Rubella virus: Difference between revisions

Latest revision as of 13:53, 5 August 2020

Also known as German measles
Causes fever, rash, ± arthritis
Congenital syndrome: deafness, cataracts, and CHD

Background

Microbiology

RNA virus in the Matonaviridae family, genus Rubivirus
- Previously in the Togaviridae family

Epidemiology

Seasonal, in spring, if no vaccine
Less contaggious than measles, spread by respiratory droplets
- Most contagious while the rash is erupting, but ranges from 10 days prior to 15 days after
- Infants with congenital rubella can shed it in body fluids for months
Epidemics happened every 6 to 9 years, with larger epidemics every 30 years
Worldwide, until it was eliminated in the Americas in 2009
- All cases are imported

Clinical Manifestations

Incubation period 18 days (range 12 to 23 days)
Benign after birth (postnatal rubella)
In adults, prodrome of fever, malaise, and anorexia, followed by the rash
Rash appears along with development of immunity
- Rash starts at the head and moves down
- Maculopapular
- May desquamate during healing
- May be absent
- Can have Forschheimer's spots (petechial lesions on the soft palate), but not pathognomonic
Adenopathy can last weeks, primarily posterior auricular, posterior cervical, and suboccipital
Can develop arthritis in a third, usually fingers, wrists, and knees
- Onset soon after the rash, can take up to a month to resolve
Hemorrhage from thrombocytopenia and vascular damage, more commonly in children
Encephalitis is rare

Congenital rubella syndrome

Refer to Congenital rubella

Diagnosis

Acute and convalescent ELISA serology, or single IgM titre
Can do PCR for viral RNA on throat swabs, CSF, or amniotic fluid

Management

First trimester infection is more likely to have congenital rubella, rare in third trimester
Confirm vaccination status of the exposed individual, in which case they will be very low risk

Prevention

Live attenuated vaccine is included in MMR at 12-15 months and 4-6 years
Vaccine is 95% effective
Should revaccinate most young women

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-= Rubella virus (German measles) =
+*Also known as German measles
+*Causes fever, rash, ± arthritis
+*Congenital syndrome: deafness, cataracts, and CHD
+==Background==
-* Fever, rash, ± arthritis
+===Microbiology===
-* Mnemonic: &quot;German toga party&quot;, &quot;Oct-toga-fest&quot;
-* Congenital syndrome: deafness, cataracts, and CHD
+*RNA virus in the Matonaviridae family, genus ''Rubivirus''
-== Microbiology ==
+**Previously in the Togaviridae family
+===Epidemiology===
-* RNA virus in the Togaviridae family, genus ''Rubivirus''
+*Seasonal, in spring, if no vaccine
-== Epidemiology ==
+*Less contaggious than measles, spread by respiratory droplets
+**Most contagious while the rash is erupting, but ranges from 10 days prior to 15 days after
+**Infants with congenital rubella can shed it in body fluids for months
+*Epidemics happened every 6 to 9 years, with larger epidemics every 30 years
+*Worldwide, until it was eliminated in the Americas in 2009
+**All cases are imported
+==Clinical Manifestations==
-* Seasonal, in spring, if no vaccine
-* Less contaggious than measles, spread by respiratory droplets
-** Most contagious while the rash is erupting, but ranges from 10 days prior to 15 days after
-** Infants with congenital rubella can shed it in body fluids for months
-* Epidemics happened every 6 to 9 years, with larger epidemics every 30 years
-* Worldwide, until it was eliminated in the Americas in 2009
-** All cases are imported
+*Incubation period [[Usual incubation period::18 days]] (range [[Incubation period range::12 to 23 days]])
-== Pathophysiology ==
+*Benign after birth (postnatal rubella)
+*In adults, prodrome of fever, malaise, and anorexia, followed by the rash
+*Rash appears along with development of immunity
+**Rash starts at the head and moves down
+**Maculopapular
+**May desquamate during healing
+**May be absent
+**Can have Forschheimer's spots (petechial lesions on the soft palate), but not pathognomonic
+*Adenopathy can last weeks, primarily posterior auricular, posterior cervical, and suboccipital
+*Can develop arthritis in a third, usually fingers, wrists, and knees
+**Onset soon after the rash, can take up to a month to resolve
+*Hemorrhage from thrombocytopenia and vascular damage, more commonly in children
+*Encephalitis is rare
+===Congenital rubella syndrome===
-*
+*Refer to [[Congenital rubella]]
-== Clinical Presentation ==
+==Diagnosis==
-* Incubation period 18 days (range 12 to 23 days)
-* Benign after birth (postnatal rubella)
-* In adults, prodrome of fever, malaise, and anorexia, followed by the rash
-* Rash appears along with development of immunity
-** Rash starts at the head and moves down
-** Maculopapular
-** May desquamate during healing
-** May be absent
-** Can have Forschheimer's spots (petechial lesions on the soft palate), but not pathognomonic
-* Adenopathy can last weeks, primarily posterior auricular, posterior cervical, and suboccipital
-* Can develop arthritis in a third, usually fingers, wrists, and knees
-** Onset soon after the rash, can take up to a month to resolve
-* Hemorrhage from thrombocytopenia and vascular damage, more commonly in children
-* Encephalitis is rare
+*Acute and convalescent ELISA serology, or single IgM titre
-=== Congenital rubella syndrome ===
+*Can do PCR for viral RNA on throat swabs, CSF, or amniotic fluid
+==Management==
-* ''Deafness'', ''cataracts'', glaucoma, congenital heart disease, and mental retardation
-* Low birth weight, thrombocytopenic purpura, organomegaly, meningoencephalitis, retinopathy, PDA, PS, developmental disorders, cryptorchidism, inguinal hernia
+*First trimester infection is more likely to have congenital rubella, rare in third trimester
-== Diagnosis ==
+*Confirm vaccination status of the exposed individual, in which case they will be very low risk
+==Prevention==
-* Acute and convalescent ELISA serology, or single IgM titre
-* Can do PCR for viral RNA on throat swabs, CSF, or amniotic fluid
+*Live attenuated vaccine is included in MMR at 12-15 months and 4-6 years
-== Management ==
+*Vaccine is 95% effective
+*Should revaccinate most young women
+[[Category:Togaviridae]]
-* First trimester infection is more likely to have congenital rubella, rare in third trimester
-* Confirm vaccination status of the exposed individual, in which case they will be very low risk
-== Vaccination ==
-* Live attenuated vaccine is included in MMR at 12-15 months and 4-6 years
-* Vaccine is 95% effective
-* Should revaccinate most young women