Pathogenesis

Infection occurs when virus-laden droplets of saliva are inhaled by a person who lacks immunity to mumps. The incubation period is long, generally 15 to 21 days, because the virus reproduces first in the upper respiratory tract, then is spread throughout the body by the bloodstream, and produces symptoms only after infecting tissues such as the parotid glands, meninges, pancreas, ovaries, or testicles. In the salivary glands, the virus multiplies in the epithelium of ducts that convey saliva to the mouth. This destroys the epithelium, which releases enormous quantities of virus into the saliva. The body's inflammatory response to the infection is responsible for the severe swelling and pain. A similar sequence of events occurs in the testicles, where the virus infects the system of tubules that convey the sperm. The marked swelling and pressure often impair the blood supply, leading to hemorrhages and death of testicular tissue. Kidney tubules are also infected, and the virus can be cultivated from the urine for 10 or more days following the onset of illness.

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