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Mumps clinical diagnostic uncertainty
Fabio Magurano1, Melissa Baggieri1, Antonella Marchi1
1National Reference Laboratory for Measles and Rubella, Department of Infectious Diseases, National Institute of Health, Rome, Italy.
Background:
During recent years, various mumps outbreaks have occurred among populations vaccinated for mumps worldwide. In Italy, improving routine coverage with two doses of measles, mumps and rubella (MMR) vaccine is one of the key strategies to eliminate measles and rubella. To monitor the effect of the vaccination programme on the population, the surveillance of these vaccine-preventable diseases has been implemented. This provided the opportunity to evaluate the accuracy of the clinical diagnosis of those diseases, including mumps. In fact, vaccinated children may develop a variety of diseases caused by a series of different viruses [Epstein-Barr virus (EBV), parainfluenza virus types 1-3, adenoviruses, herpes virus and parvovirus B19] whose symptoms (i.e. swelling of parotid glands) may mimic mumps. For this reason, laboratory diagnosis is essential to confirm clinical suspicion.
Methods:
The accuracy of clinical diagnosis of mumps was evaluated by differential diagnosis on EBV in Italy, a country at low incidence of mumps. This retrospective study investigated whether the etiology of 131 suspected mumps cases with a negative molecular/serological result for mumps virus, obtained from 2007 to 2016, were due to EBV, in order to establish a diagnosis.
Results:
Differential diagnosis revealed a EBV positivity rate of 19.8% and all cases were caused by EBV type 1.
Conclusions:
This study confirms the importance of a lab based differential diagnosis that can discriminate between different infectious diseases presenting with symptoms suggestive of mumps and, in particular, emphasize the importance to discriminate between mumps and EBV-related mononucleosis.
Insights
Mumps outbreaks occur even in vaccinated populations. Laboratory diagnosis is crucial to differentiate mumps from Epstein-Barr virus (EBV) infections, which present similar symptoms and were found in nearly 20% of suspected cases.
Area of Science:
- Infectious Diseases
- Vaccinology
- Virology
Background:
- Mumps outbreaks persist globally despite widespread measles, mumps, and rubella (MMR) vaccination.
- Clinical diagnosis of mumps can be challenging due to similar symptoms caused by other viruses, including Epstein-Barr virus (EBV).
- Accurate laboratory diagnosis is essential for differentiating mumps from other conditions presenting with parotid gland swelling.
Purpose of the Study:
- To evaluate the accuracy of clinical mumps diagnosis in Italy.
- To investigate the prevalence of Epstein-Barr virus (EBV) in suspected mumps cases with negative mumps virus results.
- To establish differential diagnosis protocols for mumps-like illnesses.
Main Methods:
- Retrospective analysis of 131 suspected mumps cases from 2007-2016 in Italy.
- Differential diagnosis focusing on EBV in cases negative for mumps virus (molecular/serological tests).
- Identification of EBV type in positive cases.
Main Results:
- Epstein-Barr virus (EBV) was identified as the causative agent in 19.8% of suspected mumps cases.
- All EBV-positive cases were attributed to EBV type 1.
- This highlights a significant rate of EBV misdiagnosis for mumps.
Conclusions:
- Laboratory-based differential diagnosis is critical for accurate identification of infectious diseases with mumps-like symptoms.
- Distinguishing between mumps and EBV-related mononucleosis is particularly important.
- This study underscores the need for robust diagnostic methods beyond clinical presentation.
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