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Tuesday, July 8, 2008

Some aspects of Mumps with homoeopathic mode of treatment

Mumps is an acute, highly infectious disease of childhood caused by mumps virus, a RNA virus belonging to the family of paramyxoviruses which has a predilection for glandular and nervous tissues. The virus is antigenically stable and only one serotype exists. Humans are the only natural hosts. No human carriers or animal reservoirs exist. One attack confers lasting immunity and so second attacks are not seen. Introduction of aggressive immunization has dramatically reduced the incidence of the disease in the developed countries.

Age- Although no age is exempt, it is primarily a disease of childhood and young adults it is uncommon before 2 years of age. It often occurs as epidemics in children of 5-15 years as well as in young people living in groups as in army camps.

Spread of infection- This infection spreads by direct contact, airborne droplets or fomites contaminated with saliva and possibly also with urine.

Source of infection- The source of infection is a patient in the late incubation or early clinical stage of illness. The peak infectivity is about a day or two before the clinical manifestation of parotitis and subsides rapidly thereafter.

Incubation Period- Long and is about 12-25 days, average being 18 days.

Clinical Features- The prodromal symptoms are non-specific and include fever, malaise, headache and anorexia usually followed by severe pain over the parotid gland with its swelling. Sometimes parotid gland swelling may be the first clinical manifestation of the illness. Parotid swelling is unilateral to start with but may become bilateral. There is stiffness of jaw, inability to open the mouth. Dryness of the mouth with foul smell is also present. There is local pain and tenderness over the parotid gland region. There is also tenderness over the posterior ramus of the mandible. The swelling of the soft tissue may proceed downwards. The enlarged parotid glands obscure the angle of the mandible and may elevate the ear lobe. The parotitis is non-suppurative and usually resolves within a week. Rarely only the submandibular gland involvement may occur.

Complications- The most commonest complication is orchitis. It is usually unilateral but may also be bilateral when it may cause sterility due to testicular atrophy. Other less common complications are arthritis, oophoritis, nephritis, pancreatitis, thyroiditis and myocarditis. Besides these, central nervous system involvement is very often seen; it may cause ‘aseptic meningitis’ as well as meningoencephalitis in some cases. But both of these usually resolve without sequelae. A portion of patients with central nervous system involvement involvement may not show any evidence of parotid gland involvement.

Laboratory Investigations- A typical case of mumps does not need any laboratory investigation for confirmation. Laboratory investigations are needed for atypical cases.

(1) Blood Examination- Some non-specific findings may be present in the blood. The WBC may be low with lymphocytes predominating. ESR and CRP may be normal or slightly elevated. Serum amylase levels may be elevated even without pancreatic involvement.

(2) Virus Isolation - Virus can be isolated in cell culture from saliva, throat swab, urine and CSF and virus identification can be performed by neutralization or inhibition of haemadsorption by specific sera.

(3) Serologic test- Positive serologic test for serum mumps IgM antibody or four-fold rise between acute- and convalescent-phase titers in serum mumps IgG antibody level may help in the establishment of the diagnosis of the disease.

(4) Reverse transcription polymerase chain reaction (RT- PCR) Test - Detection of viral RNA by this test is also helpful for confirmation of the diagnosis.

Prophylaxis- Active immunization with a live attenuated mumps virus vaccine given as a single dose can prevent the disease in children over the age of 1 year, below which age the vaccine is not recommended as it may be inhibited by maternally acquired antibodies. The vaccine is not to be given to immunosuppressed individuals or to those with severe febrile illness and also during pregnancy.

Treatment- Homoepathy plays a vital role in the treatment of mumps. Isolation of the patient and proper maintenance of oral hygiene are the first things to be borne in mind. Of the medicines, Bell ( Belladonna) 200 and Rhus.tox (Rhus Toxicodendron) 200 are to be taken alternatively at an interval of three hours between the two medicines three times daily. This should be continued for one week. Then at least for the next two weeks, both the two medicines should be continued two times daily with the gap between them increasing to not less than four hours. If there is associated throat pain, Phytolacca 200 should be added along with four times daily till the pain persists. If temperature is present, Ferrum.Phos 6x should also be given three times daily along with the main medicines.

Labels-Anorexia, Fever, Headache, Immunization, Virus, Ferrum.Phos, Bell ( Belladonna), Reverse transcription polymerase chain reaction (RT- PCR) Test, Attenuated, Isolation, Rhus.tox (Rhus Toxicodendron), Medicine, Swelling, Temperature, Serologic test, IgM, IgG, Acute, Convalescent, Antibody, Arthritis, Oophoritis, Nephritis, Pancreatitis, Thyroiditis, Myocarditis.

IN SHORT-Mumps is an acute, highly infectious viral disease of childhood which begins with non-specific symptoms like fever, malaise, headache & anorexia and is soon followed by severe pain over the parotid gland with its swelling. The parotitis is non-suppurative and usually resolves within a week. The disease may be associated with several complications the most important of which is orchitis. Prevention is done with active immunization with a live attenuated mumps virus vaccine. Treatment is as mentioned above.

But in every case a doctor should be consulted।

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