis, deafness, GBS, transverse myelitis and facial palsy. Less frequent complications include thyroiditis, myocardial involvement, pancreatitis, interstitial nephritis and arthritis.
Some of the more serious complications of mumps include meningitis, encephalitis, orchitis. The orchitis is the most common complication in adult men appearing in close to 1/3 of cases. Symptoms include testicular pain, swelling, erythma of the scrotum. Oophoritis occurs in approximately 7% of post-pubertal females.
Aseptic meningitis is the most frequent extrasalivary complication. An assymptomatic pleocytosis can be seen in >50% of patients with clinical mumps. Clinical aseptic meningitis is seen in 4-6% of patients. This most frequently manifests as headache, low grade fever and nuchal rigidity. CSF has 10-2000 WBC (mostly lymphocytes), elevated total protein and mildly depressed glucose.
Other complications include encephalitis, deafness, GBS, transverse myelitis and facial palsy. Less frequent complications include thyroiditis, myocardial involvement, pancreatitis, interstitial nephritis and arthritis.
Diagnosis can be made on the classic presentation of parotitis. Other pertinent tests include leucopenia, relative lymphocytosis and serum amylase elevation. Specific testing for mumps include IgM mumps, significant rise in IgG titres, isolation of mumps virus. PC of affected fluid (e.g. CSF) is also an option.
Treatment is symptomatic.
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