USMLE

Rubella

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Viruses - RNA Viruses
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Summary

Rubella, also known as German Measles, is an RNA virus that belongs to  the togavirus family.  Rubella causes different clinical presentations depending on who it affects.

In children and adults, rubella causes a mild condition that presents with  postauricular lymphadenopathy, arthralgias or joint pains, and a distinctive maculopapular rash that begins on the face and spreads downwards to involve the trunk and extremities. Symptoms are mild and usually resolve within a week’s time.

However, rubella can have much more serious consequences for a developing fetus. This condition, known as Congenital Rubella Syndrome, occurs when a pregnant woman is infected with rubella. Congenital rubella can lead to permanent deafness and cataracts in the newborn. It also can lead to a Patent Ductus Arteriosus or PDA, which is a cardiac malformation describing an opening between the aorta and pulmonary artery after birth. Finally, Congenital Rubella Syndrome also presents with a blueberry-muffin like rash.

Since the congenital form of rubella is so dangerous,  the MMR vaccine is a live attenuated vaccine recommended to almost everyone in the general population in order to reduce rates of rubella infections.

Key Points

  • Rubella virus
    • Also known as German Measles or 3-day Measles
    • Characteristics
      • Member of Togavirus family
    • Presentation
      • Rubella
        • Usually seen in children; mild disease with few permanent symptoms
        • Fever
        • Lymphadenopathy
          • Usually postauricular or occipital
        • Arthralgias
        • Rash spreading downward from face
          • Fine, maculopapular rash that starts on face and spreads downwards/centrifugally to involve trunk and extremities
      • Congenital Rubella
        • Serious disease leading to birth defects (a TORCH infection)
        • Sensorineural deafness
        • Cataracts
        • Patent Ductus Arteriosus (PDA)
          • Characterized by machine-like murmur on auscultation
          • Close with indomethacin
          • Other cardiac malformations may be seen
        • Blueberry muffin appearance
          • due to dermal extramedullary hematopoiesis
        • Developmental delay may be seen
    • Prophylaxis
      • MMR vaccine (Measles, Mumps, Rubella)
        • Live attenuated vaccine
        • Given at 12-15 months of age
        • Has greatly reduced incidence of congenital rubella