MUMPS AND MALE INFERTILITY
By Chinelo Mbamalu
Mumps a self-limiting viral illness can be cause of male sterility, a little more than half of all men who develop mumps-related orchitis detect some shrinkage of their testicles, and about one out of every ten men has their sperm count drop (the amount of healthy sperm their body can produce).
WHAT ARE MUMPS?
Mumps (Parotitis) is a systemic viral infectious virus that was once a common pediatric illness. The prevalence of mumps in the population has fallen significantly since universal vaccination was implemented. Headache, fever, lethargy, anorexia, and malaise are common symptoms of mumps infection, which are followed by parotitis (swelling of one or both salivary glands) is the disease’s defining symptom. More frequently than not, the sickness is self-limiting, and patients recover completely. Mumps (Parotitis) is a systemic viral infection which is usually self-limiting and primarily affects. Mumps is a contagious disease and has an incubation period of 14 to 18 days from exposure to onset of symptoms and 7 to 10 days for the duration of the disease. It is vaccine-preventable and can only be transmitted and affected by humans. In Nigeria there are fewer than 10 thousand cases yearly.
ETIOLOGY
Mumps is a paramyxovirus with a single-stranded RNA genome. The mumps virus is known to have only one serotype. The ribonucleocapsid is formed when nucleoprotein, phosphoprotein, and polymerase work together with genomic RNA to replicate the virus. The ribonucleocapsid is surrounded by a lipid bilayer produced from the host. Viral neuraminidase and fusion proteins are found within this lipid bilayer, allowing the virus to bind to cells and enter them. Virus-neutralizing antibodies are drawn to these fusion complexes. The virus is a stable virus that does not combine.. It is transmitted through person to person direct contact via the respiratory tract to the salivary glands where it reproduces.
PATHOPHYSIOLOGY
The only natural hosts for viral mumps are humans. The virus has a seven to twenty-one day incubation period. Individuals are most contagious 1 to 2 days before the beginning of symptoms. Primary replication takes place in the mucosal epithelium of the upper airway. Viremia is caused by the infection of mononuclear cells in regional lymph nodes, which causes systemic inflammation in the salivary glands, testes, ovaries, pancreas, mammary glands, and central nervous system (CNS)
MODE OF TRANSMISSION
● Kissing an infected person
● Sneezing/coughing
● Sharing cutleries with an infected person
● Sharing foods and drinks
RISK FACTORS
● Lack of immunization
● International travel
● Age (kids between 2 to 12)
● Seasons (winter, spring)
● Immune deficiencies increase the risk of infection by the mumps virus.
SYMPTOMS
At the onset
● Low-grade fever
● Headache
● Muscle aches,
● Decreased appetite.
After a few days
● Swollen parotid gland
● Ear ache
● Pain with pressure
● Pain while swallowing
● Trouble chewing
● High-grade fever
● Dry mouth
● Joint pain
DIAGNOSIS AND TESTS
It can be usually diagnosed based on swollen salivary glands. Other tests include
● Lab tests — sample of blood, urine or saliva is taken to confirm the diagnosis
● Check for tonsil position — tonsils can be pushed aside when infected
● A buccal swab specimen collected <3 days after parotitis onset is the preferred specimen to confirm mumps infection.
● Sample of cerebrospinal fluid (CSF) is taken only in severe cases
● Mumps infection can be confirmed by a positive mumps-specific immunoglobulin M (IgM) titer or by demonstration of a significant rise in mumps-specific immunoglobulin G (IgG) antibody titers between acute and convalescent sera specimens.
TREATMENT
It is a viral disease so it can’t be treated with antibiotics and no antiviral medications have been proven to be effective against it.
Without complications, It is generally a self-limiting disease that produces lifelong immunity. It can be managed by:
● Analgesics are prescribed to ease the pain
● Warm or cold compress to ease the swollen gland.
● Plenty of fluids — water and not fruit juices as these can stimulate saliva production which could be painful.
● Eating soft and liquid foods since chewing can be painful
● Gargling warm saltwater
In most cases, people begin to recover in 2 weeks.
COMPLICATIONS
Complications are more frequent in adults than children, the most common are:
● Orchitis — testicles swell and become painful, this happens to 1 in 5 adult males with mumps. The swelling normally goes down within 1 week; tenderness can last longer than that. This rarely results in infertility.
● Oophoritis — ovaries swell and are painful; it occurs in 1 in 20 adult females. The swelling will subside as the immune system fights off the virus. This rarely results in infertility.
● Viral meningitis — this is one of the rarest common complications. It happens when the virus spreads through the bloodstream and infects the body’s central nervous system (brain and spinal cord).
● Inflamed pancreas (pancreatitis) — the pain will be experienced in the upper abdomen; this occurs in 1 out of 20 cases and is usually mild.
If a pregnant woman contracts mumps in the first 12–16 weeks of her pregnancy, she will have a slightly increased risk of miscarriage.
Rarer complications of mumps include:
● Encephalitis — the brain swells causing neurological issues. In some cases, this can be fatal. This is a very rare risk factor and affects just 1 in 6,000 cases.
● Hearing loss — this is the rarest of all the complications affecting just 1 in 15,000.
● Transverse myelitis
● Polyneuritis
● Guillain-Barré syndrome
● Cerebellar ataxia (with encephalitis)
● Keratouveitis
● Thyroiditis
● Myocarditis
● Mastitis
● Pneumonia
● Nephritis
● Arthritis
● Thrombocytopenia purpura
PREVENTION
● Vaccination- there are 2 forms of the mumps vaccination MMR (measles, mumps and rubella ) and MMRV (measles, mumps, rubella and varicella) vaccines. It is given in two doses, the first at <1 year and the second as a booster dose at 4 years. It can also be given to adults who aren’t pregnant, immunocompromised or allergic to neomycin.
Most people experience no side effects and less than 1 million people have an allergic reaction to the vaccine. Rare side effects include rashes, fever and joint ache. The disease can’t be contracted from the vaccine.
● If infected with the disease, avoid crowded places.
● Wash hands thoroughly
● Cover nose and mouth when. sneezing/coughing
The goal is to maintain a high immunization rate, especially among young infants and children.
REFERENCES
John Mersch, MD, FAAP; How to Cure Mumps: Vaccine, Symptoms, Causes, Contagious & in Adults MedicineNet (2021) https://www.medicinenet.com/mumps/article.htm
MedicalNewsToday (December 14, 2017) Mumps: Symptoms, causes, and treatment https://www.medicalnewstoday.com/articles/224382
Germaine L Defendi, MD, MS, FAAP ; Mumps: Practice Essentials, Etiology, Epidemiology Medscape (2017) https://reference.medscape.com/article/966678-overview
CDC; Mumps | Laboratory Testing for Mumps Infection | CDC (2021)
