Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ Key Features +++ Essentials of Diagnosis ++ History of rubella vaccination usually absent Fever with postauricular and occipital adenopathy Maculopapular rash beginning on face, rapidly spreading to the entire body, and disappearing by fourth day Congenital infection Retarded growth and development Cataracts, retinopathy Purpuric "blueberry muffin" rash at birth Jaundice, thrombocytopenia Deafness Congenital heart defect +++ General Considerations ++ Causes a mild, self-limited exanthema (over 80% of infections are subclinical) However, infection during pregnancy leads to teratogenicity and miscarriage Endemic rubella is absent in the United States and the Americas Congenital rubella in infants born to unimmunized women and the occasional woman who is reinfected in pregnancy, is very rare Sporadic cases occur in immigrants to the United States from Asia and Africa +++ Clinical Findings +++ Symptoms and Signs ++ Incubation period is 14–21 days Transmitted by aerosolized respiratory secretions Patients are infectious 5 days before until 5 days after the rash Infection in children Young children may only have rash Rash consists of erythematous discrete maculopapules beginning on the face and spreading to the trunk and extremities within 24 hours Older patients often have a nonspecific prodrome of low-grade fever, ocular pain, sore throat, and myalgia Postauricular and suboccipital adenopathy (sometimes generalized) is characteristic Congenital infection More than 80% of women infected in the first 4 months of pregnancy (25% near the end of the second trimester) deliver an affected infant Congenital disease occurs in < 5% of women infected later in pregnancy Later infections can result in isolated defects, such as Growth retardation Cardiac anomalies (pulmonary artery stenosis, patent ductus arteriosus, ventricular septal defect) Ocular anomalies (cataracts, microphthalmia, glaucoma, retinitis) Deafness (sensorineural) Cerebral disorders (chronic encephalitis, retardation) Hematologic disorders (thrombocytopenia, dermal nests of extramedullary hematopoiesis or purpura ("blueberry muffin" rash), lymphopenia Hepatitis, osteomyelitis, immune disorders, malabsorption, diabetes +++ Differential Diagnosis ++ Measles Enterovirus Adenovirus Epstein-Barr virus Roseola Parvovirus Toxoplasma gondii infection Drug reactions Congenital cytomegalovirus infection, toxoplasmosis, and syphilis +++ Diagnosis +++ Laboratory Findings ++ Leukopenia is common Platelet counts may be low Congenital infection Associated with low platelet counts, abnormal liver function tests, hemolytic anemia, and CSF pleocytosis Virus may be isolated from oral secretions or urine from 1 week before to 2 weeks after onset of rash Children are infectious for months Direct RNA amplification (PCR) is common and very sensitive Serologic immunoassay diagnosis is best made by demonstrating a fourfold rise in antibody titer between specimens drawn 1–2 weeks apart +++ Imaging ++ Radiography: Pneumonitis and bone metaphyseal longitudinal lucencies may be present in children with congenital infection +++ Treatment ++ Symptomatic therapy is sufficient Arthritis may improve with administration of anti-inflammatory agents +++ Outcome ... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Download the Access App: iOS | Android Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.