Rubella
Rubella: Excerpt from Handbook of Diseases
Commonly called German measles, rubella is an acute, mildly contagious viral disease that produces a distinctive 3-day rash and lymphadenopathy. It’s most common among children ages 5 to 9, adolescents, and young adults.
Worldwide in distribution, rubella flourishes during spring (particularly in big cities), and epidemics occur sporadically. This disease is self-limiting, and the prognosis is excellent.
Causes
The rubella virus is transmitted through contact with the blood, urine, stools, or nasopharyngeal secretions of infected persons and possibly by contact with contaminated articles of clothing. Transplacental transmission, especially in the first trimester of pregnancy, can cause serious birth defects.
Humans are the only known hosts for the rubella virus. The period of communicability lasts from about 10 days before until 5 days after the rash appears.
Signs and symptoms
In children, after an incubation period of 16 to 18 days, an exanthematous, maculopapular rash erupts abruptly. In adolescents and adults, prodromal signs and symptoms — headache, anorexia, malaise, low-grade fever, coryza, lymphadenopathy and, sometimes, conjunctivitis — are the first signs and symptoms. Suboccipital, postauricular, and postcervical lymph node enlargement is a hallmark of rubella.
Short-term rash
Typically, the rubella rash begins on the face. This maculopapular eruption spreads rapidly, sometimes covering the trunk and extremities within hours. Small, red, petechial macules on the soft palate (Forschheimer spots) may precede or accompany the rash.
By the end of the 2nd day, the facial rash begins to fade, but the rash on the trunk may be confluent and may be mistaken for scarlet fever. The rash continues to fade in the downward order in which it appeared. The rash generally disappears on the 3rd day, but it may persist for 4 to 5 days — sometimes accompanied by mild coryza and conjunctivitis.
The rapid appearance and disappearance of the rubella rash distinguishes it from rubeola. Rubella can appear without a rash, but this occurrence is rare. Low-grade fever (99° to 101° F [37.2° to 38.3° C]) may accompany the rash, but it usually doesn’t persist after the 1st day of the rash; rarely, temperature may reach 104° F (40° C).
AGE ALERT: Complications seldom occur in children with rubella, but when they do, they typically appear as hemorrhagic problems such as thrombocytopenia. Many young women, however, experience transient joint pain or arthritis, usually just as the rash is fading. Fever may then recur. These complications usually subside spontaneously within 5 to 30 days.
GENDER INFLUENCE: Congenital rubella syndrome occurs in 25% of infants born to women who acquire rubella during the first trimester of pregnancy. However, defects are rare if the infection occurs after the 20th week of pregnancy. Complications in the fetus may include deafness, cataracts, microcephaly, mental retardation, congenital heart defects, and other problems. Miscarriage or stillbirth may also occur.
Diagnosis
The rubella rash, lymphadenopathy, other characteristic signs, and a history of exposure to infected people usually permit clinical diagnosis without laboratory tests. However, cell cultures of the throat, blood, urine, and cerebrospinal fluid can confirm that the virus is present. Convalescent serum that shows a fourfold rise in antibody titers confirms the diagnosis.
Treatment
Because the rubella rash is self-limiting and only mildly pruritic, it doesn’t require topical or systemic medication. Treatment consists of aspirin for fever and joint pain. Bed rest isn’t necessary, but the patient should be isolated until the rash disappears.
Immunization with live-virus vaccine RA27/3, the only rubella vaccine available in the United States, is necessary for prevention and appears to be more immunogenic than previous vaccines. The rubella vaccine should be given with measles and mumps vaccines at age 15 months to decrease the cost and the number of injections needed.
Special considerations
❑ Make the patient with active rubella as comfortable as possible. Give children books to read or games to play to keep them occupied.
❑ Explain why respiratory isolation is necessary. Make sure the patient understands how important it is to avoid exposing pregnant women to this disease.
❑ Report confirmed cases of rubella to local public health officials.
When giving the rubella vaccine:
❑ Obtain a history of allergies, especially to neomycin. If the patient has this allergy or has had a reaction to immunization in the past, check with the physician before giving the vaccine.
❑ If the patient is a woman of childbearing age, ask her whether she’s pregnant. If she is or thinks she may be, don’t give the vaccine.
CLINICAL TIP: Warn women who receive rubella vaccine to use an effective means of birth control for at least 3 months after immunization.
❑ Give the vaccine at least 3 months after any administration of immune globulin or blood, which could have antibodies that neutralize the vaccine.
❑ If the patient suffers from immunocompromise or immunodeficiency disease or is receiving immunosuppressant, radiation, or corticosteroid therapy, avoid giving him the vaccine. Instead, administer immune serum globulin to prevent or reduce infection.
❑ After giving the vaccine, observe the patient for signs of anaphylaxis for at least 30 minutes. Keep epinephrine 1:1,000 handy.
❑ Warn the patient that mild fever, slight rash, transient arthralgia (in adolescents), and arthritis (in elderly patients) are possible. Suggest aspirin or acetaminophen for fever.
❑ Advise the patient to apply warmth to the injection site for 24 hours after immunization (to help the body absorb the vaccine). If swelling persists after the initial 24 hours, suggest a cold compress to promote vasoconstriction and prevent antigenic cyst formation.
Pictures
Book Source Details
- Book Title: Handbook of Diseases
- Author(s): Springhouse
- Year of Publication: 2003
- Copyright Details: Handbook of Diseases, Copyright © 2003 Lippincott Williams & Wilkins.
More About Rubella
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Medical Books Excerpts
- Rubella
- "Professional Guide to Diseases (Eighth Edition)" (2005)
- [ read ]
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: Handbook of Diseases
Authors: Springhouse
Publisher: Lippincott Williams & Wilkins
Copyright: 2003
ISBN: 1-58255-266-5
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