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RUBELLA

(German measles)

Dr. dr. Syahril pasaribu, DTM&H. MSc(CTM). SpA(K)
Sub Bagian Infeksi/Tropis
Bagian Ilmu Kesehatan Anak FK-USU

Highly sensitive to heat. paticularly of the postauricular. suboccipital. and cervical lymph nodes. a 3-day rash. . and generalized lymph node enlargement.Definition : Rubella is an acute infectious disease characterized by minimal or absent prodromal symptoms. Present in the blod and nasopharyngeal secretions. Etiology : Rubella virus  RNA SS.

anorexia. sore throat. headache. In adolescents and adults. cough. mild conjunctivitis. In the child the first apparent sign of illness is the appearanece of the rash.Postnatally Acquired Rubella Clinical manifestations : Incubation period : 16-18 (14-21) days. the eruption is preceded by a 1-5 day prodromal period characterized by low grade fever. malaise. and lymphadenopathy . coryza.

the rash begins to disappear from the face. On the second day. and extremities. Exanthem : the rash appears first on the face and then spreads downward rapidly to the neck. By the end of the first day.Lymph node involvement : lymph node enlargement may begin as 7 days before onset of rash. the rash has disappeared. and cervical nodes are most commonly involved. There is generalized lymphadenopathy. the entire body may be covered with the discrete pink-red maculopapules. The eruption appears. arms. By the end of the third day. postauricular. . and disappears more quickly than does the rash of measles. spreads. but the occipital. trunk.

Serological tests : virus neutralizing.Fever : may be normal or slightly elevated. Arthritis 2. CF. HI Complication : 1. Encephalitis 3. Blood picture : WBC count is low Diagnosis : 1. purpura . Detection of causative agent 3. Confirmatory clinical factors 2.

Treatment of complications . Symptomatic 2.Prognosis : excellent Immunity : permanent immunity Treatment : 1.

Rubella embryopathy may be caused by : 1. Inhibition of cellular multiplication 2. . A fetal infection probsbly will be chronic and persistent if it acquired during the early weeks and months of gestation (rubella embryopathy). A combination of both factors. persisent infection during the crucial period of organogenesis 3. fetal viremia. Chronic.CONGENITAL RUBELLA Pathogenesis : maternal viremia  placental infection.

microphthalmia 3. deafness. Manfestations of congenital rubella : 1. microcephaly.Clinical manifestations : Classic rubella syndrome (Gregg. Deafness . cataracts. glaucoma. congenital heart disease. 1940)  intrauterine growth retardation. Eye defects : cataracts. Growth retardation (low birth weight) 2. retinopathy. and mental retardation.

Thrombocytopenic purpura 9. CNS defects : psychomotor retardation. Hepatomegaly 7. Bone lesions . spastic quadriparesis. encephalitis. CSF pleocytosis. Cardiac defects : PDA.4. mental retardation. PS. Myocardial necrosis 5. Hepatitis 8. progressive panencephalitis 6. Splenomegaly 10. microcephaly. VSD.

Diabetes mellitus 13.11. Psychiatric disorders 14. A history of possible rubella or exposure to rubella during first trimester of pregnancy 2. Thyroid disorders 15. Precocious puberty Diagnosis : 1. The presence of one or more of the various manifestations of congenital rubella . Interstitial pnemonitis 12.

urine. Immunological response : .3. CSF. Virus isolation from pharyngeal secretions. 4.

Herpes simplex virus infection Prognosis : Neonatal thrombocytopenic purpura  bad prognosis with the MR 35%. Deaths usually occurred during the first 6 months of life. Cytomegalavirus infection 2. In the absent of purpura  MR 10% . Congenital toxoplasmosis 3.Differential diagnosis : 1. Congenital syphilis 4.

Preventive measures : vaccination with MMR II or Trimovax .