Rubella

Rubella is now rare because of widespread

compliance with childhood immunization programs.

The disease is usually a benign and inconsequential

viral illness unless exposure occurs in utero.

Congenital rubella syndrome is associated with

clinically significant congenital malformations.
 Pathophysiology

• single-stranded RNA togavirus that is

transmitted by means of respiratory
droplets.
• the virus replicates in the nasopharynx
and regional lymph nodes, resulting in
viremia. The virus then may spread to the
skin, CNS, synovial fluid, and
transplacentally to a developing fetus
 History

• The incubation period of rubella is 14-23 days.

• The prodrome is characterized by the following:
• Malaise
• Fever
• Anorexia
• Headache
• Mild conjunctivitis
• Rhinorrhea
The rash develops within 1-5 days of symptom onset, starting on the
face and forehead and spreading caudally to involve the trunk and
extremities.
• The rash tends to clear in the same order as it appeared.
• The rash may be pruritic, but it usually resolves within 3 days
without residua.
 Physical

• Lymphadenopathy may be present,

particularly in the posterior auricular,
posterior cervical, and suboccipital chains.
• The rash consists of pink macules and
papules, which may become confluent,
resulting in a scarlatiniform eruption.
• Petechiae of the soft palate, known as the
Forchheimer sign, may be present.
 The diagnosis of rubella
• clinical
• seroconversion in response to rubella antigens
may confirm it
Antibodies are often present shortly after the rash
appears and increase in titer during the next 2-3
weeks.
Elevated levels of immunoglobulin M (IgM)
antibodies are particularly helpful findings in
newborns. IgM antibodies do not cross the
placenta and indicate a recent infection acquired
after birth
 COMPLICATIONS
• Infection in healthy children or young adults is generally self-
limited and without sequelae.

• The most common complications

• arthropathies of the fingers, wrists, and knees that can persist for
a year or more.
• thrombocytopenia with purpura and hemorrhage is a rare
complication of rubella.
• congenital rubella syndrome is associated with malformations of
multiple organ systems including the CNS and cardiac, ocular,
and skeletal systems. Infants with congenital rubella syndrome
who survive into adulthood may be plagued by autoimmune
disorders and dysgammaglobulinemia.
• Damage to the fetus is most likely when maternal infection occurs
during the first 2 months of pregnancy, although there is risk
associated with infection up to 5 months.
 Treatment
• No antiviral therapy for rubella is available.
• Treatment is supportive