Rubella Infection

Introduction 

Rubella is an acute febrile illness caused by Rubella virus, a single-stranded RNA virus of Togavirus family 

-It is commonly known as German measles or 3-day measles. 

-the virus enters the body through inhalation 

-it replicates in the upper respiratory tract and spreads in the bloodstream to other organs, skin and lymphoid tissues 

-the incubation period is 14 to 21 days 

-the virus has high infectivity but low virulence

Symptoms & Signs 

A.Infection in young children and adults: Fever, rash, malaise, arthralgia, lymphadenopathy, which is most prominent in the posterior cervical and postauricular areas.

Arthralgia: The most common complication of Rubella is arthralgia, and it occurs most frequently in women 

Rubella rash: A fine, pink maculopapular rash begins on the face and rapidly spreads to the trunk and extremities. It lasts for 3 days.  

B.Congenital Infection

-The greatest significance of rubella is not the acute illness but the risk of fetal damage in pregnant women. 

-the risk of fetal malformation is highest in the early stages of pregnancy 

-Intravenous immune globulin injected into the mother does not protect the fetus against rubella infection 

-The classic triad of congenital rubella consists of cataracts, cardiac abnormalities, and deafness. 

-The most common developmental manifestation of congenital rubella is mental retardation.

A.General: Failure to thrive, growth retardation, malabsorption  

B.Cerebral: Microcephaly, encephalitis

C.Ocular: Cataracts, glaucoma, microphthalmia, chorioretinitis 

D.Deafness: Sensorineural in most cases 

E.Cardiac: Pulmonary artery stenosis, pulmonary valvular stenosis,

patent ductus arteriosus, ventricular septal defect

F.Hematologic: Thrombocytopenia, lymphopenia, intravascular coagulation 

G.Skin: Blueberry muffin purpura on head, neck and trunk 

Diagnosis 

Confirmation of the diagnosis requires laboratory studies. 

A. Nucleic Acid Detection: Rubella virus nucleic acid is detected using RT-PCR 
B. Isolation and Identification of Virus: Rubella virus isolated from nasopharyngeal or throat swabs 
C. Serology: Rubella HI test 

Treatment 

Infection in young children and adults: Rubella is a mild, self-limited illness; no specific treatment is indicated; Patients should be isolated for 7 days after rash onset

Congenital infection: there is no specific treatment 

Prevention 

The primary purpose of rubella vaccination is to prevent congenital rubella infections. 

-Live attenuated rubella vaccine (MMR or MMRV) given in two doses, first dose at 12 to 15 months of age and the second dose at 4 to 6 years of age

-Pregnancy should be avoided for at least 28 days after vaccination.

-Pregnant women should not receive the vaccine, but should be screened for rubella IgG antibodies

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