rubella

Question 1

what is another names or rubella?

Answer 1

german measles, 3-day measles

Question 2

what is a major complication of rubella?

Answer 2

severe congenital anomalies which occur with infection of susceptible host during pregnancy

Question 3

how is rubella spread?

Answer 3

spread by oral droplets or transplacentally, HIGHLY CONTAGIOUS

Question 4

what age group is most often affected with rubella?

Answer 4

used to be 5-14, now teens and young adults

Question 5

maternal antibody protects infants from rubella for how many months?

Answer 5

6 months

Question 6

how long is the incubation phase of rubella?

Answer 6

14-21 days

Question 7

when is rubella most contagious?

Answer 7

from 2 days before until 5-7 days after the onset of rash

Question 8

what is the causative organism of rubella?

Answer 8

rubivirus: RNA virus in the toga virus family, humans are only natural host

Question 9

how does rubella present during prodrome phase?

Answer 9

• catarrhal symptoms: low grade fever, OCULAR PAIN***, sore throat, myalgias
• lymphadenopathy occurs 24 hours prior to rash: post-auricular, posterior cervical, post occipital**

Question 10

how does rubella present on the skin?

Answer 10

exanthem: erythematous, maculopapular, confluent, less extensive than measles
> day 1: begins on FACE, spreads quickly to trunk and extremities within 24 hours
> day 2: pinpoint, resembles scarletina
> day 3: clears, occasional mild desquamation

Question 11

what are some associated symptoms of rubella?

Answer 11

• slight fever up to 3 days
• polyarthritis: usually of hands, knees, and wrists (esp. in older girls/women) – lasts several days to 2 weeks
• forschheimer spots: 20% develop petechial spots on soft palate before rash appears (may make you think you are dealing with strep!)

Question 12

with primary infection during pregnancy, 25-90% of fetuses are infected…the highest infection rate is during what trimester?

Answer 12

first trimester – 30% have congenital anomalies if infected during 1st trimester

Question 13

what are the most common anomalies seen in babies exposed to rubella? (4)

Answer 13

1. congenital cataracts
2. patent ductus arteriosus
3. sensorineural hearing loss
4. meningoencephalitis

Question 14

infants with congenital rubella infection may have?

Answer 14

• growth retardation, radiolucent bone disease, hepatosplenomegaly, thrombocytopenia, jaundice, purport
• blueberry muffin syndrome! - sites of extra medullary hematopoiesis

Question 15

how would you evaluate/diagnose an individual who you think may have rubella?

Answer 15

• primarily a clinical diagnosis
• confirmed by acute and convalescent IgG titers ( >4x increase) or direct measurement of IgM antibody
• with congenital infection, diagnosis is confirmed by viral culture of the urine

Question 16

what are some treatment options for rubella?

Answer 16

• non congenital: self-limiting, supportive measures
• congenital: chronic/persistent infection (infants shed live virus for 1 year and must be kept in isolation in hospital, away from pregnant women)