What is parotitis

Parotitis is an inflammation or infection of the parotid salivary glands. Of all the salivary glands, the parotid gland is most commonly affected by an inflammatory or infectious process. Infections of the parotid gland range from acute to severe parotitis. Viral parotitis can be caused by mumps virus (a paramyxovirus, a member of the Rubulavirus family), Epstein-Barr virus, coxsackievirus, and influenza A and parainfluenza viruses. Acute bacterial suppurative parotitis is generally caused by Staphylococcus aureus, Streptococcus species, and rarely, gram-negative bacteria. Anaerobic bacteria, mostly Peptostreptococcus species and Bacteroides species, and pigmented Porphyromonas species and Prevotella species have been recently recognized as an important cause bacterial parotitis. Beta-lactamase-producing organisms can be isolated in almost three fourths of the patients. Predisposing factors to suppurative bacterial suppurative parotitis are dehydration, malnutrition, oral cancers, immunosuppression, salivary stones (sialolithiasis) and medications that diminish salivation. Pus, aspirated from a suppurative parotic abscess, should be plated on media that are supportive for the growth of aerobic and anaerobic bacteria, mycobacteria, and fungi. Early and proper antimicrobial therapy may prevent abscess formation. Initial empiric therapy that is directed against both aerobic and anaerobic bacteria may be required until a specific causal diagnosis is available. Surgical drainage may be indicated when pus has formed. This may prevent complications and facilitate recovery.

Viral parotitis caused by paramyxovirus (mumps) is a contagious disease that typically starts with a few days of fever, headache, muscle aches, tiredness, and loss of appetite. Then most people will have swelling of their salivary glands. This is what causes the puffy cheeks and a tender, swollen jaw.

Mumps can be serious, but most people with mumps recover completely within two weeks. While infected with mumps, many people feel tired and achy, have a fever, and swollen salivary glands on the side of the face. Others may feel extremely ill and be unable to eat because of jaw pain, and a few will develop serious complications. Men and adolescent boys can develop pain or swelling in their testicles. Women and adolescent girls can develop pain or swelling in their ovaries. Inflammation of the protective membranes covering the brain and spinal cord (meningitis) and loss of hearing can also occur, and in rare cases, this hearing loss can be permanent. The most serious complication is inflammation of the brain (encephalitis), which can lead to death or permanent disability.

Even though the mumps vaccine (measles-mumps-rubella (MMR) vaccine) has drastically reduced mumps cases, outbreaks still occur. From January 1 to April 26, 2019, 41 states and the District of Columbia in the U.S. reported mumps infections in 736 people to the Centers for Disease Control and Prevention (CDC) ¹. Outbreaks have most commonly occurred among groups of people who have prolonged, close contact, such as sharing water bottles or cups, kissing, practicing sports together, or living in close quarters, with a person who has mumps. Some vaccinated people may still get mumps if they are exposed to the virus. However, mumps symptoms are milder in vaccinated people. Make sure you are protected against mumps with measles-mumps-rubella (MMR) vaccine.

There’s no medical cure for mumps, but the measles-mumps-rubella (MMR) vaccine can prevent it. Treatment involves managing symptoms (relieving pain, preventing dehydration, etc.) while the immune system works to clear the infection from the body. Rest as much as possible. Try to ease symptoms with cold compresses and over-the-counter pain relievers such as ibuprofen (Advil, Motrin IB, others) and acetaminophen (Tylenol, others).

When mumps involves the testicles, doctors may prescribe medicines for pain and swelling.

Because mumps is caused by a virus, it cannot be treated with antibiotics.

Bacterial parotitis treatment includes maintenance of hydration and administration of parenteral antimicrobial therapy for acute bacterial suppurative parotitis. Once an abscess has formed surgical drainage is required. The choice of antimicrobial depends on the bacterial agent. Maintenance of good oral hygiene, adequate hydration, and early and proper therapy of bacterial infection of the oropharynx may reduce the occurrence of suppurative parotitis.

Is parotitis contagious?

Yes, the mumps virus is contagious. You can catch mumps virus by being with another person who has it. Mumps virus spreads in tiny drops of fluid from the mouth and nose of someone who is infected through sneezing, coughing, or even laughing.

Mumps virus can also spread through direct contact, such as picking up tissues or drinking from glasses used by an infected person.

People who have mumps are most contagious from 2 days before symptoms begin to 6 days after they end. It can spread from people who are infected but have no symptoms.

Mumps is spreads through direct contact with saliva or respiratory droplets from the mouth, nose, or throat. An infected person can spread the mumps virus by:

• coughing, sneezing, or talking
• sharing items that may have saliva on them, such as water bottles or cups
• participating in close-contact activities with others, such as playing sports, dancing, or kissing
• touching objects or surfaces with unwashed hands that are then touched by others

An infected person can likely spread mumps from a few days before their salivary glands begin to swell to up to five days after the swelling begins. A person with mumps should limit their contact with others during this time. For example, stay home from school and do not attend social events.

Before the routine mumps vaccination (measles-mumps-rubella (MMR) vaccine) program in the United States, mumps was a common illness in infants, children and young adults. Now it is a rare disease in the U.S.

Mumps virus transmission

The mumps virus replicates in the upper respiratory tract and is transmitted person to person through direct contact with saliva or respiratory droplets of a person infected with mumps. The risk of spreading the virus increases the longer and the closer the contact a person has with someone who has mumps. The infectious period is considered from 2 days before to 5 days after parotitis onset, although virus has been isolated from saliva as early as 7 days prior to and up to 9 days after parotitis onset. Mumps virus has also been isolated up to 14 days in urine and semen.

When a person is ill with mumps, they should avoid contact with others from the time of diagnosis until 5 days after the onset of parotitis by staying home from work or school and staying in a separate room if possible.

Mumps outbreaks

Mumps outbreaks can still occur in U.S. communities of people who previously had one or two doses of MMR vaccine ¹. This is particularly common in close-contact settings. High vaccination coverage helps limit the size, duration, and spread of mumps outbreaks ¹.

• From 2015 to 2017, the U.S. saw a range of different mumps outbreak settings and sizes. Cases started to increase in late 2015. From January 2016 to June 2017, health departments reported 150 outbreaks (9,200 cases), including households, schools, universities, athletics teams and facilities, church groups, workplaces, and large parties and events.
  • The largest outbreak occurred in a close-knit community in northwest Arkansas that resulted in nearly 3,000 cases.
  • Two large outbreaks from Iowa and Illinois each involved several hundred university students.
  • About half of outbreaks involved greater than 10 cases.
• From 2009 to 2010, two large outbreaks occurred.
  • One outbreak involved over 3,000 people and mostly affected students who were part of a close-knit religious community in New York City and attended schools in which they participated in activities that involved very close contact. The outbreak started when an infected student returned from the United Kingdom where a large mumps outbreak was occurring.
  • The second outbreak involved about 500 people, mostly school-aged children, in the U.S. Territory of Guam.
• In 2006, the United States experienced a multi-state mumps outbreak involving more than 6,500 reported cases. This resurgence predominantly affected college-aged students living in the Midwest, with outbreaks occurring on many different Midwestern college campuses.

I’ve been told that I need to stay away from people while I’m sick with mumps. What does that mean and why does it matter?

When you have mumps, you should avoid contact with other people until five days after your salivary glands begin to swell because you are contagious during this time. You should not go to work, school, or any social events. You should stay home when you are sick with mumps and limit contact with the people you live with; for example, sleep in a separate room by yourself if you can. Staying home while sick with mumps is an important way to avoid spreading the virus to other people. People who are infected with mumps don’t get sick right away—it can take 2 to 4 weeks for them to show signs of infection.

What else should I do to prevent mumps from spreading?

In addition to staying away from others when you have mumps, you can help prevent the mumps virus from spreading by:

• Covering your mouth and nose with a tissue when you cough or sneeze, and put your used tissue in the trash can. If you don’t have a tissue, cough or sneeze into your upper sleeve or elbow, not your hands.
• Washing your hands often with soap and water.
• Avoiding sharing objects that might have saliva on them, like water bottles or cups.
• Disinfecting frequently touched surfaces, such as toys, doorknobs, tables, counters.

I got the vaccine but still got mumps. Does this mean the vaccine doesn’t work?

Measles-mumps-rubella vaccine (MMR vaccine) prevents most, but not all, cases of mumps and complications caused by the disease. People who have received two doses of the MMR vaccine are about nine times less likely to get mumps than unvaccinated people who have the same exposure to mumps virus. However, some people who receive two doses of MMR can still get mumps, especially if they have prolonged, close contact with someone who has the disease. If a vaccinated person does get mumps, they will likely have less severe illness than an unvaccinated person.

Before there was a vaccine, mumps was a common childhood disease in the United States. In some cases, the disease caused complications, such as permanent deafness in children and, occasionally, swelling of the brain (encephalitis), which in rare cases resulted in death. From year to year, the number of mumps cases can range from roughly a couple hundred to a couple thousand. In some years, there are more cases of mumps than usual because of outbreaks.

What should I do during a mumps outbreak?

Make sure you and your family are up to date on your MMR vaccine. Your local public health authorities or institution might recommend that people who belong to a group at increased risk for mumps get an additional dose. These groups are usually those who are likely to have close contact, such as sharing sport equipment or drinks, kissing, or living in close quarters, with a person who has mumps. Your local public health authorities will communicate to the groups at increased risk that they should receive this dose. If you already have two doses of MMR, it is not necessary to seek out vaccination unless you are part of this group.

Let your doctor know right away if you think that you or someone in your family may have mumps.

In any situation, including when there is a mumps outbreak, washing hands often with soap and water and having good health practices are the most important steps you can take to avoid getting sick and spreading germs to others.

How long does mumps last?

Children usually recover from mumps in about 10–12 days. It takes about 1 week for the swelling to disappear in each parotid gland. But both glands don’t usually swell at the same time.

Parotitis causes

Viral parotitis

Viral parotitis can be caused by:

• Mumps virus,
• Epstein-Barr virus,
• Coxsackievirus,
• Influenza A
• Parainfluenza viruses.

Mumps is caused by a mumps virus. The mumps virus spreads from person to person by drops of moisture from the nose and mouth, such as through sneezing. It is also spread through direct contact with items that have infected saliva on them. If you’re not immune, you can contract mumps by breathing in saliva droplets from an infected person who has just sneezed or coughed. You can also contract mumps from sharing utensils or cups with someone who has mumps.

Mumps most often occurs in children ages 2 through 12 who have not been vaccinated against the disease. However, the infection can occur at any age and may also be seen in college age students.

The time between being exposed to the virus and getting sick (incubation period) is about 12 to 25 days.

Mumps may also infect the:

• Central nervous system (brain and spinal cord)
• Pancreas
• Testes

Acute bacterial suppurative parotitis

The most common pathogens associated with acute bacterial parotitis are:

• Staphylococcus aureus
• Anaerobic bacteria. The predominant anaerobes include gram-negative bacilli (including pigmented Prevotella and Porphyromonas spp.), Fusobacterium spp., and Peptostreptococcus spp. Streptococcus spp. (including S. pneumoniae) and gram-negative bacilli (including Escherichia coli) have also been reported. Gram-negative organisms are often seen in hospitalized patients.
• Organisms less frequently found are Arachnia, Haemophilus influenzae, Klebsiella pneumoniae, Salmonella spp., Pseudomonas aeruginosa, Treponema pallidum, cat-scratch bacillus, and Eikenella corrodens.
• Mycobacterium tuberculosis and atypical mycobacteria are rare causes of parotitis.

Mumps prevention

The best way to prevent mumps is to be vaccinated against the disease. Most people have immunity to mumps once they’re fully vaccinated.

Mumps vaccination

Vaccination with MMR vaccine is the best way to prevent mumps and mumps complications. The mumps vaccine is included in the combination measles-mumps-rubella (MMR) and measles-mumps-rubella-varicella (MMRV) vaccines. Two doses of mumps vaccine are 88% (range 31% to 95%) effective at preventing the disease; one dose is 78% (range 49% to 91%) effective. CDC recommends that children get two doses of MMR vaccine:

1. the first dose at 12 through 15 months of age, and
2. the second dose at 4 through 6 years of age.

Teens and adults should also be up to date on MMR vaccinations.

College students, international travelers and health care workers in particular are encouraged to make sure they’ve had two doses of the MMR vaccine. A single dose is not completely effective at preventing mumps.

MMR vaccine is safe and effective. A person with two doses of MMR vaccine has about an 88% reduction in risk for mumps; a person with one dose has a 78% reduction in risk for mumps.

A third dose of vaccine isn’t routinely recommended. But your doctor might recommend a third dose if you are in an area that is experiencing an outbreak. A study of a recent mumps outbreak on a college campus showed that students who received a third dose of MMR vaccine had a much lower risk of contracting the disease.

Children may also get MMRV vaccine, which protects against measles, mumps, rubella, and varicella (chickenpox). This vaccine is only licensed for use in children who are 12 months through 12 years of age.

In October 2017, the Advisory Committee on Immunization Practices (ACIP) recommended that people identified by public health authorities as being part of a group at increased risk for acquiring mumps because of a mumps outbreak should receive a third dose of MMR vaccine. The purpose of the recommendation is to improve protection of people in outbreak settings against mumps disease and mumps-related complications.

Your health department will provide information on groups at increased risk who should receive a dose. If you suspect an outbreak, or are unsure if your patient belongs to a group at increased risk, contact your local health department for more information.
You should not give a third dose unless your patient is part of a group at increased risk as determined by your local public health authorities.
MMR vaccine has not been shown to prevent illness in persons already infected with mumps and should not be used as post-exposure prophylaxis in immediate close contacts.

Those who don’t need the MMR vaccine

You don’t need a vaccination if you:

• Had two doses of the MMR vaccine after 12 months of age
• Had one dose of MMR after 12 months of age and you’re a preschool child or an adult who isn’t at high risk of measles or mumps exposure
• Have blood tests that demonstrate your immunity to measles, mumps and rubella
• Were born before 1957 — most people in that age group were likely infected by the virus naturally and have immunity

Also, the vaccine isn’t recommended for:

• People who have had a life-threatening allergic reaction to the antibiotic neomycin or any other component of the MMR vaccine
• Pregnant women or women who plan to get pregnant within the next four weeks
• People with severely compromised immune systems

Those who should get the MMR vaccine

You should get vaccinated if you don’t fit the criteria listed above and if you:

• Are a nonpregnant woman of childbearing age
• Attend college or another postsecondary school
• Work in a hospital, medical facility, child care center or school
• Plan to travel overseas or take a cruise

Those who should wait to get the MMR vaccine

Consider waiting if:

• You’re moderately or severely ill. Wait until you recover.
• You’re pregnant. Wait until after you give birth.

Those who should check with their doctors

Talk to your doctor before getting vaccinated for mumps if you:

• Have cancer
• Have a blood disorder
• Have a disease that affects your immune system, such as HIV/AIDS
• Are being treated with drugs, such as steroids, that affect your immune system
• Have received another vaccine within the past four weeks

Side effects of the vaccine

The MMR vaccine is very safe and effective. Getting the MMR vaccine is much safer than getting mumps.

Most people experience no side effects from the vaccine. Some people experience a mild fever or rash or achy joints for a short time.

Rarely, children who get the MMR vaccine might experience a seizure caused by fever. But these seizures haven’t been associated with any long-term problems.

Extensive reports — from the American Academy of Pediatrics, the Institute of Medicine and the Centers for Disease Control and Prevention — conclude that there’s no link between the MMR vaccine and autism.

Parotitis symptoms

Mumps is an illness and viral parotitis caused by the mumps virus, is best known for the puffy cheeks and tender, swollen jaw that it causes. This is a result of swollen parotid salivary glands under the ears on one or both sides, often referred to as parotitis.

The average incubation period for mumps virus is 16 to 18 days, with a range of 12 to 25 days. Symptoms typically appear 16-18 days after infection, but this period can range from 12–25 days after infection.

Some people who get mumps have very mild symptoms (like a cold), or no symptoms at all and may not know they have the disease.

In rare cases, mumps can cause more severe complications.

Most people with mumps recover completely within two weeks.

Symptoms of mumps may include:

• Face pain
• Fever
• Headache
• Sore throat
• Loss of appetite
• Swelling of the parotid glands (the largest salivary glands, located between the ear and the jaw)
• Swelling of the temples or jaw (temporomandibular area)

Other symptoms that might begin a few days before parotitis include:

• Fever
• Headache
• Muscle aches
• Tiredness
• Loss of appetite

Symptoms that can occur in males are:

• Testicle lump
• Testicle pain
• Scrotal swelling

Mumps usually involves pain, tenderness, and swelling in one or both parotid salivary glands (cheek and jaw area). Swelling usually peaks in 1 to 3 days and then subsides during the next week. The swollen tissue pushes the angle of the ear up and out. As swelling worsens, the angle of the jawbone below the ear is no longer visible. Often, the jawbone cannot be felt because of swelling of the parotid. One parotid may swell before the other, and in 25% of patients, only one side swells. Other salivary glands (submandibular and sublingual) under the floor of the mouth also may swell but do so less frequently (10%).

Nonspecific prodromal symptoms may precede parotitis by several days, including low-grade fever which may last 3 to 4 days, myalgia, anorexia, malaise, and headache. Parotitis usually lasts at least 2 days, but may persist longer than 10 days. Mumps infection may also present only with nonspecific or primarily respiratory symptoms, or may be asymptomatic. Recurrent parotitis, when parotitis on one side resolves but is followed days to weeks later by parotitis on the other side, can also occur in mumps patients. Vaccinated cases are less likely to present severe symptoms or complications than under- or unvaccinated cases.

Mumps infection is most often confused with swelling of the lymph nodes of the neck. Lymph node swelling can be differentiated by the well-defined borders of the lymph nodes, their location behind the angle of the jawbone, and lack of the ear protrusion or obscuring of the angle of the jaw, which are characteristics of mumps.

Mumps complications

Complications of mumps are rare, but some are potentially serious.

Most mumps complications involve inflammation and swelling in some part of the body, such as:

• Testicles. This condition, known as orchitis, causes one or both testicles to swell in males who’ve reached puberty. Orchitis is painful, but it rarely leads to the inability to father a child (sterility).
• Brain. Viral infections such as mumps can lead to inflammation of the brain (encephalitis). Encephalitis can cause neurological problems and become life-threatening.
• Membranes and cerebrospinal fluid (CSF) around the brain and spinal cord. This condition, known as meningitis, can occur if the mumps virus spreads through your bloodstream to infect your central nervous system.
• Pancreas. The signs and symptoms of this condition, known as pancreatitis, include pain in the upper abdomen, nausea and vomiting.

Other complications of mumps include:

• Hearing loss. Hearing loss can occur in one or both ears. Although rare, the hearing loss is sometimes permanent.
• Heart problems. Rarely, mumps has been associated with abnormal heartbeat and diseases of the heart muscle.
• Miscarriage. Contracting mumps while you’re pregnant, especially early in your pregnancy, may lead to miscarriage.

Mumps complications include orchitis, oophoritis, mastitis, meningitis, encephalitis, pancreatitis, and hearing loss. Complications can occur in the absence of parotitis and occur less frequently in vaccinated patients. Some complications of mumps are known to occur more frequently among adults than children.

Orchitis occurs in approximately 20–30% of unvaccinated and 6–7% of vaccinated postpubertal male mumps patients. In 60% to 83% of males with mumps orchitis, only one testis is affected. Mumps orchitis has not been linked to infertility, but may result in testicular atrophy and hypofertility. Among adolescent and adult female mumps patients in the United States, rates of oophoritis and mastitis have been ≤1%. However, these complications may be more difficult to recognize and are likely underreported. Pancreatitis, deafness, meningitis, and encephalitis have been reported in less than 1% of cases in recent U.S. outbreaks. Cases of nephritis and myocarditis and other sequelae, including paralysis, seizures, cranial nerve palsies, and hydrocephalus, in mumps patients have been reported but are very rare. Death from mumps is exceedingly rare. There have been no mumps-related deaths reported in the United States during recent mumps outbreaks.

Mumps during pregnancy

Mumps that occurs in pregnant women is generally benign and not more severe than in women who are not pregnant. Like other infections, there is a theoretical risk that mumps during the early months of pregnancy may cause complications. Most studies on the effects of gestational mumps on the fetus were conducted in the 1950s–60s when the disease was more common before mumps vaccine was available. One study from 1966 reported an association between mumps infection during the first trimester of pregnancy and an increase in the rate of spontaneous abortion or intrauterine fetal death ², but this result has not been observed in other studies ³. One study of low birth weight in relation to mumps during pregnancy found no significant association1. While there are case reports of congenital malformations in infants born to mothers who had mumps during pregnancy, the only prospective, controlled study found rates of malformations were similar between mothers who had mumps and those who did not have mumps during pregnancy ⁴.

Parotitis diagnosis

The health care provider will perform an exam and ask about the symptoms, especially when they started.

No tests are needed in most cases. The provider can usually diagnose mumps by looking at the symptoms.

Blood tests may be needed to confirm the diagnosis.

Laboratory tests to diagnose Mumps

Reverse transcription polymerase chain reaction (RT-PCR) and viral culture are used to confirm mumps infection. Buccal swabs are most commonly used for RT-PCR testing, but urine and CSF (cerebrospinal fluid) may also be used in specific situations. IgM serology can also be used to aid in diagnosing mumps infection. A patient’s vaccination status and timing of specimen collection are important for interpreting laboratory results. A negative test result does not rule out mumps infection.

Parotitis treatment

There is no specific treatment for mumps parotitis. Mumps is caused by a virus, so antibiotics aren’t effective. But most children and adults recover from an uncomplicated case of mumps within a few weeks. People with mumps are generally no longer contagious and can safely return to work or school about five days after the appearance of signs and symptoms.

The following things can be done to relieve symptoms:

• Apply ice or heat packs to the neck area.
• Take acetaminophen (Tylenol) to relieve pain. DO NOT give aspirin to children with a viral illness because of the risk for Reye syndrome.
• Drink extra fluid.
• Eat soft foods.
• Gargle with warm salt water.

Bacterial parotitis treatment includes maintenance of hydration and administration of parenteral antimicrobial therapy for acute bacterial suppurative parotitis. Once an abscess has formed surgical drainage is required. The choice of antimicrobial depends on the bacterial agent. Maintenance of good oral hygiene, adequate hydration, and early and proper therapy of bacterial infection of the oropharynx may reduce the occurrence of suppurative parotitis.

Parotitis treatment at home

Rest is the best treatment. There’s little your doctor can do to speed recovery.

But you can take some steps to ease pain and discomfort and keep others from becoming infected. Try to:

• Isolate yourself or your child to prevent spreading the disease to others. Someone with mumps may be contagious up to five days after the onset of signs and symptoms.
• Take over-the-counter pain relievers such as acetaminophen (Tylenol, others) or a nonsteroidal anti-inflammatory drug such as ibuprofen (Advil, Motrin IB, others) to ease symptoms.
• Use a warm or cold compress to ease the pain of swollen glands.
• Wear an athletic supporter and use cold compresses to ease the pain of tender testicles.
• Avoid foods that require lots of chewing. Try broth-based soups or soft foods, such as mashed potatoes or oatmeal.
• Avoid sour foods, such as citrus fruits or juices, which stimulate saliva production.
• Drink plenty of fluids.

If your child has mumps, watch for complications. Call your doctor if your child develops:

• Fever of 103 °F (39 °C) or greater
• Trouble eating or drinking
• Confusion or disorientation
• Abdominal pain
• In boys, pain and swelling of the testicles

Mumps prognosis

People with mumps do well most of the time, even if organs are involved. After the illness is over in about 7 days, they’ll be immune to mumps for the rest of their life.

1. Mumps Cases and Outbreaks. https://www.cdc.gov/mumps/outbreaks.html[↩][↩][↩]
2. Siegel M, Fuerst HT, Peress NS. Comparative fetal mortality in maternal virus diseases. A prospective study on rubella, measles, mumps, chicken pox and hepatitis. N Engl J Med 1966;274(14):768-71[↩]
3. Wilson CB, Nizet V, Maldonado YA, Remington JS, Klein JO. Remington and Klein’s infectious diseases of the fetus and newborn infant. 8th Edition, Elsevier Health Sciences, 2016[↩]
4. Siegel M. Congenital malformations following chickenpox, measles, mumps, and hepatitis. Results of a cohort study. JAMA 1973;226(13):1521-4.[↩]