Pediatrics

1. Rubella
Kebede M. ,Pediatrician

2. Introduction
• Also called German measles or 3 day measles
• It is a mild, often exanthematous disease of infants
and children.
• Its major clinical significance is transplacental
infection and fetal damage as part of the congenital
rubella syndrome (CRS).

3. Etiology
• Rubella virus
a single-stranded RNA virus
Humans are the only known host.

4. PATHOGENESIS
• The viral mechanisms for cell injury and death in
postnatal or congenital rubella are not well
understood.
• Following infection, the virus replicates in the
respiratory epithelium and then spreads to regional
lymph nodes.
• Viremia ensues and is most intense from 10-17 days
after infection.

5. Pathog…
• Viral shedding from the nasopharynx begins
approximately 10 days after infection and may be
detected up to 2 wk following onset of the rash.
• The period of highest communicability is from 5 days
before to 6 days after the appearance of the rash.
• The most important risk factor for severe congenital
defects is the stage of gestation at the time of
infection.
• Maternal infection during the 1st 8 wk of gestation
results in the most severe and widespread defects.

6. Pathog…
• The most distinctive feature of congenital rubella is
chronicity.
• Once the fetus is infected early in gestation, the virus
persists in fetal tissue until well beyond delivery.
• Persistence suggests the possibility of ongoing tissue
damage and reactivation, most notably in the brain.

7. Clinical Features
1. Prodromal phase
Follows an incubation period of 14-21 days
low-grade fever, sore throat, red eyes with or
without eye pain, headache, malaise, anorexia, and
lymphadenopathy.
2. Exanthematous (rash ) phase
In children, the first manifestation of rubella is
usually the rash.
The duration of the rash is generally 3 days.

8. Clinical…
• It begins on the face and neck as small, irregular
pink macules that coalesce, and it spreads
centrifugally to involve the torso and extremities,
where it tends to occur as discrete macules.
3. Recovery phase
• The rash fades from the face as it extends to the rest
of the body so that the whole body may not be
involved at any one time.
• It usually resolves without desquamation.
• Subclinical infections are common, and 25-40% of
children may not have a rash.

9. Diagnosis
• Laboratory
• CBC - Leukopenia, neutropenia, and mild thrombocytopenia (
during postnatal rubella).
• Rubella immunoglobulin (Ig) M enzyme immunosorbent assay
for confirmation of the diagnosis of congenital rubella.
• Polymerase chain reaction test, or viral culture
Confirmatory

10. Congenital Rubella Syndrome
• Cataract
• Deafness
• CHD (PDA, PA stenosis, PS)
• LBW
• Psychomotor retardation
• Neonatal purpura
• Death

11. Treatment
• There is no specific treatment available for either
acquired rubella or CRS.
• Supportive care
a. Postanatal rubella
• Antipyretics
• Analgesics.
• Intravenous immunoglobulin or corticosteroids can
be considered for severe, nonremitting
thrombocytopenia.

12. Treat…
b. CRS
• Pediatric, cardiac, audiologic, ophthalmologic, and neurologic
evaluation and follow-up because many manifestations may not
be readily apparent initially or may worsen with time.

13. Prevention
• Isolation
from susceptible individuals for 7 days after onset of the rash.
• Vaccination - MMR vaccine

14. Thank You!!!