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Updated: Sep 7 2018

Rubella Virus

  • Snapshot
    • A 3-year-old girl is brought to the pediatrician’s office for a rash that began on the face and spread to the rest of her body. The rash is sometimes itchy. The girl also has a low-grade fever. She had just moved from South America to the US and had not received her childhood vaccinations. On physical exam, she has postauricular lymphadenopathy, a pink non-confluent maculopapular rash, and petechiae on her soft palate.
  • Introduction
    • Classification
      • rubella virus
        • an enveloped, single-stranded, positive-sense RNA virus
        • icosahedral capsid
        • a togavirus
        • causes rubella (German 3-day measles)
        • transmission via respiratory secretions
    • Epidemiology
      • incidence
        • decreased in the US due to vaccination
        • endemic in other parts of the world
      • demographics
        • any age can be affected
      • risk factors
        • lack of vaccination
        • travel to or from endemic areas
    • Pathogenesis
      • the virus replicates in the upper respiratory tract and lymph nodes
      • it then disseminates throughout the body
      • can spread through the placenta to cause vertical transmission
        • may result in miscarriage or congenital rubella syndrome
    • Associated conditions
      • congenital rubella syndrome
        • blueberry muffin appearance
          • dermal extramedullary hematopoiesis
        • cataracts
        • deafness
        • congenital heart disease (pulmonary artery stenosis or patent ductus arteriosus)
    • Prevention
      • measles, mumps, and rubella (MMR) vaccine
        • given over 2 doses
    • Prognosis
      • infection may be asymptomatic but still contagious
  • Presentation
    • Symptoms
      • low-grade fever
      • polyarthritis and polyarthralgia
        • more common in adult females
        • fingers, wrists, and knees are most commonly involved
    • Physical exam
      • lymphadenopathy before the rash
        • postauricular lymphadenopathy is classic
        • may also have posterior cervical and suboccipital lymphadenopathy
      • fine, pink, non-confluent maculopapular rash
        • starts on face and spreads to trunk and extremities
        • may be itchy
        • desquamates
        • rash resolves in 3 days
      • petechial rash on soft palate (Forschheimer spots)
      • orchitis
  • Studies
    • Labs
      • detection of rubella-specific immunoglobulin M or G
      • detection of virus on reverse transcriptase-polymerase chain reaction
    • Making the diagnosis
      • based on clinical presentation and confirmed with laboratory studies
  • Differential
    • Parvovirus B19 infection
      • distinguishing factors
        • slapped cheek rash
        • maculopapular rash on trunk and limbs that does not spread from head/neck downward
    • Measles
      • distinguishing factors
        • confluent maculopapular rash
        • coryza and Koplik spots
  • Treatment
    • Management approach
      • mainstay of treatment is supportive care and prevention with vaccines
    • Conservative
      • supportive care
        • indication
          • all patients
        • modalities
          • anti-pyretics
          • analgesics
          • hydration
  • Complications
    • Vertical transmission to fetus
      • congenital rubella syndrome
    • Thrombocytopenic purpura
    • Guillain-Barré syndrome
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