Rubella

Infectious diseases

Clinicals - History

Fact Explanation
Rash Rubella (German measles) is commonly a mild disease characterized by a rash.It affects children and adolescents and can also affect young adults. The maculopapular rash appears first on the face and neck and quickly spreads to the trunk and upper extremities and then to the legs. While progressing downwards, it fades on the face. Lesions are discrete at first, but rapidly coalesce to produce a flushed appearance.Rash usually lasts 3 to 5 days.. Rash
Rubella (German measles) is commonly a mild disease characterized by a rash.It affects children and adolescents and can also affect young adults. The maculopapular rash appears first on the face and neck and quickly spreads to the trunk and upper extremities and then to the legs. While progressing downwards, it fades on the face. Lesions are discrete at first, but rapidly coalesce to produce a flushed appearance.Rash usually lasts 3 to 5 days..
Fever Postnatal rubella is often asymptomatic but may result in a generally mild, self-limited illness. They may get low grade fever. Usually the onset of rash is often accompanied by low-grade fever. Even though the rash lasts about 3 to 5 days,associated fever rarely persists for more than 24 hours.. Fever
Postnatal rubella is often asymptomatic but may result in a generally mild, self-limited illness. They may get low grade fever. Usually the onset of rash is often accompanied by low-grade fever. Even though the rash lasts about 3 to 5 days,associated fever rarely persists for more than 24 hours..
Headache Adolescents and adults may experience headache as a typical mild prodromal symptom.Usually not seen in infected children.Occurs 1 to 5 days before the rash. Other features include fever and malaise.. Headache
Adolescents and adults may experience headache as a typical mild prodromal symptom.Usually not seen in infected children.Occurs 1 to 5 days before the rash. Other features include fever and malaise..
Arthralgia and Arthritis Rubella can cause complications, associated with transient joint involvement such as arthritis and arthralgia being the most frequent. Usually these symptoms are more prevalent and severe in RV-infected women than in RV-infected men..
Symptoms begin with in one week of the appearance of rash.. This etiological association is suspected due to detection of rubella virus from peripheral blood or synovial fluid lymphocytes of affected joints and detection of viral antigen in synovial fluid.But little is known concerning host response to rubella virus and the mechanisms by which this virus has exerts its arthritogenic potential in vivo. .
Arthralgia and Arthritis
Rubella can cause complications, associated with transient joint involvement such as arthritis and arthralgia being the most frequent. Usually these symptoms are more prevalent and severe in RV-infected women than in RV-infected men..
Symptoms begin with in one week of the appearance of rash.. This etiological association is suspected due to detection of rubella virus from peripheral blood or synovial fluid lymphocytes of affected joints and detection of viral antigen in synovial fluid.But little is known concerning host response to rubella virus and the mechanisms by which this virus has exerts its arthritogenic potential in vivo. .
Post infectious encephalopathy / encephalomyelitis Post infectious encephalopathy or encephalomyelitis are very occasionally associated with postnatally acquired rubella.. This is known to be developed abruptly after the fading of exanthem.The pathogenesis of post rubella neurogenic complications is not completely understood. But two different mechanisms including direct invasion of the virus and host immune response has been observed.. Post infectious encephalopathy / encephalomyelitis
Post infectious encephalopathy or encephalomyelitis are very occasionally associated with postnatally acquired rubella.. This is known to be developed abruptly after the fading of exanthem.The pathogenesis of post rubella neurogenic complications is not completely understood. But two different mechanisms including direct invasion of the virus and host immune response has been observed..
Stillbirth Rubella infection acquired during pregnancy can result in stillbirth and also spontaneous abortion.. Microscopic analyses of aborted infected fetuses revealed cellular damage in multiple sites.It was associated with non inflammatory necrosis commonly in the structures of the eyes, heart, brain, and ears of aborted RV infected fetuses.. Stillbirth
Rubella infection acquired during pregnancy can result in stillbirth and also spontaneous abortion.. Microscopic analyses of aborted infected fetuses revealed cellular damage in multiple sites.It was associated with non inflammatory necrosis commonly in the structures of the eyes, heart, brain, and ears of aborted RV infected fetuses..
Progressive rubella panencephalitis A rare and usually fatal neurodegenerative disorder termed progressive rubella panencephalitis has also been reported as a late complication of childhood rubella.. It is a recently recognized inflammatory disorder of CNS that appears to be a delayed reactivation of congenital rubella and postnatal rubella infection. Neurological deterioration begins with dementia and gait disturbance in the second decade and leads to death with in several years.. Progressive rubella panencephalitis
A rare and usually fatal neurodegenerative disorder termed progressive rubella panencephalitis has also been reported as a late complication of childhood rubella.. It is a recently recognized inflammatory disorder of CNS that appears to be a delayed reactivation of congenital rubella and postnatal rubella infection. Neurological deterioration begins with dementia and gait disturbance in the second decade and leads to death with in several years..

Clinicals - Examination

Fact Explanation
Lymphadenopathy Lymphadenopathy can be characteristic, involving the posterior cervical and occipital nodes, which can persist after the rash has resolved.. The virus almost certainly multiplies in cells of the respiratory tract, extends to local lymph nodes, and then undergoes viremic spread to target organs. Subsequent additional replication is seen in selected target organs, such as the spleen and lymph nodes.. Lymphadenopathy
Lymphadenopathy can be characteristic, involving the posterior cervical and occipital nodes, which can persist after the rash has resolved.. The virus almost certainly multiplies in cells of the respiratory tract, extends to local lymph nodes, and then undergoes viremic spread to target organs. Subsequent additional replication is seen in selected target organs, such as the spleen and lymph nodes..
Conjunctivitis In some patients rubella rash accompanied by mild bulbar conjunctivitis.The rubella virus agent is probably acquired through the droplets entering the upper respiratory tract but it can also enter by conjunctiva.. Conjunctivitis
In some patients rubella rash accompanied by mild bulbar conjunctivitis.The rubella virus agent is probably acquired through the droplets entering the upper respiratory tract but it can also enter by conjunctiva..
Thrombocytopenic purpura More serious complications that are occasionally associated with postnatally acquired rubella.. Widely known and frequently diagnosed following rubella.Purpura may be fulminating and may occur at the height of the febrile illness.The time interval between the exanthema and the detection of virus may vary from a week to months.. Thrombocytopenic purpura
More serious complications that are occasionally associated with postnatally acquired rubella.. Widely known and frequently diagnosed following rubella.Purpura may be fulminating and may occur at the height of the febrile illness.The time interval between the exanthema and the detection of virus may vary from a week to months..
Congenital rubella syndrome (CRS) in infants. Maternal infection early in pregnancy leads to the congenital rubella syndrome (CRS) in infants. Infection in the early gestation period causes more severe damage to the fetus. Maternal infection during the first 8 weeks after the last menstrual period results in nearly all fetuses becoming infected. And also up to 100% of infected fetuses developing congenital defects.The clinical manifestations of CRS are varied. Deafness being the most common. Other clinical features include cardiac disease, mental retardation, and ocular conditions such as cataracts and glaucoma. Those complications occurred due to its teratogenicity in maternal infection.. Congenital rubella syndrome (CRS) in infants.
Maternal infection early in pregnancy leads to the congenital rubella syndrome (CRS) in infants. Infection in the early gestation period causes more severe damage to the fetus. Maternal infection during the first 8 weeks after the last menstrual period results in nearly all fetuses becoming infected. And also up to 100% of infected fetuses developing congenital defects.The clinical manifestations of CRS are varied. Deafness being the most common. Other clinical features include cardiac disease, mental retardation, and ocular conditions such as cataracts and glaucoma. Those complications occurred due to its teratogenicity in maternal infection..

Investigations - Diagnosis

Fact Explanation
Full blood count As in many other viral diseases White blood cell count (WBC) range from low to normal.Frequently the number of atypical lymphocytes is increased.. Full blood count
As in many other viral diseases White blood cell count (WBC) range from low to normal.Frequently the number of atypical lymphocytes is increased..
Viral isolation from clinical specimen Rubella virus has been regularly demonstrated in pharyngeal secretions for 5 days and feces for 4 days after onset of rash.It has been sporadically recovered from pharyngeal and rectal swabbing for 14 and 8 days respectively after beginning of the eruption and as long as one week prior to the rash.. Virus can be readily recovered in cell cultures from respiratory tract secretions and, in infants with congenital infection, from urine, cerebrospinal fluid, and blood. Presence of virus in inoculated cultures can be recognized by viral interference or immunoperoxidase staining assays. But virus isolation procedures are costly and require a relatively sophisticated virologic laboratory.Because of that they are seldom used except for the diagnosis of congenital rubella.. Viral isolation from clinical specimen
Rubella virus has been regularly demonstrated in pharyngeal secretions for 5 days and feces for 4 days after onset of rash.It has been sporadically recovered from pharyngeal and rectal swabbing for 14 and 8 days respectively after beginning of the eruption and as long as one week prior to the rash.. Virus can be readily recovered in cell cultures from respiratory tract secretions and, in infants with congenital infection, from urine, cerebrospinal fluid, and blood. Presence of virus in inoculated cultures can be recognized by viral interference or immunoperoxidase staining assays. But virus isolation procedures are costly and require a relatively sophisticated virologic laboratory.Because of that they are seldom used except for the diagnosis of congenital rubella..
ELISA A serological assay (ELISA) can be easily and quickly performed to detect the presence rubella-specific antibodies. IgM is detectable within 7 to 10 days following the initial exanthema. False-positives may occur if the patient has a positive Rh factor, is infected with parvovirus, or has a positive heterophile test for infectious mononucleosis. Seven to 21 days after the first ELISA, they should obtain an additional ELISA to confirm the diagnosis. Infection can be confirmed by a positive IgM, a fourfold rise in IgG, or a positive culture. ELISA
A serological assay (ELISA) can be easily and quickly performed to detect the presence rubella-specific antibodies. IgM is detectable within 7 to 10 days following the initial exanthema. False-positives may occur if the patient has a positive Rh factor, is infected with parvovirus, or has a positive heterophile test for infectious mononucleosis. Seven to 21 days after the first ELISA, they should obtain an additional ELISA to confirm the diagnosis. Infection can be confirmed by a positive IgM, a fourfold rise in IgG, or a positive culture.

Investigations - Management

Fact Explanation
CSF (cerebrospinal fluid ) examination Should be examined in all suspected patients to exclude purulent meningitis.. CSF (cerebrospinal fluid ) examination
Should be examined in all suspected patients to exclude purulent meningitis..
Amniocentesis, Cordocentesis, or Chorionic villus sampling If obstetric patient is positive for rubella infection, rubella may be diagnosed in the fetus by collecting either a specimen of amniotic fluid, cord blood, or placental tissue by amniocentesis, cordocentesis, or chorionic villus sampling (respectively) for use in laboratory assays. These laboratory assays include PCR, fluorescence, in situ hybridization, or ELISA (to quantify rubella-specific IgM).. Amniocentesis, Cordocentesis, or Chorionic villus sampling
If obstetric patient is positive for rubella infection, rubella may be diagnosed in the fetus by collecting either a specimen of amniotic fluid, cord blood, or placental tissue by amniocentesis, cordocentesis, or chorionic villus sampling (respectively) for use in laboratory assays. These laboratory assays include PCR, fluorescence, in situ hybridization, or ELISA (to quantify rubella-specific IgM)..

Management - Supportive

Fact Explanation
Supportive care There is no specific treatment for rubella.Treatment consists of supportive care. Supportive therapy to address nutritional status, hemorrhagic complications, and secondary infections is therefore essential to optimize treatment outcomes.. Supportive care
There is no specific treatment for rubella.Treatment consists of supportive care. Supportive therapy to address nutritional status, hemorrhagic complications, and secondary infections is therefore essential to optimize treatment outcomes..

Management - Specific

Fact Explanation
Immunoglobulin There are no specific chemotherapeutic measures available for the treatment of rubella. Immunoglobulin has been used in attempts to prevent rubella in pregnant women exposed to the virus.. Intramuscular administration of immune globulin (20 ml, given at two injection sites) within 72 hours of exposure may be administered to the obstetric patient to suppress, but not eliminate, symptoms. Infants with CRS have been born to women who received immune globulin therapy soon after exposure. So it is not a routine prophylaxis and should only be administered if the patient chooses not to terminate her pregnancy. Otherwise, treatment is limited to symptomatic relief.. Immunoglobulin
There are no specific chemotherapeutic measures available for the treatment of rubella. Immunoglobulin has been used in attempts to prevent rubella in pregnant women exposed to the virus.. Intramuscular administration of immune globulin (20 ml, given at two injection sites) within 72 hours of exposure may be administered to the obstetric patient to suppress, but not eliminate, symptoms. Infants with CRS have been born to women who received immune globulin therapy soon after exposure. So it is not a routine prophylaxis and should only be administered if the patient chooses not to terminate her pregnancy. Otherwise, treatment is limited to symptomatic relief..
Vaccination Use to control the spread of the disease. Rubella can be prevented by routine childhood immunization and by immunization of susceptible adolescents and adult populations with live attenuated rubella vaccine. It induced immunity by producing a modified rubella infection in susceptible recipients. It is administered subcutaneously.. MMR vaccine is used. Current recommended schedule is to receive the first dose at 12-15 months followed by the second dose at 4-6 years (before elementary school enrollment). In non pregnant women asked not to get pregnant for at least 28 days following the MMR vaccine series because of the theoretical risk posed by the live albeit attenuated vaccine viruses.. However the anti-rubella vaccination represent the only way to prevent serious complications thus it should be indicated either in boys.. Vaccination
Use to control the spread of the disease. Rubella can be prevented by routine childhood immunization and by immunization of susceptible adolescents and adult populations with live attenuated rubella vaccine. It induced immunity by producing a modified rubella infection in susceptible recipients. It is administered subcutaneously.. MMR vaccine is used. Current recommended schedule is to receive the first dose at 12-15 months followed by the second dose at 4-6 years (before elementary school enrollment). In non pregnant women asked not to get pregnant for at least 28 days following the MMR vaccine series because of the theoretical risk posed by the live albeit attenuated vaccine viruses.. However the anti-rubella vaccination represent the only way to prevent serious complications thus it should be indicated either in boys..

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