Buccal/throat swabs. Massage the parotid (salivary) glands for 30 seconds. Swab the buccal cavity, which is the space near the upper rear molars between the cheek and teeth; Stensen's duct drains into this space. Immediately place the swab into a tube of viral transport medium (VTM). Urine and blood specimens should also be routinely collected and submitted for testing to enhance the likelihood of detecting mumps virus RNA by real-time PCR. For suspected mumps cases complicated by meningitis or encephalitis, a CSF sample should be submitted along with the other sample types mentioned above.
Keep specimen at 4C
Alternative specimen types include a NASOPHARYNGEAL ASPIRATE and COMBINED THROAT AND NASOPHARYNGEAL SWABS. Collect the aspirate in a leukens trap and immediately transport to Clinical Virology Laboratory. Refer to the Nursing Procedure Manual, Section VII, Respiratory Care, 7:14:a for complete instructions on the collection of a nasopharyngeal aspirate using a leukens trap. Nasal washings, tracheal aspirates, bronchoalveolar lavage specimens, and lung tissue may be submitted. Place tissue in Viral Transport Medium. Collection of COMBINED THROAT AND NASOPHARYNGEAL SWABS is recommended for patients in which aspirates or washings cannot be readily obtained. For collection of nasopharyngeal swab specimen:1. Insert swab into one nostril.2. Press swab tip on the mucosal surface of the mid-inferior portion of the inferior turbinate, and rub the swab tip several times across the mucosal surface to loosen and collect cellular material.3. Withdrawal the swab; place swab into tube of Viral Transport Medium.For collection of oropharyngeal swab specimen:1. Ask patient to open mouth widely and phonate an 'ah'.2. Gently depress the tongue with a tongue blade.3. Guide a swab over the tongue into the posterior oropharynx.4. Using a gentle back-and-forth sweeping motion, swab the area behind the uvula and between the tonsillar pillars.5. Withdrawal the swab; place swab into the same tube of Viral Transport Medium that contains the nasoparyngeal swab.
Swab specimens not received in viral transport medium or received in bacteriological transport medium are discouraged. DO NOT USE CALCIUM ALGINATE OR WOODEN SHAFT SWABS FOR COLLECTION OF SPECIMENS; ONLY USE DACRON OR RAYON TIPPED SWABS ON PLASTIC OR METAL SHAFTS.
Indirect immunofluorescence using primary monoclonal antibodies specific to mumps virus antigens and fluorescein-labeled secondary monoclonal antibodies.
Following an incubation period of 14-18 days, mumps begins with a nonspecific prodrome of low-grade fever, headache, respiratory symptoms, malaise, and myalgia. Most common feature is swelling of salivary glands in 30-40%, particularly the parotid glands. Swelling is usually bilateral; unilateral in 25% of cases. Severe illness with complications more likely in adults. The virus is transmitted from person to person through respiratory secretions and is quite contagious. Greatest communicability is 1-2 days before to 5 days after onset of parotid gland swelling. Illness lasts a week to 10 days. Complications include orchitis in 20-30% of infected postpubescent males, oophoritis and mastitis in 5% of postpubertal females; sterility and impaired fertility are uncommon. Mumps can also be complicated by meningitis and encephalitis.
Clinical diagnosis of mumps is unreliable; requires laboratory confirmation. Although once a common disease in children, fewer physicians now recognize the clinical features of mumps. Also, many viruses, including parainfluenza virus, enteroviruses, EBV, CMV, HIV, and influenza virus, can cause acute parotitis. Mumps virus PCR is most useful in detecting mumps virus RNA from buccal/throat swabs, urine, blood, and CSF (for meningitis/encephalitis) specimens to diagnose acute disease in unvaccinated or previously vaccinated individuals. Outbreaks of mumps still
occur in the United States despite high coverage rates with vaccine. The disease is normally imported from abroad or associated with importation from other countries and outbreaks arise in people who have not been immunized and as a result of two-dose vaccine failure. Therefore, both unvaccinated and vaccinated persons are at risk for acquiring mumps themselves and transmitting the virus to
others. Living in closed communities in crowded conditions is a contributing factor in the spread of the virus.
If positive, results are reported as mumps virus antigen detected.
Negative or no mumps virus antigen detected
It is recommended that a nasopharyngeal aspirate, urine, blood, and CSF (if patient has central nervous system disease) be submitted for PCR and serum be collected and submitted for mumps-specific IgM and IgG serologies when collecting specimens for rapid mumps antigen detection.