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Difficulty with mumps diagnosis: what is the contribution of mumps mimickers?
Todd F Hatchette1, James B Mahony, Sylvia Chong
1Division of Microbiology, Department of Pathology and Laboratory Medicine, Capital District Health Authority, Nova Scotia, Canada. todd.hatchette@cdha.nshealth.ca
Background:
Mumps is a vaccine preventable disease that typically presents with unilateral or bilateral parotitis. In February 2007, mumps re-emerged in university students in Nova Scotia. Despite highly sensitive methods for mumps virus detection, only 14% (298/2082) of cases during the peak of the outbreak were laboratory confirmed.
Objectives:
Due to the low positivity rate, this study investigated whether infection with other viral pathogens caused mumps-like presentations during the outbreak.
Study Design:
148 buccal specimens from patients who presented with unilateral or bilateral parotitis but had negative laboratory tests for mumps virus were tested for Epstein-Barr virus (EBV) and cytomegalovirus (CMV) by quantitative PCR and 21 different viral markers using the Luminex xTAG Respiratory Virus Panel (RVP). Companion sera to each buccal specimen were available for EBV and CMV serology to differentiate acute infection from reactivation.
Results:
No correlation was observed since viral pathogens were detected in both the parotitis and non-parotitis groups.
Conclusion:
Although there was co-circulation of other viral pathogens during the mumps outbreak, no difference was observed in the prevalence between patients who presented with or without parotitis. The low positivity rate for specimens submitted for mumps diagnostics was likely the result of increased Public Health messaging and physician inexperience in recognizing mumps infection, suggesting the clinical acumen for mumps diagnosis based solely on clinical presentation is low.
Insights
During a mumps outbreak, other viral infections did not explain the low laboratory confirmation rate for parotitis cases. Clinical diagnosis of mumps based on symptoms alone is unreliable.
Area of Science:
- Epidemiology
- Virology
- Public Health
Background:
- Mumps is a vaccine-preventable illness often causing parotitis.
- A 2007 mumps outbreak in Nova Scotia had a low laboratory confirmation rate (14%).
- This low rate prompted investigation into other causes of mumps-like symptoms.
Purpose of the Study:
- To determine if other viral pathogens caused mumps-like presentations during the outbreak.
- To investigate the low laboratory confirmation rate of mumps cases.
Main Methods:
- 148 buccal specimens from patients with parotitis but negative mumps tests were analyzed.
- Tests included quantitative PCR for Epstein-Barr virus (EBV) and cytomegalovirus (CMV).
- The Luminex xTAG Respiratory Virus Panel (RVP) tested for 21 viral markers; serology differentiated acute infection from reactivation.
Main Results:
- Viral pathogens were detected in both parotitis and non-parotitis groups.
- No correlation was found between other viral infections and parotitis.
- The prevalence of co-circulating viral pathogens did not differ between groups.
Conclusions:
- Other viral pathogens circulated during the mumps outbreak but did not explain the low diagnostic yield.
- Increased public health messaging and physician inexperience likely contributed to the low mumps positivity rate.
- Clinical diagnosis of mumps based solely on presentation has low accuracy.
