RUBELLA

Objectives
• To define Rubella

• To briefly describe the pathogenesis, clinical manifestation

and complications of Rubella

• Discuss the laboratory findings and diagnosis

• Discuss the treatment and prevention

RUBELLA
• a.k.a German Measles or 3- day Measles
• Mild exanthematous disease of infants and
children
• Caused by Rubella virus
• from Family Togaviridae, Genus Rubivirus
• a single stranded RNA virus
• Transmission: Oral droplet, transplacental
 Pathogenesis

• Virus replicates in the respiratory epithelium

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and spreads to regional lymph nodes
Following infection

Viremia

Viremia ensues and is most intense from 10 to 17 days

after infection.
 Viral Shredding
• From nasopharynx begins approx. 10
days after infection and until 2 weeks
after rash

Period of Highest
Communicability
• 5 days before to 6 days after the
appearance of rash
 headache
Low grade fever

Red eyes w/ or
w/out eye pain

Lymphadenopathy
Sore throat
(suboccipital, postauricular,
anterior cervical lymph
nodes

anorexia
malaise

After an incubation period of 14-21

days, prodrome begins.

Clinical Manifestation
 Forchheimer spots
Rash • Petechial hemorrhages on
• 1st manifestation soft palate
• Irregular pink macule • Appears as tiny rose-
• Begins on face and neck colored lesions
• Spreads centrifugally to involve
torso and extremities

 Rash fades from the face as it extends to the rest of the

body
 duration is generally 3 days, and resolves without
desquamation
 Subclinical infections are common where no rash appears
 Teenagers and adults tend to be more
symptomatic and have systemic manifestations, up to 70% of
females demonstrating arthralgias and arthritis
 Leukopenia Mild
Neutropenia Thrombocytopenia

Laboratory Findings
Complications

• Post infectious thrombocytopenia

• Occurs in 1/3000 cases more
frequently in children and girls

• Manifests about 2 wk following onset

of rash as petechiae, epistaxis, GI
bleeding, hematuria

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Complications
• Arthritis
• Occurs more commonly in adults
especially women

• Begins within 1 week of onset of

exanthem

• Classically involves small joints of

the hands

• Self-limited and resolves with wks 11

without sequelae
Complications

• Encephalitis
• Most serious complication of
postnatal rubella

• Occurs in 2 forms
• Post infectious syndrome
• Progressive Panenecephalitis

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Complications
• Post Infectious Encephalitis
• Uncommon

• Appears within 7 days of onset of the rash

• Headache, seizure, confusion, coma, focal

neurologic signs, ataxia

• CSF may be normal or may have a mild

mononuclear pleocytosis and/ elevated protein
concentration

• Good prognosis
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Complications
• Progressive Rubella Panencephalitis
• Extremely rare complication

• Has an onset and course similar to those of

subacute sclerosing panencephalitis associated
with measles

• Virus may be isolated from brain tissue, suggesting

infectious pathogenesis, albeit a “slow one”

• Death occurs 2-5 yrs after onset

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Complications

• Guillain-Barre Syndrome
• Peripheral Neuritis
• Myocarditis

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Congenital Rubella Syndrome

• one viral infection which could lead

to congenital anomalies

• Transmission is through
transplacental infection

• Pathologic findings is often severe

and may involve every organ system

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 Pathogenesis
Placenta is infected

1 3
• Virus spreads through vascular system
• Happens during maternal viremia of developing fetus and may infect any
organ
Pathogenesis

• Maternal infection during the first 8th week of gestation results

in the most severe and wide spread defects

• Most distinctive feature is chronicity

• virus persists in fetal tissue with ongoing damage and reactivation until
well beyond delivery

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 Classic Triad of Congenital Rubella

Sensorineural Hearing Loss

the most common manifestation

Ocular abnormalities
Cataract, infantile glaucoma, and salt
and pepper retinopathy
*Unilateral and bilateral cataracts are the most
serious ocular finding 1/3 of infants
Congenital Heart Disease
Occur in half of px during 1st 8th wk of gestation
Patent Ductus arteriosus most common,
pulmonary arteries and valvular disease
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Other Clinical Manifestations

• Microcephaly
• Interstitial pneumonitis
• Neurologic abnormalities
• Meningoencephalitis
• 10-20% of infants and may persist upto 12 mo
• PRP
• Postnatal growth retardation
• Immunologic deficiency
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Other Clinical Manifestations

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 Rubella IgM immunosorbent assay
• Most common
• Present about 4 days after
rash
Reverse Transcriptase PCR
• For confirmation
• Viral isolation thru
nasopharyngeal secretions,
Urine in newborn, Cord blood
or placenta, Amniotic fluid

Diagnostic Test
Treatment
Postnatal Rubella
SUPPORTIVE CARE
• Antipyretics and analgesics
• IV immunoglobulin or
corticosteroids for severe
nonremitting thrombocytopenia
Congenital Rubella
Syndrome
Complex
• Pediatric, cardiac, audiologic,
ophthalmologic, and neurologic
evaluation and follow up
• Hearing screening
Prognosis

• Excellent prognosis

• Reinfection
• with wild virus is possible postnatally
• Significant increase in IgG antibody level and/ or an IgM response in an
individual who has a documented rubella-specific IgG

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Prevention

• Isolation for 7 days after onset of rash

• Standard droplet precaution

• Contact precaution
• Children with CRS up to 1 yr old or until negative and pharyngeal secretions are
negative

• Immunoglobulin prophylaxis for exposed pregnant women

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Vaccination
• MMR and MMRV
• MMR
• 12-15 months
• 2nd dose: 4-6 years old
• Should not be administered to severely immunocompromised patients
• May be used as postexposure prophylaxis administered within 3 days
after exposure
• Adverse reactions are uncommon
• Rashes in children
• Arthralgia and arthritis in adults
• Peripheral neuropathies and transient thrombocytopenia
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Thank You!