Rubella

• Rubella:

  • Also called German measles or 3-day measles
  • viral disease caused by the rubella virus
  • Characterised by a rash, swollen glands and fever
  • Disease is usually mild and of little significant unless you are pregnant - congenital rubella syndrome
• Rubella is highly contagious - spread via respiratory droplets

  Symptoms start 2 weeks after exposure
• Presentation:

  • Slight fever, sore throat, runny nose and malaise - usually before the rash
  • Lymphadenopathy - most commonly postauricular and occipital/posterior cervical
  • Erythematous macular rash that starts on the face and spreads to the rest of the body. Rash classically lasts 3 days and is milder than rash seen in measles
  • Forchheimer sign - pinpoint or larger petechiae on the soft palate and uvula during the prodromal period
  • Pain and swelling in the joints - arthritis may become chronic and persist for months or years
• Diagnosis:

  • Investigations usually not needed as mild, self-limiting illness
  • Diagnosis is confirmed by IgG and IgM serology
• Management:

  • Supportive
  • Notify public health
  • Avoid pregnant women
  • Children should stay off school for at least 5 days after the rash appears
• Complications (rare):

  • Thrombocytopenia
  • Encephalitis
  • Arthralgia or arthritis (usually adults)
  • Otitis media
  • Congenital rubella (in pregnant women) - triad of deafness, blindness and congenital heart disease
• Congenital rubella:

  • Infection in the first trimester comes with a 50% chance of the infant being affected - miscarriage, stillbirth and congenital rubella syndrome. Features of congenital rubella syndrome:
  • Sensorineural hearing loss
  • Eye abnormalities - cataract, glaucoma
  • Congenital heart disease - patent ductus arteriosis
  • Intellectual disability
  • Meningoencephalitis
  • Hepatitis (jaundice)
  • Diabetes
  • Thyroid disorders