The onset of mumps is marked by fever, loss of appetite, and headache. Typically these symptoms are followed by painful swelling of one or both parotid glands (figure 24.10). Spasm of the underlying muscle makes it difficult to chew or talk. The word mumps probably derives from the verb mump, meaning "to mumble" or "whisper." Symptoms of mumps usually disappear in about a week.

Although painful parotid swelling is characteristic of mumps, up to half of the cases of mumps virus infection show no obvious parotid involvement. Symptoms can arise elsewhere in the body with or without parotid swelling. For example, headache and stiff neck indicate that the virus is causing meningitis, infection of the coverings of the brain, a common manifestation of mumps virus infection. Generally, mumps symptoms are much more severe in individuals past the onset of puberty. For example, about one-quarter of cases of mumps in post-pubertal boys and men are complicated by rapid intensely painful swelling of one or both testicles to three to four times their normal size. Atrophy, or shrinkage, of the involved testicles commonly develops after recovery from the illness, and in rare cases, sterility is a sequel. In women and post-pubertal girls, ovarian involvement occurs in about one of 20 cases, manifested by pelvic pain. Pregnant women with mumps commonly miscarry, but birth defects do not result from mumps as they do from rubella. Serious consequences of mumps are rare and are most likely to occur in older people. These consequences include deafness and death from encephalitis, or brain infection. ■ rubella, p. 552

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