Polite Dissent

A patient came in the office stating very clearly that she wanted some penicillin. She had recently visited her family in the Philippines and they had all come down with sore throats. Her nephew had it first, then other relatives got it, and now she had started noticing a sore throat on the plane trip back to the U.S.. She was running a fever and feeling very tired. She had talked to her family back in the Philippines and they told her their doctor had given them penicillin, so that’s what she wanted.

On exam, she was a heavyset Filipino woman who appeared slightly jowly. She was running a 102.5° fever, but her vital signs were otherwise normal. Her throat appeared normal with no signs of infection. The rest of her exam was essentially normal as well.

Still, something didn’t sit right and I took a closer look. She had very chubby cheeks, but underneath the fat there was a definite inflammation of both of her parotid glands (the large salivary glands located just in front of and below the ears). With this piece of evidence, the diagnosis was clear. She had what once had been a classic childhood disease. I told her that penicillin wouldn’t do her any good and tried to explain why (though I don’t think she understood. She still wanted antibiotics). I sent her to the lab to check an antibody titer to confirm the diagnosis.

This patient has a case of the mumps, an uncommon disease in the United States. Mumps is a viral disease that is very contagious and spread by airborne droplets. The most common symptoms include fever, fatigue, painful swallowing, painful chewing and swollen parotid glands. About 1/3 of patient show no significant symptoms. There is no treatment for mumps other than time; most cases resolve in 1-2 weeks. Though rare, serious complications can occur including meningitis, pancreatitis, and orchitis (which can lead to sterility).

Mumps has been very rare in the United States since the introduction of the mumps vaccine (included in the MMR vaccine) in 1967. While once there were over 200,000 cases annually, there are now less than 300 cases per year. Many of those (like this patient) are probably imported. Mumps is a reportable disease.

The nurses and I had a hard time explaining to this patient that penicillin would not help because mumps is a viral illness. She was also quite upset when we wouldn’t let her baby-sit her 9 month old grandson until she had gotten over the mumps (the MMR vaccine isn’t given to children until they are at least a year old). No one else in her family came down with the disease, though they (except the young grandson) had all been immunized.