Rubella (from Latin "little red", aka German measles, 3 day measles) is a disease caused by the rubella virus. Known as "German" measles because it was first described by German doctors.
Patient information
What is rubella?
It's a disease caused by the rubella virus.
Sx
Disease is often mild, and attacks often pass unnoticed. Minimal systemic upset
Maculopapular rash, the primary Sx
Pink or light red, not as bright as measles
Itchy
Begins on the face, which spreads to the trunks/limbs, the facial rash usually clearing up as it spreads to other parts of the body
Usually fades away after 3 days, w/ children recovering more quickly than adults. As it dissapears, there is no stainng or peeling of the skin. However, skin might shed in very small flakes where the rash covered
Swollen lymph nodes are common, and may last a few weeks
Fever
Sore throat
Fatigue
Transient arthropathy (joint pain) may occur in adults
Deterioration of the skin are very rare
Patient information
What happens in a disease caused by the measles virus?
It can cause a maculopapular rash, which means a combination of red and bumpy. It usually fades away after 3 days, so it's a quicky. It can cause swollen lymph nodes. It can also cause flu like symptoms, so high temperatures, sore throat, feeling tired.
Pathophysiology
Rubella virus is the pathogenic agent of the disease rubella, and is the cause of congenital rubella syndrome when infection occurs during the 1st weeks of pregnancy. It belongs to the family Togaviridae, whose members commonly have a genome of single-stranded RNA of positive polarity which is enclosed by an icosahedral capsid. The molecular basis for the causation of congenital rubella syndrome are not yet completely clear, but in vitro studies with cell lines showed that rubella virus has an apoptic effect on certain cell types. There is evidence for a p53-dependent mechanism
Acquired rubella is transmitted via airborne droplet emision from the upper respiratory tract of active cases. The virus may also be present in urine, feces, and on the skin
Only humans are infected, and reservoirs. Insects do not spread the disease
Disease has incubation period (i.e. time between exposure to pathogen, to when Sx first appear) of 2 weeks
Pt's are infectious during the week before, and after the appearance of the rash. Babies born with CSR however, may be infectious for more than 1 year. CRS is thus a significant reservoir, to other infants, and importantly, pregnant women
Dx
Verify immunity, by:
Finding the virus in blood, throat, or urine
Testing blood for IgM antibodies, in Pt's recently infected, which can persist for over 1 year
Tx
Prevention, w/:
Rubella vaccine, with a single dose is >95% effective. It is often given as the MMR vaccine, w/ measles and mumps
In mothers, offered to all susceptible non-pregnant women of childbearing age. Note however, that because of possible teratogenicity, MMR vaccine is NOT recommended during pregnancy, but should be vaccinated ASAP in the postpartum period
In the newborn, MMR is recommended 1st at 12-18mo, and a 2nd dose at 36 months
Screening, of all women of childbearing age at their 1st preconception counselling visit, via Hx of vaccination, or by serology
Sx relief, as there is no specific Tx once infected. Newborns affected involve:
Surgery → congenital heart defects, cataracts
Low vision devices → macular degeneration
Counselling and monitoring
Prognosis
Usually mild, self limiting, and often asymptomatic
Except for CRS, the virus is rapidly eliminated in most Pt's
Once recovered, Pt's are immune to future infections
Prognosis of kids born w/ CRS is poor
Complications
Bleeding problems
Testicular swelling
Neuritis (inflammation of nerves)
Infection of a mother during pregnancy, is serious; if the mother is infected <20 weeks gestation (particularly trimester 1), it can cause congenital rubella syndrome (CRS) or miscarriage (20%), as the infection passes through the placenta, causing problems with the eyes (e.g. cataracts, blindness), ears (e.g. deafness), heart (e.g. patent ductus arteriosus), and brain. It may also cause prematurity, low birth weight, neonatal thrombocytopenia, anemia, and hepatitis. CRS is the main reason the rubella vaccine was developed
Epidemiology
Common childhood infection, in many areas of the world
Each year, 100k cases of CRS occur
Rate of disease has decreased due to vaccination, w/ WHO declaring in 2015 America was free of rubella. There are ongoing efforts to eliminate the disease globally
The population vaccination rate of MMR is <80%, so women might make it to childbearing age w/o developing immunity
Many others who contract rubella within trimester 1 have a miscarriage or stillborn
Notifiable disease
See also
Measles (do not confuse rubella with "rubeola"
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