Rubella

Question 1

What is a “exanthem”?

Answer 1

An “exanthem” is an eruptive widespread rash.

Question 2

What are the 6 viral exanthemas?

Answer 2

Originally there were six “viral exanthemas” known as first, second, third, fourth, fifth and sixth disease. These have since been renamed as we have learned more about their underlying causes:

• First disease: measles
• Second disease: scarlet Fever
• Third disease: rubella (German measles)
• Fourth disease: Dukes’ Disease
• Fifth disease: parvovirus B19
• Sixth disease: roseola Infantum

Question 3

What causes measles?

Answer 3

Measles is caused by the measles virus.

Question 4

How is measles spread?

Answer 4

It is highly contagious via respiratory droplets.

Question 5

How does measles present?

Answer 5

Symptoms start 10 – 12 days after exposure, with fever, coryzal symptoms and conjunctivitis.

Koplik spots are greyish white spots on the buccal mucosa. They appear 2 days after the fever. They are pathognomonic for measles, meaning if a patient has Koplik spots, you can diagnose measles.

The rash starts on the face, classically behind the ears, 3 – 5 days after the fever. It then spreads to the rest of the body. The rash is an erythematous, macular rash with flat lesio

Question 6

Briefly describe the management of measles

Answer 6

Measles is self resolving after 7-10 days of symptoms.

Question 7

How long should children remain off school for with measles?

Answer 7

Children should be isolated until 4 days after their symptoms resolve.

Question 8

Is measles a notifiable disease?

Answer 8

Measles is a notifiable disease and all cases need to be reported to public health.

Question 9

What % of patients with measles develop complications?

Answer 9

30% of patients with measles develop a complication.

Question 10

What are the complications of measles?

Answer 10

Complications include:

• Pneumonia
• Diarrhoea
• Dehydration
• Encephalitis
• Meningitis
• Hearing loss
• Vision loss
• Death

Question 11

What causes Scarlet fever?

Answer 11

Scarlet fever is associated with group A streptococcus infection, usually tonsillitis. It is not caused by a virus.

Scarlet fever is caused by an exotoxin produced by the streptococcus pyogenes (group A strep) bacteria.

Question 12

How does Scarlet fever present?

Answer 12

It is characterised by a red-pink, blotchy, macular rash with rough “sandpaper” skin that starts on the trunk and spreads outwards. Patients can have red, flushed cheeks.

Other features:

• Fever
• Lethargy
• Flushed face
• Sore throat
• Strawberry tongue
• Cervical lymphadenopathy

Question 13

Briefly describe the management of Scarlet fever

Answer 13

Treatment is with antibiotics for the underlying streptococcal bacterial infection. This is with phenoxymethylpenicillin (penicillin V) for 10 days.

Question 14

Is Scarlet fever a notifiable disease?

Answer 14

Scarlet fever is a notifiable disease and all cases need to be reported to public health.

Question 15

How long should children with Scarlet fever remain off school?

Answer 15

Children should be kept off school until 24 hours after starting antibiotics.

Question 16

What other conditions is associated with group A strep infection?

Answer 16

Patients can have other conditions associated with group A strep infection:

• Post-streptococcal glomerulonephritis
• Acute rheumatic fever

Question 17

What causes rubella?

Answer 17

Rubella is caused by the rubella virus.

Question 18

How is rubella spread?

Answer 18

It is highly contagious and spread by respiratory droplets.

Question 19

How does rubella present?

Answer 19

Symptoms start 2 weeks after exposure.

It presents with a milder erythematous macular rash compared with measles. The rash starts on the face and spreads to the rest of the body. The rash classically lasts 3 days. It can be associated with a mild fever, joint pain and a sore throat. Patients often have enlarged lymph nodes (lymphadenopathy) behind the ears and at the back of the neck.

Question 20

Briefly describe the management of rubella

Answer 20

Management is supportive and the condition is self limiting.

Question 21

Is rubella a notifiable disease?

Answer 21

Rubella is a notifiable disease and all cases need to be reported to public health.

Question 22

How long should children remain off school for with rubella?

Answer 22

Children should stay off school for at least 5 days after the rash appears.

Question 23

Which group of people do children with rubella need to avoid?

Answer 23

Children should avoid pregnant women.

Question 24

What are the complications of rubella?

Answer 24

Complications are rare but include thrombocytopenia and encephalitis.

Question 25

What is the significance of rubella infection in pregnancy?

Answer 25

Rubella is dangerous in pregnancy and can lead to congenital rubella syndrome, which is a triad of deafness, blindness and congenital heart disease.