Influenza-Associated Parotitis During the 2014-2015 Influenza Season in the United States.

Background: During the 2014-2015 influenza season in the United States, 256 cases of influenza-associated parotitis were reported from 27 states. We conducted a case-control study and laboratory investigation to further describe this rare clinical manifestation of influenza. Methods: During February 2015-April 2015, we interviewed 50 cases (with parotitis) and 124 ill controls (without parotitis) with laboratory-confirmed influenza; participants resided in 11 states and were matched by age, state, hospital admission status, and specimen collection date. Influenza viruses were characterized using real-time polymerase chain reaction and next-generation sequencing. We compared cases and controls using conditional logistic regression. Specimens from additional reported cases were also analyzed. Results: Cases, 73% of whom were aged <20 years, experienced painful (86%), unilateral (68%) parotitis a median of 4 (range, 0-16) days after onset of systemic or respiratory symptoms. Cases were more likely than controls to be male (76% vs 51%; P = .005). We detected influenza A(H3N2) viruses, genetic group 3C.2a, in 100% (32/32) of case and 92% (105/108) of control specimens sequenced (P = .22). Influenza B and A(H3N2) 3C.3 and 3C.3b genetic group virus infections were detected in specimens from additional cases. Conclusions: Influenza-associated parotitis, as reported here and in prior sporadic case reports, seems to occur primarily with influenza A(H3N2) virus infection. Because of the different clinical and infection control considerations for mumps and influenza virus infections, we recommend clinicians consider influenza in the differential diagnoses among patients with acute parotitis during the influenza season.

Non-mumps Viral Parotitis During the 2014-2015 Influenza Season in the United States.

Background: During the 2014-2015 US influenza season, 320 cases of non-mumps parotitis (NMP) among residents of 21 states were reported to the Centers for Disease Control and Prevention (CDC). We conducted an epidemiologic and laboratory investigation to determine viral etiologies and clinical features of NMP during this unusually large occurrence. Methods: NMP was defined as acute parotitis or other salivary gland swelling of >2 days duration in a person with a mumps- negative laboratory result. Using a standardized questionnaire, we collected demographic and clinical information. Buccal samples were tested at the CDC for selected viruses, including mumps, influenza, human parainfluenza viruses (HPIVs) 1-4, adenoviruses, cytomegalovirus, Epstein-Barr virus (EBV), herpes simplex viruses (HSVs) 1 and 2, and human herpes viruses (HHVs) 6A and 6B. Results: Among the 320 patients, 65% were male, median age was 14.5 years (range, 0-90), and 67% reported unilateral parotitis. Commonly reported symptoms included sore throat (55%) and fever (48%). Viruses were detected in 210 (71%) of 294 NMP patients with adequate samples for testing, ≥2 viruses were detected in 37 samples, and 248 total virus detections were made among all samples. These included 156 influenza A(H3N2), 42 HHV6B, 32 EBV, 8 HPIV2, 2 HPIV3, 3 adenovirus, 4 HSV-1, and 1 HSV-2. Influenza A(H3N2), HHV6B, and EBV were the most frequently codetected viruses. Conclusions: Our findings suggest that, in addition to mumps, clinicians should consider respiratory viral (influenza) and herpes viral etiologies for parotitis, particularly among patients without epidemiologic links to mumps cases or outbreaks.

Muscle dysmorphia: risk may be influenced by goals of the weightlifter.

Athletes with muscle dysmorphia suffer from constant dissatisfaction with body size and shape because they perceive themselves as smaller and less muscular than they actually are. There may be discrepancies among the various subgroups within the weightlifting community in regards to vulnerability and susceptibility to the development of MD. The purpose of this study, therefore, was to examine and compare MD symptomology between male and female, competitive and noncompetitive, and appearance-related and performance-related weightlifters. The MD assessments were made with the muscle dysmorphia inventory (MDI). The participants included 85 competitive (55 men and 30 women) and 48 noncompetitive (24 men and 24 women) weight training athletes. Each group included athletes with a primary focus on appearance enhancement or performance enhancement. Factorial analyses of variance were used to measure differences between each group on all MDI subscales. The results showed that men scored significantly higher than did women on the supplement (p = 0.006), physique protection (p = 0.039), and body size and symmetry subscales (p < 0.001). Competitive athletes scored significantly higher than noncompetitive athletes did on diet (p < 0.001), supplement (p < 0.001), exercise dependence (p < 0.001), and body size and symmetry (p = 0.002) subscales. Finally, the athletes focused on appearance enhancement scored significantly higher than athletes focused on performance enhancement on all 6 subscales (p < 0.01). Coaches and health and fitness professionals should understand that the goals of athletes in regard to weight training can influence susceptibility to development of MD symptoms. Knowing that athletes who engage in weight training to enhance appearance may exhibit greater behavioral characteristics than those athletes who do not may be helpful so they may be able to identify, prevent, and reverse MD in the athletes they serve.