Mumps

Dear Lisa,

I have a question for you. My daughter who is away at college in Pennsylvania called me and told me that she has intense jaw pain and a large cold sore on her top and bottom lips. She went to the school dispensary and they told her that she had a swollen lymph node in her neck. They just gave her Motrin and told her to come back. They also mentioned that she should have the dentist take a look to see if the problem is with her teeth. She told me she has no pain in her gums and doesn’t think that's the problem. She is going back to the dispensary today. Any idea what might be causing the pain in her jaw?

“Daughter with Jaw Pain”

Dear “Daughter with Jaw Pain”,

Jaw pain may be due to a multitude of reasons. Dental abnormalities such as gum abscess, TMJ or Wisdom Teeth eruption are some possible causes. If your daughter’s symptoms persist it would be a good idea to consult a dentist as the infirmary suggested in order to rule out these potential problems. A teenager with an upper respiratory infection or throat infection may develop swollen lymph nodes in her cervical area which can cause pain in the neck area and under the jaw line. If your daughter continues to experience symptoms it would be important to follow up with a Physician.

Swelling of the parotid gland which is located in the jaw area also causes jaw pain. When swelling of the Parotid gland or Parotitis occurs, it extends above and below the jaw bone. (1) Parotitis has many causes including infection with Parainfluenza virus, Influenza virus, Coxsackie virus, Echovirus, Lymphocytic choriomeningitis virus, HIV, immunologic disorders, side effects to medication (iodides or guanethidine) or tumor. (2) One of the most common causes of Parotitis in children and adolescence is the Mumps virus. (1)

The Mumps is caused by a Paramyxovirus and was considered a common childhood illness until the introduction of the Vaccine in l967. ( 3). In 2005, the first outbreak of the Mumps in more than 20 years began in the United States. (4) The majority of the cases occurred in the Midwest, in young adults from 18 to 25 years old. Most of them were vaccinated for the Mumps. (4) Health officials have identified the strain that is circulating in the Midwest to be the same strain that is responsible for an outbreak in the United Kingdom. (4). There have been 70,000 cases of Mumps in the United Kingdom since 2004.

More than 4,600 people contracted the Mumps this year in the Midwest area of the United States. (5) This recent outbreak primarily involved young adult college students. (5) The states involved include Iowa, South Dakota, Nebraska, Missouri, Kansas, Pennsylvania, Illinois and Wisconsin. (5) In the past, the Mumps was a concern in the late winter and early spring, but an outbreak in a camp in Upstate New York extended to the late summer months.(3,6)

The symptoms of the Mumps include swelling of the parotid salivary gland accompanied by muscle aches, decreased appetite, headache and low grade fever. (4, 7) Many times a child develops swelling of the cheeks and neck. (7) The disease is transmitted via spread of respiratory secretions or from exposure to saliva. The spread of the virus occurs through sneezing, coughing and sharing of utensils, cups and other items contaminated with saliva. (4) The symptoms typically appear two to three weeks after a person is exposed. (4)

Since your daughter has a few risk factors including her age, her residence in Pennsylvania, living on campus at a College, and jaw pain you may want to consider seeing a doctor and discussing this possibility. It would be a good idea to ask her about her recent exposures. Has her roommates or friends recently been ill with the mumps or an undiagnosed illness? Has she had close contact with someone with the Mumps or a viral illness? Unfortunately patients that contract the Mumps may not be able to identify the source. This occurs because many patients with the Mumps develop non-specific symptoms or sometimes no symptoms at all. Because of this they can spread the germ unknowingly. (7)

If your daughter’s symptoms worsen or persist, or if she develops new symptoms such as swelling around her neck, face or jaw area, muscle aches, fever or decrease appetite she should have an evaluation by a Physician. Your daughter did report cold sores in her mouth which is typical of a virus. Coxsackie virus causes lesions around the lips and may also cause Parotitis. The physician that your daughter sees will be able to exam her cold sores and rule out Mumps and or Coxsackie virus.

I hope she's feeling better soon.

References:
(1)Bates B. A Guide to Physical Examination and History Taking. Fifth Ed. Philadelphia, PA:J.B.Lippincott Company.1991:592.
(2)Centers for Disease Control and Prevention. Mumps-Technical Q & A. Available at http://www.cdc.gov/nip/diseases/mumps/mumps-tech-faqa.htm. Accessed Oct 2006.
(3) Schwartz M, Charney E, Curry T, Ludwig S. Pediatric Primary Care. A Problem Oriented Approach. 2nd Ed. Littleton, Mass:Year Book Medical Publishers, Inc. 1990:474.
(4 )Brunell P. Health Officials investigate mumps outbreak. Infectious Diseases in Children. 2006. May:8.
(5)Rusk J. Mumps Outbreak in the Midwest Persists. Infectious Diseases in Children. 2006. August:9-10.
(6)Mumps Outbreak at a summer camp-New York, 2005. MMWR. 2005;55:175-177.
(7)Pediatrics Update. Mumps: Making Headline News. Consultant for Pediatricians. 2006. July:412-414.


Lisa-ann Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner

Pediatric Advice About Infectious Diseases