The Physician's Guide to Laboratory Test Selection and InterpretationMumps Virus
Diagnosis
Indications for Testing
- Atypical presentation of secondary complications from suspected mumps
- Epidemiologic evidence during suspected outbreak
Laboratory Testing
- Limited role for laboratory testing – usually a clinical diagnosis
- CDC mumps laboratory testing recommendations
- Serology
- Paired serology collected as soon as diagnosis suspected
- IgM antibody response normally appears 7-14 days after disease onset
- IgM antibody response may be delayed or absent in previously vaccinated patients and the period of viral excretion may be shorter
- IgG assays associated with cross-reactions
- Cross reactivity can occur with parainfluenza 1 and 3, Epstein-Barr virus, adenovirus, and herpesvirus 6
- IgG antibody levels induced by vaccine are lower than those from natural infection
- Laboratory confirmation of mumps serology (CDC)
- Culture – saliva, buccal swab, throat, urine, or cerebrospinal fluid
- RT-PCR – buccal or oral swab
- Serology
Differential Diagnosis
- Viral
- Parainfluenza virus – types 1, 2, 3
- Influenza virus– type A
- Coxsackievirus
- Epstein-Barr virus
- Adenovirus
- Herpesvirus 6
- HIV
- Bacterial parotitis – unilateral
- Parotid gland neoplasm – unilateral
- Salivary stones – unilateral
- Metabolic disorders
- Sjögren syndrome
Clinical Background
Mumps is an acute, contagious disease of short duration, usually self-limiting, and characterized by swelling of the parotid gland.
Epidemiology
- Prevalence – multiple outbreaks since 2003, each involving >1,000 people
- Age – highest incidence at 16-24 years
- Transmission
- Highly contagious and transmitted by droplets spread from the upper respiratory tract
Organism
- Paramyxoviridae family; Rubulavirus genus
- Single-stranded RNA virus
- Immunity after infection appears to be lifelong
- Silent reinfection occurs infrequently
Clinical Presentation
- Incubation period – 18-21 days
- 25-30% of all infections are silent
- Most common clinical feature is bilateral or unilateral parotitis (60-70% of infections)
- Secondary complications can involve the following
- Testes (orchitis)
- Orchitis, particularly in teenagers, can lead to decreased fertility or infertility
- Ovaries (oophoritis)
- Central nervous system – aseptic meningitis, encephalitis
- Rare – pancreatitis, peripheral neuritis, uveitis, otitis, myocarditis
- Testes (orchitis)
Treatment
- Supportive
Prevention
- Vaccination with MMR vaccine (75-90% effective)
- Mumps is uncommon in the U.S.; secondary to current vaccination programs
- Administer vaccine to infants (age 12-15 months) with revaccination during childhood (age 4-12 years)
- Since vaccine is live, attenuated virus, vaccination is not recommended for patients who are
- Significantly immunosuppressed (eg, HIV, cancer, chronic corticosteroid therapy)
- Allergic to gelatin (component of the vaccine)
- Pregnant
Indications for Laboratory Testing
- Tests generally appear in the order most useful for common clinical situations
- Click on number for test-specific information in the ARUP Laboratory Test Directory
| Test Name and Number | Recommended Use | Limitations | Follow Up |
|---|---|---|---|
| Mumps Virus Antibody, IgM 0099589 Method: Semi-Quantitative Enzyme-Linked Immunosorbent Assay |
Confirm acute infection |
IgM and IgG testing best performed with paired specimens Testing immediately post-exposure is of no value without a later convalescent specimen |
If equivocal, repeat testing in 10-14 days may be helpful |
| Mumps Virus Antibody, IgG 0050390 Method: Semi-Quantitative Chemiluminescent Immunoassay |
Determine patient's immune status to mumps |
IgM and IgG testing best performed with paired specimens |
If equivocal, repeat testing in 10-14 days may be helpful |
| Mumps Virus Culture 0065056 Method: Cell Culture/Immunofluorescence |
Confirm mumps infection Collect during first 3 days of illness; if collecting urine, collect first morning void |
Click the plus sign to expand the table of additional tests.
| Test Name and Number | Comments |
|---|---|
| Mumps Virus Antibody IgM, CSF 0054443 Method: Semi-Quantitative Enzyme-Linked Immunosorbent Assay |
Confirm mumps as the etiology of meningoencephalitis |
| Mumps Virus Antibody IgG, CSF 0054442 Method: Semi-Quantitative Chemiluminescent Immunoassay |
Confirm previous episode of mumps meningoencephalitis |
| Encephalitis Panel, CSF with Reflex to HSV Type 1 and 2 Glycoprotein G-Specific Ab, IgG 2001741 Method: Semi-Quantitative Enzyme-Linked Immunosorbent Assay/Semi-Quantitative Indirect Fluorescent Antibody Semi-Quantitative Chemiluminescent Immunoassay |
|
| Encephalitis Panel, Serum with Reflex to HSV Type 1 and Type 2 Glycoprotein G-Specific Ab, IgG 2001742 Method: Semi-Quantitative Enzyme-Linked Immunosorbent Assay/Semi-Quantitative Indirect Fluorescent Antibody/Semi-Quantitative Chemiluminescent Immunoassay |
|
| Meningoencephalitis Panel, CSF with Reflex to HSV Type 1 and Type 2 Glycoprotein G-Specific Ab, IgG 2001765 Method: Semi-Quantitative Enzyme-Linked Immunosorbent Assay/Semi-Quantitative Indirect Fluorescent Antibody/Semi-Quantitative Chemiluminescent Immunoassay |
|
| Meningoencephalitis Panel, Serum with Reflex to HSV Type 1 and Type 2 Glycoprotein G-Specific Ab, IgG 2001764 Method: Semi-Quantitative Enzyme-Linked Immunosorbent Assay/Semi-Quantitative Indirect Fluorescent Antibody/Semi-Quantitative Chemiluminescent Immunoassay |
|
| Viral Culture, Respiratory 2006499 Method: Cell Culture |
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