Laboratory Findings
Most cutaneous warts are diagnosed clinically, and specific laboratory confirmation is not required. The diagnosis of papillomavirus infections at anogenital and other sites can often be made clinically, but specific diagnostic testing may be warranted.
Culture
: Isolation of HPV by viral culture is not available.
Serology
: Not useful for diagnosis of HPV infection.
Cytologic or histologic examination
: These techniques can be considered “gold standard” for confirmation of HPV disease; however, they do not provide HPV type determination.
NAAT assays
: Most sensitive detection of HPV infection and may provide information about the genotype (or risk category) of the infecting virus if type-specific primers are used. See Human Papillomavirus (HPV) Molecular Testing in Chapter
17
, Infectious Disease Assays.
MUMPS
Definition
Mumps is usually a mild, self-limited viral infection caused by mumps virus. The virus is highly contagious and transmitted by respiratory droplets. Humans are the only natural reservoir, and children, especially in the pre–vaccination era, were the primary targets of infection. The incidence of mumps dropped >99% since the introduction of live vaccine in 1967, but recent outbreaks have occurred in the United States.
Who Should Be Suspected?
After exposure, there is a 1- to 2-week incubation period followed by onset of prodromal symptoms. Prodromal symptoms are nonspecific, including fever, malaise, myalgias, anorexia, and headache. Ninety-five percent of patients develop the characteristic swelling and tenderness of the parotid glands. Parotid swelling may last for 7–10 days. Subtle disease may develop in a minority of patients, usually adults, consisting of predominantly respiratory symptoms. Virus shedding and secondary transmission begin during the prodromal period and peak in the days before the onset of parotitis.
Mumps is associated with several common complications.
Up to 10% of patients develop symptomatic aseptic meningitis with typical symptoms of headache, mild nuchal rigidity, and low-grade fever.
CSF profile typically shows pleocytosis with lymphocyte predominance, normal or slightly elevated protein, and normal or slightly decreased glucose. Full recovery without sequelae is the rule. Less than 0.1% of patients develop mumps encephalitis, with fever and altered levels of consciousness, seizure, paralysis, ataxia, or other CNS abnormalities. Parotitis may be absent in 20–60% of patients. The peripheral WBC count is usually normal. A mild CSF mononuclear pleocytosis is typical (average 250 cells/ mL); protein is usually normal or slightly elevated (≤100 mg/dL); glucose concentration is usually normal but is decreased in ≤29% of cases.
Simultaneous serum and CSF specimens show increased mumps IgG antibody index (in 83% of patients) and mumps IgM antibody index (in approximately 67% of patients with IgM in CSF). Oligoclonal Ig in CSF is detected in 90% of cases. Virus can be isolated from CSF by culture. PCR has been reported to provide more rapid and sensitive diagnosis compared to culture. Recovery is usually complete.
Sensorineural deafness, with occasional vestibular symptoms, is a welldocumented complication of mumps.
Orchitis, manifested by high fever and severe testicular pain with testicular and scrotal swelling, occurs in 30–40% of postpubertal males with mumps infection. Symptoms typically occur approximately 10 days after onset of parotitis. There may be unilateral or bilateral involvement. WBC count and ESR are typically elevated. Full sterility is rare following mumps orchitis, but impaired fertility may be seen in a minority of patients. Oophoritis occurs in 5–10% of postpubertal females.
Other uncommon complications of mumps include arthritis, pancreatitis, and myocarditis. Mumps infection in pregnant women is not associated with congenital anomalies.
