Rubella

Question 1

Rubella Presentation

Answer 1

• Prodrome of lassitude, low grade fever, headache, mild conjunctivitis, anorexia and rhinorrhoea similar to a cold
• Rash then develop, pink discrete macule that coalesce, starting behind ears and spreading to trunk and extremities
• Cervical, sub occipital and postauricular lymphadenopathy are characteristic and may precede the rash
• Constitutional symptoms are mild
• Arthralgia common
• Petechiae on soft palate but not diagnostic
• Rash usually develops 14-17 days

Question 2

Rubella Differentials

Answer 2

• Contact dermatitis
• Erythema miltiforme
• Measles

Question 3

Rubella Investigations

Answer 3

• Clinical diagnosis unreliable
• Serological and/or PCR testing is gold standard
• Contact HPU for a kit

Question 4

Rubella Management

Answer 4

• No specific treatment
• Keep child out of school until four days after rash appears
• Avoid aspirin ?
• Ask about contact with pregnant women

Question 5

Rubella Complications

Answer 5

• Encephalopathy may develop 6 days after rash
• Arthritis and arthralgia in adults
• Thrombocytopenia
• Guillan-Barré

Question 6

Rubella in Pregnancy

Answer 6

• Can cause miscarriage and damage in 90% of surviving infants
• Same presentation as rubella
• Clinically indistinguishable from parvovirus B19
• TORCH
• IgM in saliva is investigation
• Termination is offered if positive in first 16 weeks