rubella
RUBELLA
Rubella, also known as German measles or 3-day measles, is a mild often exanthematous disease of infants and children that is severe and associated with complications in adults. It is self-limiting disease associated with a characteristic maculopapular rash.
It is caused by a single-stranded RNA virus classified as a togavirus, genus Rubivirus.
Transmission is through airborne or droplets shed from respiratory secretions.
Highly communicable at the onset of the rash, however viral shedding may also occur 5-7 days before, to 5-7 days or more following appearance of the rash.
The incubation period is 14-21 days.

Diagnosis

  • Diagnosis is based on clinical findings

Physical Examination

Congenital Rubella Syndrome

  • May have several manifestations including the following:
    • Deafness - most common finding
    • Eye defects (eg cataracts, glaucoma, salt-&-pepper retinopathy)
    • Cardiac abnormalities (eg patent ductus arteriosus, pulmonic stenosis)
    • Neurologic defects (eg microcephaly, mental retardation)
  • Manifestations may be delayed from 2-4 yr & may include DM, glaucoma, thyroid dysfunction

Laboratory Tests

Lab Exam

  • Serologic test is the most common method of confirming rubella infection, however it is seldom needed except in pregnant women where it is imperative
    • There is a fourfold rise in rubella IgG antibody titer in acute- & convalescent-phase serum specimens
    • Presence of rubella specific IgM antibody
    • In newborns, increased levels of IgM antibodies indicate a recent infection acquired after birth
    • Ideal time for serum collection is w/in 7-10 days after the onset of illness & 14-21 days later
    • Enzyme-linked immunosorbent assay (ELISA) is often used to test for rubella antibodies
  • Positive viral culture may confirm rubella infection
    • Virus may be isolated from blood, throat, nasal, urine & cerebrospinal fluid specimens of rubella & CRS patients
    • Rubella virus may be isolated during the acute phase, 1 wk before to 2 wks after the onset of rash
    • Not generally used for routine diagnosis

Complications

  • Uncommon in patients & generally not life-threatening
  • May include postinfectious thrombocytopenia, orchitis, Guillain-Barré syndrome & peripheral neuritis
  • Encephalitis is the most serious complication, occurs in 2 forms
    • Postinfectious encephalitis appears w/in 7 days after the onset of rash
    • May present w/ seizures, confusion, ataxia & focal neurologic signs
    • Most patients recover completely
  • Progressive rubella panencephalitis has an onset & course similar to subacute sclerosing panencephalitis, a complication of measles
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