Elevated serum C-reactive protein in mumps orchitis

A case of mumps orchitis with a high concentration of C-reactive protein (CRP) prompted us to evaluate the inflammatory response in mumps complications. We compared the CRP titers in mumps patients with orchitis and meningitis. The serum CRP titers were significantly higher in the patients with orchitis than in those with meningitis.     

Neuropathology and immunohistochemistry of the brain-stem in neonates with congenital hydrocephalus: Comparative studies between aqueductal stenosis and Arnold-Chiari malformation

Neuropathological and immunohistochemical studies were done on the brain-stem of neonates who had congenital hydrocephalus with aqueductal stenosis or Arnold-Chiari malformation (ACM). The infants with aqueductal stenosis showed heterogeneity in their clinicopathological findings while the infants with ACM were relatively similar in neuropathological findings. There were prominent astrogliosis, decreased immunoreactivity with antisera to tyrosine hydroxylase and myelin basic protein in the periaqueductal area, and an increased reactivity with antiserum to substance P in the tegmentum of most patients with aqueductal stenosis and other malformations. In ACM, there was little gliosis in the tegmentum and periaqueductal area and minimal immunoreactivity of tyrosine hydroxylase, myelin basic protein and substance P. In both groups of cases, the cells in the periaqueductal region differ in neurotransmitter/neuromodulator immunoreactivity and degree of myelination reflecting a difference possibly in their maldevelopment.     

Complementary findings in clinical and epidemiologic features of mumps and mumps meningoencephalitis in children without mumps vaccination

BACKGROUND: Mumps vaccine has not yet been included in the routine vaccination programme, for this reason mumps is still one of the most common infections for children in Turkey. One of the major complication of mumps is meningoencephalitis, which although usually heals spontaneously, it may cause neurologic complications. METHODS: This study was undertaken to investigate epidemiologic and demographic characteristics in children with mumps and mumps meningoencephalitis and clinical/laboratory findings in children with mumps meningoencephalitis diagnosed over a 11 year period. A total of 2422 mumps and 135 mumps meningoencephalitis cases were covered in this study which constitutes one of the largest series of mumps meningoencephalitis in the literature. The mean age of mumps and mumps meningoencephalitis cases were 6.6 +/- 2.7 and 7.6 +/- 2.6 years, respectively. RESULTS: There was a male predominance both among the cases of mumps and mumps meningoencephalitis. The age and seasonal distributions were similar in the mumps and mumps meningoencephalitis groups. The most common symptoms of mumps meningoencephalitis were fever (97%), vomiting (94%) and headache (88.8%). The mean cerebrospinal fluid (CSF) total cell count and lymphocyte count were 540 +/- 460/mm(3) and 300 +/- 330/mm(3), respectively. The mean CSF protein and glucose levels were found to be 56.97 +/- 27.94 mg/dL and 53.67 +/- 15.46 mg/dL, respectively. The mean of CSF/blood glucose ratio was 0.53 +/- 0.16. The mean duration of hospitalization in mumps meningoencephalitis cases was found to be 5.1 +/- 2.4 days and this was longer in boys (P < 0.05). CONCLUSION: In patients with mumps meningoencephalitis, higher CSF protein levels and lower CSF glucose/blood glucose ratio were associated with longer hospitalization periods. There was no death.     

Enhanced expression of cytokines/chemokines in cerebrospinal fluids in mumps meningitis in children

Background: The mumps virus is frequently the causative agent in aseptic meningitis and mumps has still prevailed in Japan. We compared data obtained from patients with mumps meningitis and patients with aseptic meningitis caused by other viruses in order to identify mumps meningitis‐specific cytokine/chemokine alterations in cerebrospinal fluide (CSF). Methods: We elucidated the cytokine/chemokine network based on the cytokine/chemokine profiles in CSF from children with mumps meningitis and meningitis due to other viral infections using multiplex cytokine measurement. Seventeen cytokines/chemokines, namely interleukin (IL)‐1β, IL‐2, IL‐4, IL‐5, IL‐6, IL‐7, IL‐8, IL‐10, IL‐12 (p70), IL‐13, IL‐17, interferon (IFN)‐γ, tumor necrosis factor (TNF)‐α, granulocyte colony‐stimulating factor (G‐CSF), granulocyte monocyte colony‐stimulating factor (GM‐CSF), monocyte chemoattractant protein‐1 (MCP‐1) and macrophage inflammatory protein‐1β (MIP‐1β), were measured simultaneously in CSF supernatants from eight children with mumps meningitis, 11 children with other types of viral meningitis and eight children with fever without neurological complications such as convulsion. Results: We found that IL‐8, IL‐10, IL‐12, IL‐13 and IFN‐γ showed a statistically significant increase in CSF from mumps meningitis when compared to other types of viral meningitis and fever without neurological complications. Conclusion: Mumps meningitis may induce a distinct immunological response when compared with other types of viral meningitis.     

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     

Leukocyte migration inhibition by a brain tissue antigen and electroencephalography in uncomplicated measles.

In 11 patients with uncomplicated measles and in 10 control patients with acute enteritis, electroencephalography and leukocyte migration inhibition test using basic myelin protein as antigen were carried out. There were no EEG abnormalities and no migration inhibition in the control group. Leukocyte migration inhibition was observed in 9 measles patients; among these 5 had slight or moderate EEG abnormalities. It is suggested that EEG abnormalities have the same pathological background in uncomplicated measles as in measles encephalitis.     

Increased Serum Levels of Anti-Mumps and Rubella Viruses Antibodies in Children with Kawasaki Disease

Serum IgM and IgG antibodies against mumps virus and rubella virus were quantitated serially by enzyme-linked immunosorbent assays in 15 children with Kawasaki disease. IgM antibody against mumps virus and IgG antibody against rubella virus were increased significantly in children with Kawasaki disease who had no previous history of mumps virus or rubella virus infection. Booster-like effect in IgG antibody levels against mumps virus was observed in children with Kawasaki disease who had a previous history of exposure to mumps virus. Since none of the patients manifested clinical symptoms of mumps or rubella, the increased antibody levels against mumps and rubella may represent a part of the nonspecific increase in serum immunoglobulins in children with Kawasaki disease.     

Ascending myelopathy after chemotherapy for central nervous system acute lymphoblastic leukemia: correlation with cerebrospinal fluid myelin basic protein

Ascending myelopathy developed in a previously irradiated 10-year-old boy after intraventricular methotrexate and cytosine arabinoside were given for central nervous system relapse of acute lymphoblastic leukemia. The course was fatal in 10 weeks. Cerebrospinal fluid myelin basic protein levels, indicating a demyelinative process, rose prior to the onset of clinical symptoms and remained at very high levels until death. Myelin basic protein may be useful as a predictor of chemotherapy-associated neurotoxicity.     

Aseptic meningitis after vaccination against measles and mumps

This retrospective study (1979 to 1986) investigated the possible etiologic relationship between vaccination and aseptic meningitis in 115 hospitalized children who became ill within 30 days of vaccination with the Leningrad 3 strain of mumps virus and the Edmonston-Zagreb strain of measles virus. The etiologic viral diagnosis was based on serologic tests and the isolation of virus from cell cultures which distinguished between attenuated and "virulent" mumps virus. The incidence of mumps vaccine-associated meningitis was 1/1000 vaccine recipients. In 92% of children the incubation period was 11 to 25 days and 28% had associated swelling of the salivary glands. Sixteen cases (13.9%) had a positive cerebrospinal fluid culture (attenuated mumps virus, 6 cases; "virulent" mumps virus, 7 cases; echoviruses, 3 cases). Clustering of cases, seasonal occurrence and age of the patients suggested causal relationship with the vaccination in the majority of children. In 4 patients with attenuated virus isolation from cerebrospinal fluid the incubation period ranged from 17 to 20 days. Clinical findings did not differ from natural mumps meningitis. The course was uncomplicated and at discharge the patients had no sequelae. Measles virus was never found as a cause of the meningitis. The mumps vaccine virus should be recognized as one of the causative agents of aseptic meningitis in countries where less attenuated mumps vaccine is used.     

Acute ascending motoric paraplegia following intrathecal chemotherapy for treatment of acute lymphoblastic leukemia in children: case reports and review of the literature

Severe side effects of chemotherapy in pediatric patients with acute lymphoblastic leukemia are rare, but well-known. We present two pediatric patients who developed ascending motoric paraplegia (AMP) following intrathecal chemotherapy. Both patients suffered from progressive weakness of their lower extremities, neurogenic bladder dysfunction, autonomous neural dysregulation and minor sensory deficits. Despite an initially similar clinical picture, progression and outcome were fairly different. There is convincing evidence that AMP is caused by spinal cord toxicity of intrathecally applied toxic agents such as cytarabin and/or methotrexate leading to spinal demyelinisation as demonstrated by elevated myelin basic protein in cerebrospinal fluid.     

Complications after preventive mumps vaccination in West Germany (including multiple preventive vaccinations)

Since the introduction of mumps vaccination in the Federal Republic of Germany 34 untoward vaccinal reactions were collected. In 2 cases of aseptic meningitis after mumps immunisation mumps virus was isolated from the CSF. The final investigation showed mumps virus (wild type) in one case; in the other a mumps vaccine-like strain (Jeryl-Lynn) was identified. Both patients recovered completely. These complications do not outweigh the enormous benefits of mumps immunisation.     

Facial palsy associated with mumps parotitis.

Peripheral facial nerve paralysis is relatively common in the pediatric age group. However, facial palsy rarely has been documented in patients with mumps parotitis. This case report describes the findings of a 3-year-old Japanese boy who developed facial palsy immediately after mumps parotitis. This work calls attention to a possible association between mumps parotitis and facial palsy.     

Mumps as a cause of admission to hospital: an estimate for Western Australia 1981

Close to 40% of children admitted to Princess Margaret Hospital with mumps over the period 1979 to 1982 were diagnosed retrospectively as a result of virological tests and their illness was not coded as being due to mumps. This clinical underestimate of the incidence of mumps is due to the frequent absence of salivary gland enlargement, especially in preschool children. In such cases there is usually evidence of inflammation of the upper respiratory tract. The main clinical features leading to admission were neck stiffness, fits and high fever. An appropriate adjustment was made to the figures obtained from the computerised data on discharges with the diagnosis of mumps from Western Australian hospitals in 1981. This led to the estimate that 104 patients suffering from mumps were discharged from hospital during that year. It was also estimated that mumps was responsible for 379 in-patient days. Our findings show that the benefit cost ratios for mumps immunization of others are underestimates.     

Prospective study of 59 cases of viral meningitis in children. Clinical and virologic diagnosis. Epidemiology and physiopathology

In a prospective 2 year study of 59 cases of childhood meningitis, mumps was the most common etiological virus (39%), followed by enterovirus (27%). The analysis of the cases suggested that a diagnosis of the infectious agent may be arrived at using clinical data such as the degree of nuchal rigidity, the age of the patients, and the presence of associated parotiditis or macular rash. Pleiocytosis in the CSF was higher and included a larger percentage of lymphocytes during mumps meningitis than during enterovirus meningitis. Mumps or enterovirus were isolated in the CSF of 23% (mumps) and 27% (enterovirus) of the patients. Alpha interferon which was acid labile was detected in the CSF of 89% and 63% respectively of patients with mumps and enterovirus meningitis.     

Mumps as a cause of admission to hospital: An estimate for Western Australia 1981

Close to 40% of children admitted to Princess Margaret Hospital with mumps over the period 1979 to 1982 were diagnosed retrospectively as a result of virological tests and their illness was not coded as being due to mumps. This clinical underestimate of the incidence of mumps is due to the frequent absence of salivary gland enlargement, especially in preschool children. In such cases there is usually evidence of inflammation of the upper respiratory tract. The main clinical features leading to admission were neck stiffness, fits and high fever. An appropriate adjustment was made to the figures obtained from the computerised data on discharges with the diagnosis of mumps from Western Australian hospitals in 1981. This led to the estimate that 104 patients suffering from mumps were discharged from hospital during that year. It was also estimated that mumps was responsible for 379 in-patient days. Our findings show that the benefit cost ratios for mumps immunization of others are underestimates.     

Epidemiologic studies on Mumps

An intrafamilial serological and virological surveillance of mumps was carried out in Nagoya, a Japanese large city; where urbanization has been in progress rapidly and children are suffering from mumps sporadically nearly all the year around. Fourty five families with sporadic cases of mumps were studied. Of 59 sensitive contacts in the family, 33 suffered from clinically apparent mumps and 24 progressed subclinical infection. Only two of them escaped from the infection after exposure. Subclinical infections were more frequent in younger children. Among 7 sensitive contacts who resulted in subclinical infection after the exposure, 5 children were found to discharge mumps virus. Virus was also isolated from two mothers of the indicator cases, although their serological examinations revealed that they were apparently re-infected persons. It may be possible to postulate that 1) in the families dwelling in the urban area of the city, mumps virus has very high communicability, 2) subclinical infections were more frequent in younger children, 3) subclinically infected and re-infected persons would be sources of virus transmission, as well as mumps patients.     

2004~2018年全国流行性腮腺炎发病特征及重点防控人群分析

目的 分析2004~2018年我国流行性腮腺炎（简称流腮）的流行病学特征,为确定流腮防控重点人群提供数据支持。方法 通过国家人口与健康科学数据共享服务平台和国家卫生健康委员会疾病预防控制局报告的2004~2018年全国流腮报告发病数据,采用描述性流行病学方法,分析流腮的发病特征。结果 2004~2018年全国共报告流腮4 272 368例,年平均报告发病率为21.44/10万。2008年起单剂含腮腺炎成份的疫苗加入国家计划免疫,但各年发病率范围仍在12.84/10万~35.59/10万之间。北京、天津和上海实施第2剂麻疹-腮腺炎-风疹联合减毒活疫苗（MMR）常规免疫后,三地区的流腮报告发病率均降至10/10万左右。2004~2016年间3~14岁人群流腮发病占比81.16%。2004~2013各年份多以6岁儿童流腮发病率最高。结论 单剂含有腮腺炎成份的疫苗接种对流腮发病率无明显影响。从各年龄组流腮发病率看,6岁儿童最高。建议在学龄前儿童开展第2剂次含腮腺炎成分疫苗接种。     

Changes in Lipid Classes and Fatty Acid Compositions in Purified Myelin of EAE Guinea Pig Brain

Purified myelin fractions were prepared from brains of control and EAE sensitized guinea pigs on the 5th, 9th and 15th day after injection of antigen. Lipid classes were quantified and expressed as per cent of micromol contents of phospholipids and galactolipids, and fatty acid compositions each of them were analyzed. Cerebroside was markedly reduced with progress of the day, keeping Sulf/Osd ratio in normal constant (0.31–0.36). This was a characteristic finding in this study. Phosphatidyl ethanolamine, ethanolamine plasmalogen and sphingomyelin were also decreasing when compared among phospholipids whereas phosphatidyl choline was increasing. Fatty acid composition showed little change. Anionic lipids like sulfatide are said to play an important role in binding non-ionic and zwitterionic lipids tightly to the myelin protein. From many reports on electron microscopic observations, it could be considered that the mode of insults to the myelin “lipid” would be rather secondary in demyelination process. The significance of the findings in this study and informations above mentioned were discussed, and a mechanism of demyelination was speculated. In brief, some factors might cause the ionic derangement in the basic amino group of myelin protein, the target of immune reaction, and anionic lipids might therefore be separated from it, being accompanied by such other lipids as cerebroside.     

Serum amyloid A protein in acute viral infections

Concentrations of serum amyloid A protein (SAA) were measured in 254 children with viral diseases, including measles, varicella, rubella, mumps, echo-30 meningitis, chronic hepatitis B and C, and in eight with Kawasaki disease. Latex agglutination nephelometric immunoassay was used for assaying SAA. In 191 out of 195 patients (98%), SAA concentrations became markedly raised in the acute phase of the viral disease: measles (97%), varicella (100%), mumps (95%), and echo-30 meningitis (99%) with mean titres of 82.4, 80.5, 60.2, 75.2, and 101.1 micrograms/ml respectively. This increase in SAA was followed by a rapid return to normal concentrations (< 5 micrograms/ml) during convalescence. Remarkably higher concentrations of SAA (mean 1630 micrograms/ml) were detected in the acute phase of patients with Kawasaki disease, but in most of the children with chronic hepatitis B or C, the titres of SAA remained normal. There was no close correlation between SAA and serum concentrations for alpha 1-acid glycoprotein, beta 2-microglobulin, transferrin, and IgG. There was a clear correlation between SAA and C reactive protein concentrations, although SAA showed a greater incremental change than C reactive protein in the acute phase. In the acute phase of these viral diseases, 56% of the patients had raised SAA concentrations (> or = 5 micrograms/ml) with normal C reactive protein concentrations (< 5 micrograms/ml). These results indicate that SAA could be useful as an inflammatory marker in children with acute viral infections.     

Mumps disease and its health impact: an outbreak-based report

An outbreak of mumps in a middle school (grades 6 to 8) in Ohio during 1981 was investigated to describe the clinical findings, health impact, and costs. Individuals with clinical mumps in the middle school and in family members were questioned concerning symptoms, complications, hospitalizations, school days absent, and parental work days missed. There were 62 cases of clinical mumps in the middle school and 13 cases among family members. Parotitis lasted an average of 7.4 days and fever (if present) lasted an average of 2.5 days with a mean temperature of 38.6 degrees C (101.4 degrees F). The duration of parotitis and fever increased with age. Complications included encephalitis, aseptic meningitis, orchitis, oophoritis, mastitis, and pancreatitis. Visits to physicians were made by 62.7% (47/75) of the individuals with mumps for a total of 63 visits, and two patients were hospitalized for a total of six days. Persons who attended middle school missed an average of 4.9 days of school. The estimated direct and indirect costs associated with this outbreak were $2,460 and $1,353, respectively, or $51 per case. States lacking mumps immunization requirements experienced a three-times greater incidence of mumps in 1982 than States that required all school pupils to be immunized. We recommend that all States institute compulsory mumps school immunization laws for all school children.