Rubella
Rubella: Excerpt from Professional Guide to Diseases (Eighth Edition)
Rubella, commonly called German measles, is an acute, mildly contagious viral disease that produces a distinctive 3-day rash and lymphadenopathy. It usually occurs among children ages 5 to 9, adolescents, and young adults. Rubella flourishes worldwide during the spring (particularly in big cities), and epidemics occur sporadically. This disease is self-limiting, with an excellent prognosis.
Causes
The rubella virus is transmitted through contact with the blood, urine, stools, or nasopharyngeal secretions of infected people and, possibly, by contact with contaminated articles of clothing. Transplacental transmission, especially in the first trimes-ter of pregnancy, can cause serious birth defects, such as microcephaly, mental retardation, patent ductus arteriosus, glaucoma, and bone defects. (See Congenital rubella syndrome.) Humans are the only known hosts for the rubella virus. The disease is contagious from about 10 days before the rash appears until 5 days after it has appeared.
Signs and symptoms
In children, after an incubation period of from 14 to 21 days, an exanthematous, maculopapular rash erupts abruptly. (See Incubation and duration of common rash-producing infections, page 232.) In adolescents and adults, prodromal signs and symptoms — headache, malaise, anorexia, low-grade fever, coryza, lymphadenopathy and, sometimes, conjunctivitis — are the first to appear. Suboccipital, postauricular, and postcervical lymph node enlargement is a hallmark of this disease and precedes the rash.
Typically, the rubella rash begins on the face and spreads rapidly, in many cases covering the trunk and extremities within hours. Small, red, petechial macules on the soft palate (Forschheimer spots) may precede or accompany the rash but are not diagnostic of rubella. By the end of the second day, the facial rash begins to fade, but the rash on the trunk may become confluent and be mistaken for scarlet fever. The rash continues to fade in the downward order in which it appeared. It generally disappears on the third day, but it may persist for 4 or 5 days — sometimes accompanied by mild coryza and conjunctivitis. The rapid appearance and disappearance of the rubella rash distinguishes it from rubeola. In rare cases, rubella can occur without a rash. Low-grade fever may accompany the rash (99° to 101° F [37.2° to 38.3° C]), but it usually doesn’t persist after the first day of the rash; rarely, temperature may reach 104° F (40° C).
Complications seldom occur in children with rubella, but when they do, they commonly 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.
A significant number of cases, 20% to 50%, are asymptomatic.
Diagnosis
The rubella rash, lymphadenopathy, other characteristic signs, and a history of exposure to infected people usually permit clinical diagnosis without laboratory tests.
CONFIRMING DIAGNOSIS The rubella rash has been confused with scarlet fever, measles (rubeola), infectious mononucleosis, roseola, erythema infectiosum, and other viral exanthems. Therefore, without exposure history, laboratory confirmation is beneficial. Cell cultures of the throat, blood, urine, and cerebrospinal fluid can confirm the virus’ presence. Convalescent serum that shows a fourfold rise in antibody titers corroborates 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 number of injections.
Special considerations
❑Make the patient with active rubella as comfortable as possible. If the patient is a child, give him children's books to read or games to play to keep him occupied.
❑Explain to the patient why droplet precautions are necessary. Congenital rubella requires contact precautions until age 1. Make sure the patient understands how important it is to avoid exposing women who are pregnant to this disease.
❑Report confirmed cases of rubella to local public health officials.
Before 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.
❑Ask women of childbearing age if they're pregnant. If they are or think they may be, don’t give the vaccine or perform a pregnancy test first. 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.
❑Don’t vaccinate patients who are immunocompromised, patients with immunodeficiency diseases, or those receiving immunosuppressive, radiation, or corticosteroid therapy. Instead, administer immune serum globulin as ordered, to prevent or reduce infection in susceptible patients.
After giving the rubella vaccine:
❑Observe the patient for signs of anaphylaxis for at least 30 minutes. Keep epinephrine 1:1,000 handy.
❑Warn the patient about possible mild fever, slight rash, transient arthralgia (in adolescents), and arthritis (in elderly patients). Suggest aspirin or acetaminophen for fever.
❑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: Professional Guide to Diseases (Eighth Edition)
- Author(s): Springhouse
- Year of Publication: 2005
- Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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