Meningitis aséptica en pacientes con parotiditis viral durante un brote epidémico / Aseptic meningitis associated to mumps during an epidemic outbreak

Resumen Comunicamos dos casos de meningitis aséptica asociadas a parotiditis viral en mujeres de edad mediana, una de ellas embarazada. Ambas se presentaron pocos días después del aumento de volumen parotídeo, con cefalea, fiebre y signos meníngeos, pleocitosis de predominio mononuclear en el LCR y resultados negativos para otras causas. La parotiditis fue confirmada por serología IgG e IgM positiva. Las pacientes tuvieron una evolución favorable con desaparición total de sus síntomas. Ambos casos ocurrieron durante un brote regional de parotiditis. La meningitis aséptica es una complicación frecuente de las parotiditis. Su diagnóstico puede lograrse por el aumento de volumen glandular precedente, la pleocitosis de predominio mononuclear en el LCR y una serología IgM e IgG positiva o detección genómica por RPC en muestra urinaria o salival. Esta complicación es más probable que sea observada durante brotes de parotiditis viral.

We report two cases of acute aseptic meningitis associated to mumps in middle-aged women, one pregnant. Both presented shortly after parotid gland enlargement. Neurological complications were suspected by headache, fever and meningeal signs and confirmed by CSF findings (mononuclear predominant pleocytosis) with negative results for alternative causes. Mumps were confirmed by positive IgM and IgG serology. Both patients were discharged with a favorable evolution and complete disappearance of symptoms. Cases were concurrent with a regional mumps outbreak. Conclusions: Aseptic meningitis is a rare mumps-associated neurological complication. Its diagnostic can be achieved by precedent parotid enlargement, mononuclear pleocytosis in the CSF and positive IgM and IgG serology or viral detection by PCR in urine or salivary samples. This complication would be more probably observed during mumps outbreaks.

Mumps myocarditis as a cause of neonatal cardiogenic shock

The mothers may be infected during pregnancy with infectious agents. Mumps induced myocarditis, especially endocardial fibroelastosis, was previously a common disease of infants but is rare now. A 25 day old male infant admitted to the intensive care of our hospital because of cardiogenic shock. Further studies revealed ischemic electrocardiograms, poor ventricular function, and positive results by polymerase chain reaction [PCR] technique for mumps virus. Regarding this case, although is very rare but mumps myocarditis should be included in the differential diagnosis of left ventricular dysfunction in neonatal period

Relationship between aseptic meningitis and MMR vaccination

Mumps is a predominant disease of young children recognized by fever and parotitis. Meningitis and meningoencephalitis are the most frequent complications of the disease. Mumps live vaccine is available in many countries. In Iran routine 2 dose administration of MMR was launched in 2004. Vaccine produce a subclinical and noncommunicable infection but in part of Europes, Canada and Japan where different vaccines have been used, rates of vaccine-induced aseptic meningitis have been high. The purpose of this study is to survey the occurrence of Aseptic meningitis as an adverse effect of MMR vaccination and to determine its clinical and laborabry characteristics. In this prospective study during 2004-2005 cases of Aseptic meningitis who was admitted in Infection and neurology wards of Tabriz Pediatric Medical center were studied. Sex, age, clinical manifestations, lab data and duration between vaccination and appearance of symptoms were recorded and analyzed. In 44 cases of aseptic meningitis there was history of MMR vaccination within 30 days [average: 21.7 days]. Seventy five percent of patients were male. The mean age of patients was 31 months. 40.9% of cases were 13 months old. Febrile seizure [54.5%] and meningeal signs with parotid enlargement [29.5%] were the most clinical manifestation. The mean Total and lymphocyte cell count in cerebrospinal fluid were 674.43 and 550.2/mm[3], respectively. The mean glucose and protein levels were found to be 54.3 and 48.34 mg/dl, respectively. The results of our study shows the occurrence of aseptic meningitis after immunization with the MMR vaccine which is being used by the health services in our country. According to Presence of wild virus Strains within community and to rule out the role of other viruses, PCR is recommended despite of its complexity and limitations. This complication must be considered important and followed up precisely in spite of its complete cure without any Sequela, because all of these cases occurred within 30 days after vaccination

An Adult Case of Mumps Brainstem Meningoencephalitis with a Past Measles-Mumps-Rubella (MMR) Vaccination

Severe complications such as meningoencephalitis are quite rare in the setting of mumps infection. We report here on a 24-year-old soldier with a past history of MMR vaccination who was admitted because of aseptic meningitis. His mental status rapidly deteriorated and swelling of both parotid glands was observed. The MR findings revealed discrete lesions in the brainstem and thalamus. He barely recovered within 2 months. Among the adults with failure to acquire immunity despite MMR vaccination, institutional crowding can lead to cases of potentially fatal CNS complication such as mumps meningoencephalitis.

Hematuria with mumps infection.

Two cases with macroscopic hematuria as complication of acute mumps infection is reported. The patients have neither been vaccinated against mumps nor had mumps infection earlier. Macroscopic hematuria resolved spontaneously and renal functions did not deteriorate in both the patients. Although mumps has a benign course, mild and rarely severe renal involvement may occur. Therefore, renal functions in patients with hematuria and mumps should be followed closely.

Mumps with cerebellar encephalitis.

A 30 years male patient, having typical symptoms of mumps, presented with acute cerebellar ataxia two days after the onset of parotid enlargement. The neurological symptoms showed complete recovery over the subsequent six weeks, suggestive of para-infectious cerebellar demyelination due to mumps.

Acute dysautonomia following mumps.

Pure acute or subacute dysautonomia is a rare entity. Its etiology is as yet unknown. However, majority of these cases have a preceding viral infection such as herpes simplex, infectious mononucleosis, rubella or coxsackie B. A unique patient in whom acute dysautonomia followed mumps is reported.

Mumps hemiplegia.

Neurological involvement of mumps is commonly restricted to aseptic meningitis. However, rarely mumps is associated with more severe encephalitic illness; other known associations described with mumps are cases of transverse myelitis and Gullain Barre like illness. We report a case of hemiplegia due to mumps parotitis probably caused by involvement of carotid artery.

Caxumba e infecçåo aguda do sistema nervoso central (SNC) / Mumps and infections of Central Nervous System (C.N.S.)

Dentre 916 casos de "Meningite Asséptica" internados no Hospital de Doenças Tropicais de Goiânia no período de 1982-1993, o vírus da caxumba foi o mais provável agente etiológico dde 157 (17,14 pôr cento) casos, pois havia concomitância de parotidite ou história recente de contágio intradomiciliar. Foram levantados dados sobre a idade dos pacientes, o tempo de permanência hospitalar, o tempo de duraçåo da doença e em que dia da caxumba surgiram os primeiros sinais do acometimento do S.N.C.. Os exames de rotina do L.C.R. foram solicitaddos e, no sangue a amilasemia. O tipo de acometimento nervoso, a concomitância de pancreatite e os anos e meses de maiores e menores incidências såo citados. O autor eenfatiza que o acometimento cerebral nåo deve ser considerado uma complicaçåo e sim forma clínica da parotidite epidêmica do mesmo modo que a pancreatite e a orquite

Guillain-Barre syndrome following specific viral infections--an appraisal.

Fifteen cases of Gullian-Barre syndrome (GBS) following specific infection are reported. The infections include varicella, 7 infective hepatitis, 4 measles, 2 and mumps, 2. There are no specific clinical or electrophysiological features which serve to distinguish GBS seen in association of these infections from those seen in other clinical settings. There is epidemiological evidence to suggest the association between GBS and hepatitis A, and non A non B hepatitis is more of a chance occurrence. Detailed epidemiological studies are needed to established a clear relationship between other specific viral infections and GBS.

Aetiologic factors in male infertility: clinical, microbiological and hormonal evaluation.

Seventy two infertile men were studied. History of small pox and mumps infection was noted in 4 and 3 patients respectively. Seven patients had varicocele (9.2%), and small atrophic testes were found in 9 (12.5%). Azoospermia was reported in 41 (58.3%) and oligospermia in 17 (23.6%), and 14 patients (19.4%) had normal sperm counts. Mycoplasma were grown from urethral swabs in 25 (35%) patients. Mean LH and FSH were elevated in azoospermics (p less than 0.001), E2-17B in oligospermics (p less than 0.001) and FSH in normospermic (p less than 0.01) patients. Hypergonadotropism suggestive of primary testicular failure was recorded in 43 (59.7%) patients. Hypogonadotropism was noted in 3 (4%) and hyperprolactinemia due to pituitary microadenoma induced infertility in only one patient. No aetiology could be determined in 11 (16%) patients.

Comprometimento renal num caso de caxumba: relato de caso / Renal impairment in a case of mumps: case report

O autor relata um caso de cpmprometimento renal na vigência de caxumba e chama atençäo para essa etiologia no diagnóstico diferencial das hematúrias em adultos jovens do sexo masculino.

Opsoclonus in mumps and poliovirus type 3 encephalitides: a report of 2 cases.

Two adult patients with opsoclonus and tremor of the whole body associated with viral infections are reported. The first man presented with mumps (parotitis, orchitis and encephalitis). Paired serum mumps titers were both 1:80. The second patient had conjunctivitis and dizziness. Acute and convalescent sera showed significant rise of poliovirus type 3 titer. Clonazepam attenuated the symptoms in both patients.