Rubella virus: Difference between revisions
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* Also known as German measles |
* Also known as German measles |
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* Causes fever, rash, ± arthritis |
* Causes fever, rash, ± arthritis |
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− | * Mnemonic: "German toga party", "Oct-toga-fest" |
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* Congenital syndrome: deafness, cataracts, and CHD |
* Congenital syndrome: deafness, cataracts, and CHD |
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− | = |
+ | == Background == |
+ | === Microbiology === |
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* RNA virus in the Togaviridae family, genus ''Rubivirus'' |
* RNA virus in the Togaviridae family, genus ''Rubivirus'' |
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− | = Epidemiology = |
+ | === Epidemiology === |
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* Seasonal, in spring, if no vaccine |
* Seasonal, in spring, if no vaccine |
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* Less contaggious than measles, spread by respiratory droplets |
* Less contaggious than measles, spread by respiratory droplets |
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** All cases are imported |
** All cases are imported |
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− | = Pathophysiology = |
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− | * |
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* Incubation period 18 days (range 12 to 23 days) |
* Incubation period 18 days (range 12 to 23 days) |
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* Benign after birth (postnatal rubella) |
* Benign after birth (postnatal rubella) |
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* Encephalitis is rare |
* Encephalitis is rare |
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− | == Congenital rubella syndrome == |
+ | === Congenital rubella syndrome === |
+ | * Refer to [[Congenital rubella]] |
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− | * ''Deafness'', ''cataracts'', glaucoma, congenital heart disease, and mental retardation |
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− | * Low birth weight, thrombocytopenic purpura, organomegaly, meningoencephalitis, retinopathy, PDA, PS, developmental disorders, cryptorchidism, inguinal hernia |
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* Acute and convalescent ELISA serology, or single IgM titre |
* Acute and convalescent ELISA serology, or single IgM titre |
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* Can do PCR for viral RNA on throat swabs, CSF, or amniotic fluid |
* Can do PCR for viral RNA on throat swabs, CSF, or amniotic fluid |
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− | = Management = |
+ | == Management == |
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* First trimester infection is more likely to have congenital rubella, rare in third trimester |
* First trimester infection is more likely to have congenital rubella, rare in third trimester |
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* Confirm vaccination status of the exposed individual, in which case they will be very low risk |
* Confirm vaccination status of the exposed individual, in which case they will be very low risk |
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− | = |
+ | == Prevention == |
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* Live attenuated vaccine is included in MMR at 12-15 months and 4-6 years |
* Live attenuated vaccine is included in MMR at 12-15 months and 4-6 years |
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* Vaccine is 95% effective |
* Vaccine is 95% effective |
Revision as of 21:27, 8 February 2020
- Also known as German measles
- Causes fever, rash, ± arthritis
- Congenital syndrome: deafness, cataracts, and CHD
Background
Microbiology
- RNA virus in the Togaviridae family, genus Rubivirus
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 Presentation
- 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