Complications after rubella in children. The main signs of the disease

Rubella is spicy viral disease, detected in most cases in children 2–9 years old. Compared to other childhood infectious diseases, such as chickenpox and scarlet fever, it is rare. This is due to the fact that rubella vaccination is included in the calendar mandatory vaccinations in many countries of the world. In unvaccinated children, the disease is mild and rarely accompanied by serious complications. It is most dangerous for pregnant women, its detection in the first trimester is medical indication to abortion.

The causative agent is the RNA virus Rubella virus, the only representative of the Rubivirus genus of the Togaviridae family. In external environment it is unstable, remains viable only for 5-8 hours. It quickly dies under the influence of UV rays (quartz formation), pH changes, sunlight, high temperatures, various disinfectants (formalin, chlorine-containing compounds), organic solvents, detergents. However, it survives low temperatures ah, and even in a frozen state, it is able to maintain activity for several years.

The incidence of rubella is most often recorded during periods of changing seasons: spring, winter and autumn. The virus is transmitted from infected person:

by airborne droplets (when sneezing, coughing, talking, kissing);
by contact (through toys, dishes, towels and other household items);
transplacental from a pregnant woman to a fetus.

In the first two cases, rubella is acquired. The entrance gates of infection are the mucous membranes of the respiratory tract and oral cavity, then the virus penetrates through the walls of the capillaries into the bloodstream and spreads through the bloodstream to all organs and tissues of the body. Incubation period is 2-3 weeks. With intrauterine infection through the placenta, rubella is congenital.

The carrier of Rubella virus poses a danger to others from the second half of the incubation period: a week before the rash and a week after. It spreads most easily and quickly in enclosed spaces, in crowded places (kindergartens and schools, hospital wards).

After suffering an acquired form of rubella, a child develops a strong immunity, so re-infection is extremely rare. It is fundamentally possible with malfunctions of the immune system and with severe immunodeficiency.

It is believed that 20 or more years after the disease, the immunity formed to it can be weakened, therefore, during this period, re-infection is not excluded. With secondary infection, the infection usually occurs without symptoms or with an implicit clinical picture (cough, runny nose), without a rash on the body.

In the congenital form of the disease, immunity against the rubella virus is less resistant, since it is formed in the conditions of an immature fetal immune system. Such babies are carriers of the infection for 2 years from the moment of birth and secrete the virus into environment.

Symptoms

First obvious symptoms Rubella in children appears towards the end of the incubation period. He himself is usually asymptomatic, some children may complain of malaise, weakness, be capricious, sleepy, slow. A sign of the presence of a virus in the body at this stage is a slight thickening and enlargement of the lymph nodes, first in the inguinal, axillary and submandibular regions, and then only on the back of the head and behind the ears. The occipital lymph nodes are the least resistant to Rubella virus and it is in them that its accumulation and reproduction mainly occurs.

prodromal period

The disease has a prodromal period. It does not happen to everyone and can last from several hours or up to a couple of days and be accompanied by the following symptoms:

pain in muscles and joints;
headache;
weakness;
sore throat;
nasal congestion.

The main signs of the disease

After 1–1.5 days, there is a sharp pain in the back of the neck, The lymph nodes in this area become motionless and dense, up to 1 cm in diameter. May be observed:

paroxysmal dry cough;
nasal congestion caused by swelling of the mucous membrane;
body temperature rises to 38 ° C and lasts 2 days.

Eruption period

After 2 days, a small red rash appears on the face, neck and scalp. It is a round or oval pink-red spots with a diameter of 2 - 5 mm, not merging with each other. The occurrence of rashes is due to toxic effect virus to capillaries located under the skin.

Within a few hours, the rash spreads all over the body (on the shoulders, arms, back, abdomen, groin and legs), except for the palms and feet. After 3 days, it turns into nodules, begins to turn pale and disappear, leaving no scars or age spots on the skin. Lastly, the rash passes on the buttocks, the inner surface of the thigh and arms, where the highest density of its elements is noted.

The period of rashes lasts on average from 3 to 7 days. Then the child's condition noticeably improves, appetite returns, cough and sore throat disappear, relief nasal breathing. The size and density of the lymph nodes returns to normal 14-18 days after the disappearance of the rash.

Forms of the disease

Rubella in a child can occur in two main forms:

typical (light, medium, heavy);
atypical.

With a typical form, the clinical picture described above is observed. The atypical form is not accompanied by a rash, it can proceed without symptoms. Children with atypical rubella pose a great danger in terms of uncontrolled shedding of the virus and the spread of infection.

Video: Signs, prevention and complications of rubella

Diagnostics

The primary diagnosis of rubella in a child is carried out by a pediatrician and includes:

a survey of the parents of a sick child;
analysis of complaints;
finding out whether the child is vaccinated against rubella and whether contact with the patient has taken place;
general examination and examination of rashes on the skin and mucous membranes;
palpation of the lymph nodes.

Among laboratory diagnostic methods, a general blood and urine test is prescribed. With rubella, the urine test may be unchanged, in the blood test there is an increase in the indices of lymphocytes and plasmocytes, a decrease in leukocytes, an increase in ESR is possible.

If the patient does not have a rash, to confirm the diagnosis, an enzyme-linked immunosorbent assay for the content of antibodies to the virus in the blood is performed. This study it is recommended to carry out twice: in the first three days of illness and after 7-10 days. In the presence of infection, an increase in antibody titer by 2 times or more is observed.

For young children, it is advisable to conduct additional studies aimed at excluding the development of complications.

How to distinguish from other diseases

Diagnosis can be difficult with an atypical form or when rubella in children occurs with mild symptoms.

If rubella is suspected, it is important to differentiate it from other infectious diseases accompanied by similar symptoms or allergic skin reactions. Often, by external signs, it can be confused with measles, scarlet fever, adenovirus or enterovirus infection, infectious erythema, mononucleosis.

Unlike measles, rubella is not accompanied by severe intoxication and high fever, the elements of the rash do not connect with each other, appear almost simultaneously, there are no pathological changes on the oral mucosa.

Rubella differs from scarlet fever in the absence of blanching of the nasolabial triangle, larger elements of the rash, localized mainly on the back and extensor surface of the limbs, and not on the abdomen, chest and folds of the arms and legs.

Unlike mononucleosis, with rubella, the peripheral lymph nodes are slightly enlarged, there is no purulent tonsillitis, there is no enlargement of the liver and spleen.

Treatment

Compared to adults, rubella in children is mild and rarely causes complications. The disease is characterized by a generally favorable course and, as a rule, does not require hospitalization. The exception is children with a congenital form of rubella, infants, children with severe comorbidities, as well as children who develop convulsive syndrome and other complications against the background of the disease.

There is no specific treatment for rubella. During illness it is recommended:

bed rest in the acute period (from 3 to 7 days);
wet cleaning and frequent airing of the room where the sick child is located;
plentiful drink;
food intake (preferably dietary and rich in vitamins) often and in small portions.

Medications

Of the drugs for the treatment of rubella in children, symptomatic agents can be prescribed:

vitamins (group B, ascorbic acid, ascorutin);
antihistamines with a large number of rashes (suprastin, erius, fenistil, zyrtec, zodak and others);
antipyretics based on ibuprofen or paracetamol at temperatures above 38 ° C;
lozenges or sprays severe pain in the throat (septefril, lysobact);
vasoconstrictor drops from severe nasal congestion.

Antibacterial drugs are used to treat a secondary bacterial infection, if one occurs.

Features of rubella in children under one year old

Rubella is extremely rare in children under one year of age. This is due to the fact that most women at the time of conception have either had rubella in childhood or received a vaccination against it. In this case, during fetal development and subsequent breastfeeding, the baby receives antibodies from the mother's body to a wide variety of infections, including rubella, and for about a year his body is protected by the mother's immunity.

If a woman did not have rubella before conception and was not vaccinated in childhood, then the chances of her unborn child getting rubella in utero or at the age of up to a year (before routine vaccination) are high.

Rubella in infants is dangerous to health. It may be accompanied by convulsive syndrome, DIC (disseminated intravascular coagulation), the development of meningitis and encephalitis. A feature of the course of the disease at this age is the rapid development. Characteristic rashes can be present on the skin for no more than 2 hours, and then immediately disappear without leaving a trace. In children under one year old who have had rubella, a strong immunity to this disease, which allows them to no longer be routinely vaccinated.

Video: Pediatrician about rubella in a child

Consequences in pregnant women

The most severe and dangerous is intrauterine rubella infection. And the earlier it happened, the less favorable the prognosis. When a pregnant woman is infected before 12 weeks, there is a high probability of fetal death and miscarriage or gross deviations in its development. These include damage to the central nervous system (microcephaly, hydrocephalus, chronic meningoencephalitis), defects in the formation bone tissue and the triad of vices:

eye damage (cataract, retinopathy, glaucoma, chorioretinitis, microphthalmos) up to complete blindness;
damage to the auditory analyzer up to complete hearing loss;
the development of combined abnormalities in the cardiovascular system (open ductus arteriosus, heart septal defects, pulmonary artery stenosis, incorrect localization of large vessels).

The teratogenic effect of Rubella virus is manifested in the fact that it inhibits cell division and thereby stops the development of certain organs and systems. Rubella causes fetal ischemia due to damage to the vessels of the placenta, suppresses the immune system and has a cytopathic effect on fetal cells.

If the fetus becomes infected after the 14th week of pregnancy, then the risk of malformations is significantly reduced, single defects, meningoencephalitis, mental retardation, mental disorders. Symptoms of congenital rubella in children may include low birth weight and delayed response to age-appropriate external stimuli.

Video: Why rubella is dangerous during pregnancy

Complications

Rubella in children causes complications if the child is weakened the immune system. Most often they occur due to a secondary bacterial infection. The most common complications include:

angina;
bronchitis;
meningitis;
lymphadenitis;
encephalitis.

Less common rheumatoid arthritis myocarditis, pyelonephritis, otitis media, thrombocytopenic purpura.

Prevention

The main prevention of rubella is timely vaccination. It is carried out according to the following scheme: at the age of 1-1.5 years, the child is vaccinated, and then at the age of 5-7 years - revaccination. After revaccination against the virus, a strong immunity is developed. Women who plan to bear a child at the age of 30 and older are recommended to revaccinate.

Rubella vaccination is most often carried out in conjunction with measles and mumps (MMR).

To prevent the spread of the virus from a sick person, the following measures must be taken:

isolate the patient in a separate room;
monitor personal hygiene;
provide individual dishes for the duration of the illness.

Be sure to regularly ventilate the room and wet cleaning using disinfectants in the room where the patient is located.

Hello dear moms and dads! The child developed a small red rash. What is this? Or is it a symptom of some other disease?

As always, we will not guess on the coffee grounds, but we will call the children's clinic and call the doctor at home. After all, it's about your child's health.

Why you should not go with the child to the clinic? Well, actually, it's up to you, it's just quite possible that we are dealing with rubella in children, and it is most often transmitted by airborne droplets. Therefore, your child is a danger to other children.

As soon as he sneezes, coughs, or just sits in line with the pediatrician, other children get sick. So, out of respect for other parents, and understanding that we are dealing with an infectious disease, sit at home and wait for the doctor to come.

How dangerous is rubella in children?

Rubella is an acute infectious disease characterized by the appearance and enlargement of the occipital lymph nodes. As a rule, rubella in children occurs in a mild form, without any complications and for a short time.

Children who are vaccinated may not get rubella at all, so it is important to vaccinate your child according to the national immunization schedule. And yet, what is the danger of this disease?

The fact is that in addition to the airborne method of infection, rubella can be transmitted transplacentally, that is, if a pregnant woman gets sick, the probability of infection of the fetus is very high.

Based on this, there are two types of rubella in children:

acquired;
congenital.

Acquired rubella for children is practically not dangerous, while congenital rubella can cause various physical disorders in a baby: visual impairment, deafness, heart defects. And it's not yet full list pathologies.

As practice shows, the peak of rubella infections in children occurs in April-May. Blame for reduced immunity, lack of vitamins. By the way, infants rarely get rubella, usually children aged 4 to 15 get sick with it.

The exception is newborn children with congenital rubella, they can also be a source of infection for others for another six months, and sometimes longer.

Now, let's actually talk about how rubella occurs in children? What should we prepare for?

Rubella in children: how does the disease progress?

So, to begin with, let's determine the source of infection - this is only an infected person. Infection requires close contact with the patient. The incubation period for rubella is 2-3 weeks, but on average, a rash appears about 18 days after exposure.

2-3 days before the rash appears, the child may have a headache, slight increase temperature, runny nose, complaints of a sore throat, the occipital lymph nodes may already begin to increase.

Usually the rash begins to appear, first of all, on the face and neck, in the extensor places of the limbs. Then very quickly, the rash spreads throughout the body of the child, and can persist for another three days.

The first rash is often accompanied by reddening of the skin, which resembles a rash with scarlet fever. Sometimes rubella in children is accompanied by redness of the conjunctiva of the eyes, a slight cough.

However, all these symptoms of the disease are so mild that they do not attract the attention of parents. But, nevertheless, in rare cases, rubella in children can be severe: complications from the nervous system, severe conjunctivitis, pain in the muscles of the neck.

Therefore, it is important to make an accurate diagnosis, and for this it is necessary that the child be examined by a pediatrician. Rubella is usually treated with fluids and antihistamines.

Special care for the affected areas of the skin is not required. It is enough just to observe the rules of personal hygiene of the child.

The duration of the disease in a mild form does not exceed 5 days, with complications - up to 2-3 weeks. And keep in mind that a sick child remains contagious to others for another week after the first rash.

Rubella (from lat. rubella) is an acute, highly contagious airborne (respiratory) viral infection that occurs in people who do not have acquired immunity to it. It belongs to the group of severe anthroponotic diseases, i.e. diseases that can only be transmitted from a sick person to a healthy person. However, it has been found that the virus rubella-causing, can cause disease in some species of monkeys of the marmoset family Cercopithecidae(macaques, green monkeys) and in rabbits. The possibility of infecting animals allows the development of rubella vaccines.

Historical reference

The first documented description of the symptoms of rubella was given by the German therapist F. Hofmann in 1740, but the separation into an independent disease was made only 140 years later. The nature of the disease was discovered in the 20th century by Japanese scientists Hiro and Tasaka, who showed on a group of volunteers that filtered sputum wash collected from the nasopharynx of rubivirus-infected people causes the development of this disease. After the work of Hiro and Tasaki, it took another 24 years to identify the rubella virus. Scientists from different countries of the world participated in this work: P. D. Parkman, T. X. Weller, F. A. Neva, S. A., Demidova, and others.

studying congenital anomalies development of the eye in newborns - cataracts, microphthalmos, retinopathy and corneal opacity, the Australian ophthalmologist Norbert Gregg in 1941 published data confirming the relationship of rubella infection in early pregnancy and the occurrence of malformations of newborns. The complex of congenital anomalies was called the "classic Gregg triad", in which the author included, in addition to cataracts, heart defects and.

The first rubella vaccines were developed in the late 1960s and 1970s, and the first immunization was given to US Air Force recruits at Leckland in 1979. Subsequently, the use of rubella vaccines in preventive practice has significantly reduced the overall incidence of rubella - up to 95%. Rubella incidence results are often cited over the 20-year period of vaccine use in the United States for 1964 and 1984, from which it can be seen that the ratio of rubella incidence in these years was 1,800,000: 745 cases of the disease.

Classic symptoms of rubella

According to the International Classification of Diseases (ICD-10) in 1972 as official name acute viral disease characterized by small-spotted exanthema, generalized lymphadenopathy, moderate fever and fetal damage in pregnant women, it was recommended to use the nosological term rubella.

In the definition of a disease, The four most likely manifestations of rubella (symptoms) are:

Small-spotted exanthema;
Generalized lymphadenopathy;
febrile fever;
Anomalies in the development of the fetus (in case of infection of the mother in early pregnancy).

Small-spotted exanthema(from Greek. exantheō- flower, bloom) is the common name for a rash on the skin, which manifests itself in the form of small patchy reddenings of pale pink or red color of a small diameter up to 0.5 cm, which are called razeols. They have a smooth round edge, as a rule, do not merge and do not peel off. With this disease, it occurs in 2/3 of cases of infection. Together with skin rashes, or shortly before them, rashes are possible pale pink enanthemas (i.e. rashes) on the mucous membranes. Eruptions begin on the face and then move to the trunk and limbs. The rash usually lasts 2-3 days. In addition, catarrhal phenomena in the throat, slight inflammation of the pharynx and conjunctivitis without redness (hyperemia) of the mucosa are possible. oral cavity. In children younger age rubella rash is often not manifested, so clinically it is difficult to distinguish it from similar respiratory viral infections of the oropharynx and nasopharynx (, adeno-, para- or rhinovirus infection).

Generalized lymphadenopathy manifested by a systemic increase in several (more than two) lymph nodes, first of all, the infection captures the posterior cervical and occipital lymph nodes. Lymphadenopathy manifests itself in the first days of the disease, even before the onset of a rash, and lasts for a long time - for several weeks or more. This is one of the earliest symptoms, in which the lymph nodes take the form of peas or beans, have an elastic consistency and are sensitive to light pressure.

Rubella rash symptoms

Mild to moderate fever, the first is typical for a mild form, the second for a moderate and severe form of the course of the disease. Weak (subfebrile) fever, accompanied by an increase in the body up to 38ºС, moderate (febrile) fever, accompanied by an increase in body temperature up to 38-39ºС. An increase in temperature is the result of the last phase of infection - viremia, in which there is a massive reproduction of the rubella virus and its entry into the bloodstream of an infected person. As a rule, viremia begins a week after the enlargement of the lymph nodes.

The causative agent of the disease

The etiological cause of rubella is a single-stranded plus-strand RNA-containing togavirus (family Togaviridae, genus rubivirus). The virus genome is covered with a supercapsid, i.e. its own protein nucleocapsid is additionally covered with a lipid bilayer, on the surface of which there are glycoprotein spikes thickened at the ends, the average length is 6-10 nm. Glycoprotein spikes have two varieties - E1 and E2:

The first (E1) has a hemagglutinating property in relation to erythrocytes of birds (pigeons, geese), i.e. determines the ability to dissolve the shell of red blood cells and their subsequent hemolysis (destruction);
The second (E2) is a receptor for interaction with cells.

Glycoprotein E1 (hemagglutinin) is the only external antigen of the virus. Therefore, the antigenic structure is stable and there is only one serotype (antigenic type) of the rubella virus. One of the features of the virus is the presence in its shell of the enzyme neuraminidase, which helps viral particles to penetrate through the mucous membrane into the blood and respiratory epithelium of the infected organism. In addition, it is believed that during the replication cycle, it is neuraminidase that determines the possibility of releasing the newly synthesized virus from the cell. Neuraminidase hydrolyzes the bonds between sialic acid, therefore it is sometimes called sialidase. It is part of such pathogens as cholera and virus (up to 7% of the total content in the shell), as well as the pathogen gas gangrene (Clostridium perfringens ). Since neuraminidase is found on the surface of the rubella virus envelope, it is also one of the surface antigens involved in antigen-antibody immune responses.

Reproduction (replication) of the virus begins from the moment it attaches to the surface of sensitive cells, which are the mucous membrane of the nasopharynx of adults, or the amniotic cells of the embryo. After binding to the surface of a sensitive cell, the virus enters the cytoplasm through endocytosis and accumulates in the cell in the form of endosomes (endocytic vesicles). The contents of endosomes are acidified, due to which the virus leaves the endosome and begins the process of transcription (reading information) and subsequent replication (doubling the viral RNA molecule), which includes three stages:

duplication of the genome
Synthesis and maturation of protein structures,
assembly of the virus.

Replication ends with the separation of the new virus from the host cell wall.

The virus is resistant to low temperatures (it is well preserved when frozen, at temperatures from -70 to -200 ºС). In a frozen state, it can remain infectious for years. At the same time, the rubella virus is sensitive to high temperatures (above 56 ºС) and acidic environment pH below 5.0 (some authors indicate a pH limit of 6.8), as well as in an alkaline environment - pH above 8. Therefore, it is quite easy to disinfect with conventional disinfectants. At room temperature the virus is able to remain stable for several hours. It may be noted that, like many viruses, rubivirus is not susceptible to antibiotics.

Epidemiology of the disease

The main source of infection is a sick person, and the clinical picture can be well expressed, or it can proceed without any external signs (the absence of a rash is recorded in 50% of cases). As a rule, infection occurs in 30-60% of cases of contact with a sick person.

Of particular danger of infection are children who become infected from the mother transplacentally. After birth, such children remain contagious up to 1.5-2 years, and pose a danger to adults who do not have acquired immunity, as well as children older than 0.5-1 years. It should be noted that healthy children infancy are not susceptible to infection, because they receive antibodies from a mother who has had "childhood infections" and which continue to support the child's passive immunity for 3-6 months. Most frequent age diseases of 5-10 years, however, cases of rubella in adults under 40 years of age are not uncommon. Sexual dimorphism has not been established for this disease - women and men are equally susceptible to infection and the course of the disease.

Three routes are possible for the transmission and entry of ruvirus into the body:

Airborne (is the main),
Transplacental (vertical),
Contact (through household items).

The gates for infection are the upper Airways:

The mucous membrane of the nasal cavity,
ciliated epithelium of the respiratory pharynx,
The mucous membrane of the oropharynx.

Once on the surface of susceptible mucosal cells, the virus is sent to the blood or lymph and reaches the regional lymph nodes with the lymph flow:

cervical,
behind the ear,
Occipital.

The epidemiological picture is characterized by periodic outbreaks of morbidity that occur at intervals of 6-9 years (MON, 1996), according to some authors, 10-20 years. In the period between the occurrence of outbreaks of infection, isolated cases of a local increase in the incidence are recorded. with a seasonal maximum in April-June.

The incubation of the virus takes 2-3 weeks after entering the blood, after which it begins to be released into the environment even before the appearance of a rash on the skin. The most dangerous period of contact with an infected person is one week before the onset of the clinical picture and typical signs of the disease. The ability of the virus to enter the urine and feces has been established, which causes contact way the spread of infection. However, due to the short persistence of the virus indoors, this mode of transmission is ineffective and makes little contribution to the epidemiology of the disease. However, it is important to take into account the fact that organized groups, such as preschool and school groups, military personnel, etc., increases the likelihood of infection. If a patient with rubella is detected in an organized group, it is isolated from the rest of the team for 21 days from the moment the patient is detected. Daily monitoring is established, which should include measuring body temperature, examining the skin and mucous membranes of the oral cavity, and probing the lymph nodes.

Clinical features in children and adults

IN clinical picture diseases children and adults have differences. In particular, children tolerate rubella much easier than adults and without complications. The course of the disease in adults is moderate and severe, with possible complications, such as inflammation of the joints, inflammation of the membranes and one's own brain, as well as a decrease in the blood platelet count and, as a result, hemorrhages - petechiae.

The rubella virus is extremely dangerous for women planning to become pregnant or already in early pregnancy. The consequence of infection of such a group of women is CRS-syndrome, or congenital rubella syndrome.

Forms of rubella can be divided into groups:

Acquired rubella in children
congenital rubella of newborns,
Acquired rubella in adults.

Acquired rubella in children is characterized by the following manifestations:

There may be no catarrhal period at all, or it may last only a few hours and go unnoticed in a couple of days. Inflammation may be accompanied by a set of non-specific symptoms:

hyperthermia,
A little runny nose.

The appearance and spread of rashes has a certain sequence - at the beginning of the disease they appear on the face, then move to the neck, after which they move to the trunk and limbs, but after a week they do not leave a trace. The rashes are in the form of spots, not bubbles, so they can be well distinguished from. The temperature in children with rubella can rise to 38 ºС (less often 38-39 ºС), lasts 2 days. The general severity of symptoms is maintained for one week and ends without complications with complete recovery. However, it is important to remember that the child retains the ability to infect others for the next 2 weeks. At this time, he develops lifelong immunity.

Intrauterine infection of the fetus with rubella leads to the development of congenital rubella syndrome. It is observed in 15-30% of pregnant women and poses a serious threat to the fetus. Rubivirus has an increased tropism for embryonic cells, which is due to the presence of surface receptors used by the virus to enter cells. As a result of transplacental infection of the fetus, the rubivirus disrupts the mitotic activity of the embryonic tissue and affects the vessels of the placenta. The result of the interaction of the virus and embryonic cells is a lethal and teratogenic effect. The teratogenic effect manifests itself in the form of congenital deformities (Gregg's anomalies):

Degeneration of the cochlea of the inner ear,
Development of cataracts
Malformations of the heart:
Tetralogy of Fallot,
Open Botallov duct,
Narrowing of the pulmonary trunk
Defects of the cardiac septum.

In addition to the classic Gregg triad, more extensive congenital anomalies are possible - the "extended syndrome":

Malformations of the regenerative organs,
organs of the gastrointestinal tract,
Skeleton of the bones of the skull,
Micro- and hydrocephalus.

Possible consequences of congenital rubella and other intrauterine infections (TORCH-complex)

Babies born with CRS differ from healthy newborns in:

low body weight,
Bilirubinemia (blood bilirubin content below 3.4 µmol/l),
Signs of jaundice.

In addition, it may subsequently develop diabetes and thyroiditis.

The timing of pregnancy is important, at which infection of the mother and fetus is possible. When the mother is ill with rubella:

In the early stages of pregnancy, 3-4 weeks - congenital malformations occur in 60% of cases,
At 9-12 weeks - in 15% of cases,
At 13-16 weeks at 7%.

A number of authors indicate the absence of any teratogenic effects in case of infection after the 20th week of pregnancy. Spontaneous abortion occurs in 10-40% of cases of early infection of the mother, stillbirth in 20% of cases, and neonatal mortality of newborns with CRS syndrome reaches 10-25% (overall infant mortality is below 6%).

In adults, the symptoms of rubella are accompanied by more severe intoxication, and are therefore accompanied by:

General weakness and malaise
high hyperthermia,
Headache
Chill.

It has been established that the virus can penetrate into the synovial fluid of the joints, which leads to inflammation (arthritis) and, as a result, joint pain in the knee, wrist joint and joints of the hand. When acute form arthritis virus is found in the synovial fluid, with chronic form- in blood. Women are more sensitive to arthritis of rubella etiology. In rare cases, in adults (0.03% of cases), rubella is accompanied by thrombocytopenia (a decrease in the number of platelets below 150,109 / l) and an increase in the permeability of blood vessels. Increased vascular permeability can lead to hemorrhage internal organs. Encephalitis (inflammation of the brain) is extremely rare.

Methods for diagnosing the disease

Diagnosis of rubella, as a rule, does not cause difficulty if the disease is accompanied by a typical picture of clinical signs. Therefore, in the normal course of the disease, laboratory analysis is not performed. According to indications, a general analysis of blood and urine is prescribed. Most probable character the result of a general analysis of blood and urine for rubella:

In controversial cases, with an atypical clinical picture, the following analysis methods are used to make a diagnosis of rubella:

virological method,
serological method,
Molecular genetic method.

Virological method analysis includes the use of avian and some mammalian erythrocytes. These can be red blood cells from pigeons, chickens or geese, often using rabbit erythrocytes. Rubivirus causes erythrocyte agglutination followed by hemolysis.

Serological method analysis makes it possible to determine species-specific antibodies in the patient's serum for the rubella virus. For serological analysis, paired sera are used, which make it possible to determine the increase in antibody titer. The diagnosis is confirmed by the detection of antibodies to the rubella virus class IgM or a fourfold increase in antibody titer. This type of analysis allows you to distinguish rubella from measles, with similar clinical signs.

Molecular genetic the method of analysis is associated with the use of polymerase chain reaction (PCR), which makes it possible to isolate the viral genome. The PCR method is one of the most reliable and accurate methods for diagnosing an infectious agent.

The object of study for each of the listed methods of analysis in the case of acquired rubella is the discharge of the nasopharynx or blood before rashes on the skin, as well as blood and urine after the appearance of rashes. In the case of congenital rubella, urine and feces (meconium) of newborns are used for analysis.

Since there is a risk of teratogenic effects of the fetus, the diagnosis of rubella in pregnant women or women planning their pregnancy is of particular importance to determine the presence of acquired immunity to this infection. The external symptoms of rubella are nonspecific and it is possible that in childhood the woman did not have this infection, she had a disease with similar signs that were mistaken for rubella. In addition, rubella may be asymptomatic in latent form. A positive result in the presence of acquired immunity is the presence in the blood of a woman of class G antibodies (IgG). Detection in the blood of antibodies of class M (IgM) is an indicator of the presence of the disease or that the disease has been recently transferred.

Possible indicators and their interpretation in the analysis for the presence of antibodies to rubella

Treatment of the disease

The general nature of the treatment of rubella in children and adults is practically the same. All activities should be directed towards:

The production of antibodies against viral infection,
Maintaining the body's strength in the fight against infection,
Strengthening resistance to other infections.

When children get sick, they are treated at home. Hospitalization is indicated only for epidemiological indications and in severe cases of the disease. The classic form of acquired childhood and adult rubella does not require specific treatment Therefore, according to indications, symptomatic treatment is prescribed, which should include:

With regard to drinking and diet, the following recommendations should be followed:

Drinking should be plentiful and warm, you can make a rosehip broth (rich in vitamin C), apple compote, fruit juice, non-carbonated mineral water;
Divide the meal into 4-5 meals, in small portions, so as not to overload the stomach (stimulates physiological leukocytosis),
Food should be easily digestible
The diet should include light vegetable soups, mashed potatoes, steamed meat dishes;

Antiviral treatment for rubella may include immunomodulatory drugs:

"Arbidol",
"Aflubin",
"Groprinozil",
"Anaferon"
"Viferon",
"Genferon".

The main action of these drugs is aimed at suppressing the reproduction of the viral RNA molecule (groprinosil, ana-, vi- and genferon) or stimulating the synthesis of its own interferon, as well as enhancing the growth of the cell population of blood T-lymphocytes.

As symptomatic treatment apply:

antipyretic drugs,
Antiallergic drugs.

As a rule, in children, the actual treatment of cough with rubella is not required, unless the disease is aggravated by an adjacent infection. In the event of a dry cough, drugs are used that are aimed at the formation and discharge of sputum. Among these drugs for children after a year, syrups are used:

Syrup "Gedelix" prepared from ivy leaf extract, it does not contain ethyl alcohol and it is sold without a doctor's prescription. Belongs to the group of expectorants, promotes liquefaction and separation of viscous sputum, as well as a decrease in bronchospasm. The active substance of the drug includes saponin glycosides, which increase the secretion of the bronchial mucosa.
Syrup "Linkas" often prescribed for symptomatic therapy diseases of the upper respiratory tract, which can develop against the background of rubella, so it can also be used in the treatment of rubella. It should be remembered that the composition of the drug includes 8 components of plant origin, including licorice root, marshmallow, fragrant violet, kolgan. Therefore, possible allergic effects should be considered.
Syrup "Sinekod" contains active Chemical substance butamirate, which has an effect on the respiratory center.

For the treatment of cough in adults, the drugs Ambroxol, Bromhexin, Mukaltin, Pertusin, Lazolvan, Bronholitin, etc. are used.

With the development of rhinitis, drops are prescribed:

"Nazivin", "Noxivin" and "Nazol", the composition includes oxymetazoline,
"Sanorin" and "Naftizin", as part of nafazolin,
"Galazolin", "Otrivin", "Tizin" as part of xylometazoline.

The group of these drugs differs in dosage and is sold at a concentration of 0.025% and 0.05% aqueous solution for children and 0.1% solution for adults. Preparations based on oxymetazoline dry the nasal mucosa less. The time of action of the drugs may vary, on average it ranges from 4 to 6 hours.

The most commonly used antipyretics are paracetamol for children and aspirin for adults. Ibuprofen is also used as an antipyretic, which is included together with paracetamol in the Ibuklin, as well as the Eferalgan candles. Ibuklin is sold in the form of syrup, paracetamol and aspirin in tablets. A different dosage of paracetamol tablets is possible, which is important to consider when calculating the child's body weight.

The course of rubella is accompanied by a weakening of the immune system and can provoke allergic reactions. Therefore, in some cases, antihistamines are indicated, such as:

"Parlazin",
"Loratodin",
"Ketotifen"
"Vibrocil".

"Parlazin" and "Loratodin" do not have a sedative effect, "Ketotifen", on the contrary, can cause drowsy sensations.

Disease prevention

As a specific prophylaxis for rubella, live or killed vaccines are used. Mass vaccination programs in different countries were adopted in different time, and in some countries they have not been adopted to this day, for example in countries of South Asia, where 136 cases of congenital rubella of the newborn regularly occur per 100,000 population. Since 1969 compulsory vaccination rubella has become for countries North America and Europe. In the USSR and later in the Russian Federation, until 1997, routine vaccination was not carried out, but information about the disease was entered into the vaccination card, i.e. naturally transmitted diseases were counted as vaccination. Since 2000, rubella vaccination has been included in national calendar vaccinations, according to which the rubella vaccine is given at the age of 1 year and at 6-7 years of age. The result of routine vaccination was an almost exponential drop in the incidence of 150 times: 152 cases per 200,000 people in 2005 and 1 case per 200,000 in 2015.

The following vaccines are registered and used in the Russian Federation:

Live vaccine "MMPII", manufactured in the USA,
Vaccine "Priorix", French production,
Live monovaccine "Rudivax"
Attenuated rubella vaccine produced by Serum Institute, India.

Vaccines are prepared from attenuated strains of the virus. Attenuated strains are weakened versions of the virus completely devoid of the ability to cause disease (virulence). Such viruses are repeatedly cultivated in lung tissue culture of a human embryo or in animals (green monkey kidneys) by repeated and sequential transfer of virus-containing material.

Immunization is carried out twice- the first vaccination is carried out at the age of 12 months, repeated revaccination at 6 years. Additional vaccination is carried out for girls aged 12-13 years, which prevents the risk of contracting viruses during pregnancy. Rubella vaccination is strictly prohibited 3 months before the planned pregnancy. The most commonly used vaccine for immunization is the measles-rubella vaccine, which shows high efficiency and reduces the number of injections required to form stable immunity to three infections. The use of a three-component MMR vaccines at 12 months provides long-term immunity, which in some cases persists throughout life. Re-vaccination (revaccination) at the age of 6 is aimed primarily at strengthening immunity and possible “reinsurance”, in case of absence of total immunity in 100% of vaccinated children.

After vaccination or as a result of the transfer of the disease, a stable lifelong immunity is formed in a person, which is provided by immunoglobulins. class IgG. Immunoglobulin IgG makes up the majority of globular proteins in blood serum. Structural features of the variable region in the IgG molecule provide the possibility of its binding to specific antigens, including those of a viral nature. The penetration of the rubella virus stimulates the proliferation (reproduction) and differentiation of B-lymphocytes, which are on early stages diseases synthesize immunoglobulins of the IgM class, and at subsequent stages, immunoglobulins of the IgG class are species-specific to this virus.

Video: rubella in the program "Live Healthy"

One of the most common viral infections, occurring mainly in childhood, is rubella. This viral disease, which in most cases proceeds in a mild form, is accompanied by short-term increase body temperature, small rash, enlargement of all lymph nodes. Rubella most often affects children of early and preschool age, the so-called risk group - from 1 to 7 years. Older children get sick much less often. What are the first signs, what is the incubation period, and how to treat the disease - we will consider further.

What is rubella?

Rubella in children is a disease belonging to a group of infectious, viral nature, the main symptoms of which are fever, a widespread small punctate rash on the body and catarrhal phenomena on the side of the respiratory organs.

The rubella virus tolerates freezing well, retains its aggressiveness at room temperature for several hours, and quickly dies under the influence of ultraviolet radiation, heating and disinfectants.

Factors that destroy the rubella virus:

drying;
the action of acids and alkalis (the virus is destroyed when the pH decreases less than 6.8 and increases more than 8.0);
action of ultraviolet radiation;
the action of ethers;
action of formalin;
action of disinfectants.

Transmission routes

A person can only get rubella from another person. The infection is transmitted by airborne droplets (the virus enters the air from the mucous membrane of the respiratory organs of a sick person, and then is inhaled by a healthy person). Most cases of infection occur during the incubation period, when the virus has already settled in the body, but has not yet manifested itself by external signs.

Rubella transmission routes:

Airborne;
Transplacental (especially in the first trimester of pregnancy);
In young children, the virus can be passed from mouth to mouth through toys.

The carrier of Rubella virus poses a danger to others from the second half of the incubation period: a week before the rash and a week after.

The risk of morbidity is high for those who have never been ill and have not been vaccinated; children 2-9 years old fall under this category of people. Outbreaks of morbidity are characterized by seasonality - winter-spring. Epidemic outbreaks recur every 10 years. After the disease, a stable lifelong immunity is formed, but according to some reports, re-infection is still possible.

When released into the external environment, the microorganism retains its aggressive properties for 5-8 hours, depending on the dryness and temperature of the air.

Incubation period

The incubation period for rubella is from 10 days to 25. It is believed that children in whom the disease occurs without any manifestations or with mild severe symptoms, are stronger sources of infection than children with obvious signs of infection.

A baby can get rubella if he has been in contact with:

infected people who have all the characteristic symptoms;
patients with an atypical form of the disease (with an uncharacteristic course of rubella, a rash may be completely absent, and many other signs);
infants who are diagnosed with a congenital form of the disease (in such children, the virus in the body can multiply for 1.5 years).

Typical symptoms of the disease are noticeable at the end of the incubation period.

How does rubella begin: the first signs in a child

Signs of rubella in children often resemble and largely due to the nature of the rash. Red spots appear rapidly, quickly cover the entire surface of the body. The first are localized on the neck, face, head, and then spread to the back, buttocks, and the surface of the limbs.

How rubella starts:

First, the following symptoms appear: nasal congestion, sore throat, weakness, drowsiness, temperature.
Further, enlarged lymph nodes and their swelling become noticeable. Pain is noted on palpation.
Most characteristic symptom at diagnosis - red spots.

The course of the infectious process in rubella in children is divided into several periods:

incubation (from the moment the infection enters the human body to the development initial symptoms diseases);
period of precursors (prodromal);
rash period;
convalescence (recovery).

What rubella looks like: photos of children with a rash

Not all parents know how rubella manifests itself and looks like, and they often confuse this disease with a typical cold or acute respiratory disease. But it is necessary to carefully diagnose each similar case and take measures to prevent complications of the infection, which may affect brain structures, nerve fibers, spinal cord, and connective tissue. Especially often the walls of small blood vessels are affected.

Rubella rash in children is localized around the ears, on the cheeks, in the region of the nasolabial triangle, on the neck. After 1 - 2 days, the elements spread throughout the body from top to bottom, and after 3 days they turn pale and begin to disappear. Rashes never capture the skin of the palms and feet, but are most disturbed on the inner surface of the thighs, the outer part of the forearms, on the buttocks.

Rubella symptoms in children

From the moment of infection with rubella to the appearance of the first symptoms, an incubation period passes, which lasts 11-24 days (in most patients - 16-20 days). At this time, the virus enters the cells of the respiratory mucosa, and from there into the bloodstream, spreads with the bloodstream throughout the body, multiplies and accumulates.

In the incubation period, rubella manifests itself as follows:

the temperature rises (slightly);
weakness;
conjunctivitis;
throat pain;
runny nose;
enlarged lymph nodes;
the final symptom is the appearance of a rash.

After 1–1.5 days, there is a sharp pain in the back of the neck, the lymph nodes in this area become motionless and dense, up to 1 cm in diameter. May be observed:

Children have the following symptoms:

body temperature rises to 38 ° C and lasts 2 days;
a slight increase and slight soreness of the cervical and submandibular lymph nodes;
redness of the throat;
slight runny nose;
conjunctivitis.

Skin rashes with rubella (exanthema) appear first on the face, neck and behind the ear, after which it quickly spreads down the body. This process goes quickly, so sometimes it seems that the rash appeared simultaneously on the whole body.

The highest concentration of elements is observed on the back, buttocks and extensor surfaces of the limbs. The rash can be all over the body, but in other localizations it is more scarce. The rash usually does not itch.

If the children have reached an older age, parents may complain of pain in the muscles, joints, initially rashes appear in the face, but then a rash starts on the body, spreading over the limbs, torso, scalp.

The period of rashes lasts on average from 3 to 7 days. Then the child's condition noticeably improves, appetite returns, cough and sore throat disappear, nasal breathing is facilitated. The size and density of the lymph nodes returns to normal 14-18 days after the disappearance of the rash.

Complications

Complications of rubella, as a rule, are detected in its severe course and are most often represented by the following pathologies:

Accession of a secondary bacterial infection (pneumonia, otitis media);
Serous meningitis or encephalitis characterized by a relatively benign course ( this complication may develop on days 4-7 of illness);
thrombocytopenic purpura;
Intrauterine fetal death;
birth defects development.

The reason for the occurrence of complications is the severe course of rubella, lack of treatment, non-compliance with medical prescriptions, the addition of a secondary infection of a bacterial nature against a background of reduced immunity.

Diagnostics

With the development or only suspicion of infection with rubella, you should immediately contact a doctor such as an infectious disease specialist.

Even knowing how rubella manifests itself in children, it is not always possible to unambiguously determine this infection. Considering that the most "talking" symptom - a rash - appears towards the end of the disease, it is necessary to establish a diagnosis based on the anamnesis, data on the epidemiological situation and laboratory tests.

The diagnostic study includes the following laboratory tests:

General blood analysis ( elevated ESR, lymphocytosis, leukopenia, possible detection of plasma cells).
Serological examination of nasal mucus (RSK, RIA, ELISA, RTGA).
Determination of the concentration of antiviral immunoglobulins.

Diseases similar in symptoms to rubella:

adenovirus infection - a cold disease in which the lymph nodes increase;
enterovirus infection: enteroviruses can affect the intestines (acute intestinal infection), respiratory system (pneumonia, colds), skin and lymph nodes;
measles is a viral disease that also manifests itself in the form of a rash on the skin;
infectious - a viral disease in which there are signs of a cold, increase in the lymph nodes, liver, spleen;
- fungal disease in which spots appear on the skin;
hives - an allergic reaction in which red spots appear on the skin;
infectious erythema - a red skin rash that can occur in some patients with any infectious disease.

Rubella treatment

Special medicines, which could directly affect the virus, namely rubella, has not been developed. Usually the disease proceeds in a mild form and the child's body, in the absence of complications, copes well with the disease itself.

An important aspect is only the observance of bed rest, abundant drinking regime, for the speedy removal of pathogen toxins from the body, as well as the appointment of drugs that help eliminate the symptoms that occur.

Specific treatment has not been developed, so they use:

bed rest for 3-7 days;
full nutrition, taking into account age characteristics;
Etiotropic therapy with the use of viracides (arbidol, isoprinosine), immunomodulators (interferon, viferon) and immunostimulants (cycloferon, anaferon).
detoxification therapy - drinking plenty of water;
Askorutin 500 mg three times a day (replenishing vitamin deficiency).
Temperature, headache, body aches are relieved by antispasmodics and children's anti-inflammatory drugs: Paracetamol, No-shpa, Nurofen.
symptomatic therapy (expectorants - certain group it is used for a certain type of cough, i.e. it is impossible to use expectorants and antitussives at the same time), mucolytics, antipyretics, analgesics).

Medications are prescribed to prevent complications and relieve symptoms

Rubella treatment in a hospital is required if the child develops a convulsive syndrome and there are signs of infection spreading through the blood-brain barrier. In this case, the disease is a threat to the health and life of the child.

Principles of rubella treatment in children under 1 year old:

treatment only if infectious department for the entire period of rashes and contagiousness, for constant monitoring of the child by medical personnel;
in some cases, detoxification therapy is recommended by prescribing droppers with various infusion solutions;
antihistamines are prescribed in all cases;
symptomatic drugs (against fever, vomiting, other drugs with the development of signs of complications);
vitamins, especially C and A;
correct diet.

Rubella in children under one year of age gives a stable lifelong immunity, which allows you to refuse vaccination in a timely manner.

With congenital rubella, a child is treated by several specialists, depending on the affected organs: a dermatologist, neurologist, endocrinologist, ophthalmologist, ENT doctor and others.

Even if the child feels well, he should not visit kindergarten, school or other public places. It is best to stay at home for at least a week. At the same time, it is important to ensure that the child receives vitamins and means that strengthen the immune system. It is also desirable that the child drink as much liquid as possible.

Prevention

The main methods of prevention:

A sick baby is isolated from other children until complete recovery. Usually, the sick person, from the onset of the rash, is isolated for 10 days. Sometimes (if there are pregnant women in the family or group), the quarantine period is extended to 3 weeks.
Complete exclusion of contact between pregnant women and a sick person. In the event of contact - repeated serology for 10-20 days (identification of an asymptomatic course). The introduction of immunoglobulin does not prevent the development of rubella during the period of gestation.
All children are vaccinated against rubella according to the vaccination schedule. It is given as an intramuscular or subcutaneous injection. Vaccination after 15-20 days forms a strong immunity in the child, which remains active for more than 20 years.

Rubella. Symptoms, signs, treatment, consequences and prevention of the disease. Rubella vaccination - timing, effectiveness, whether to vaccinate, complications after vaccination. Rubella during pregnancy - consequences, prevention.

Rubella- this is a viral disease, which in most cases proceeds in a mild form, accompanied by a short-term increase in body temperature, a small rash, an increase in all lymph nodes. In pregnant women, the disease leads to damage to the fetus.

Rubella symptoms were first described in 1740 by German physician F. Hofmann. In 1880, rubella was recognized as a separate independent disease, but its causes were unknown, so there was no effective treatment. The virus itself was first isolated and studied in 1961 independently by several scientists at once: T. X. Weller, P. D. Parkman, F. A. Neva.

Rubella causative agent

Rubella is a virus that contains RNA(a molecule of ribonucleic acid, which includes all the genes of the pathogen), which, according to the classification, belongs to the family of Togaviruses, the genus Rubiviruses.

The rubella virus has a size of 60 - 70 nm, it is covered with a protein shell, on which there is some kind of villi - with the help of them, the pathogen attaches to the cells.

The main characteristics of this pathogen are the ability to destroy and stick together red blood cells. To do this, he has special proteins-enzymes. It also contains the enzyme neuraminidase, which affects the nervous tissue.

In the external environment, the rubella virus is rapidly destroyed.

Factors that destroy the rubella virus:

drying;
the action of acids and alkalis (the virus is destroyed when the pH decreases less than 6.8 and increases more than 8.0);
action of ultraviolet radiation;
the action of ethers;
action of formalin;
action of disinfectants.

Causes of Rubella

Sources of infection and modes of transmission

Sources of infection:

sick people who have all the symptoms of the disease;
patients with an atypical (uncharacteristic, unusual) course, who do not have a rash and some other symptoms;
children with congenital rubella (the virus can multiply in their body for 1.5 years or more).

You can become infected from a patient only during the last week of the incubation period or within a week from the moment when a rash appears on the patient's skin.
If a pregnant woman is sick with rubella, then the virus can be transmitted to the fetus with blood flow through the placenta - this transmission route is called transplacental.

Incidence

Rubella is characterized by epidemic outbreaks that occur every 6 to 9 years. Most outbreaks occur between April and June. At the same time, not only children begin to get sick, but also adults, especially those who are constantly in a large team.

Since vaccines have been widely used, the incidence of rubella has steadily declined from outbreak to outbreak. For comparison: in 1964, 1.8 million cases of the disease were noted in the United States, and in 1984 - only 745 cases.

The mechanism of the development of the disease

Once in the respiratory tract, the virus begins to penetrate into the cells of the mucous membrane, and from them into the blood. With the bloodstream, it spreads throughout the body, causing the most pronounced disorders in the lymph nodes and skin.

The body reacts to the introduction of the virus by the formation of specific antibodies. Their number in the bloodstream constantly increases during illness, and they can be detected if laboratory tests are performed.

After recovery, a person remains immune to the rubella virus for life.

The rubella virus has a cytopathic effect: it is able to damage chromosomes in embryonic cells, leading to mutations and congenital malformations. Therefore, infection of a pregnant woman poses a high threat to the fetus. When infected during pregnancy, the virus enters the bloodstream and is transferred to the placenta - the organ by which the umbilical cord is attached to the wall of the uterus, which ensures the saturation of the blood of the fetus with oxygen and its nutrition. In the placenta, the virus accumulates in large quantities, after which it enters the blood of the fetus.

Rubella symptoms

During the incubation period, patients usually do not worry about anything, they do not make any complaints.

Symptoms that may occur during the rubella incubation period:

Weakness, malaise, fatigue, slight increase body temperature (not more than 38 ° C). This is due to the fact that the virus accumulates in the blood and causes intoxication (poisoning by viral toxins), with a specific effect on the nervous system.
Redness of the mucous membrane of the pharynx. It is detected during a throat examination by a doctor. Associated with the inflammation that the virus causes by penetrating into the cells of the mucous membrane.
Runny nose, congestion and discharge from the nose. These symptoms are caused by inflammation resulting from the introduction of the virus.
Redness of the eyes - occurs when the virus enters the conjunctiva.
Enlarged lymph nodes - they are palpable in different places under the skin. The virus enters them with blood flow, accumulates in them and causes an inflammatory process.

The incubation period ends with the appearance of a rash on the patient's body. The week before, the patient begins to be contagious.

The height of the disease

Typical (usual) form of rubella

The rubella virus has a toxic effect on small vessels that are under the skin. Because of this, a red rash appears on the patient's body. Depending on the condition of the patient, there are mild and moderate forms of the disease. The severe form is characterized by the development of complications.

General symptoms

In mild to moderate rubella, there are practically no other symptoms other than a rash. The person feels well. The temperature does not rise or does not exceed 37 °C.

Rash

The rash appears on the skin of the face and then spreads down the body. It consists of red spots with a diameter of 5-7 mm and located on smooth, unchanged skin. The spots do not rise above the level of the skin. If you press on the spot or stretch the skin, it will disappear and then reappear. This is because the spots are caused by strong expansion subcutaneous capillaries. They always retain their original dimensions and do not merge with each other.

Uncharacteristic types of rash with rubella, which occur in individual cases:

large spots, which have dimensions of 10 mm or more;
papule - elevation on the skin caused by inflammatory edema;
large spots with scalloped edges - are formed due to the fact that in some patients small spots increase in size and merge with each other.

Rubella rash is more visible on the trunk than on the face. It is especially well visible in the ulnar and popliteal fossae, on the buttocks, upper back, lower back. The rash usually lasts 2-3 days and then disappears.

If the rash is pale and poorly visible, then it is detected using the "cuff method". A cuff from a tonometer (a device for measuring blood pressure) and pump it up. The cuff squeezes the veins, as a result, the blood stagnates in the arm, the capillaries under the skin expand even more, the rash intensifies, and it can be easily identified.

Some patients complain that they are worried about itching of the skin.

Respiratory and eye symptoms

runny nose and nasal discharge associated with viral infection of the nasal mucosa;
sore throat and dry cough as a result of damage to the mucous membrane of the pharynx and larynx;
tearing pain in the eyes - with the penetration of the virus into the mucous membrane of the conjunctiva.

Rash on the palate

In some patients with rubella, small spots of bright red color can be found in the sky. They appear for the same reason as a skin rash.

Damage to the lymph nodes, spleen and liver

With the flow of blood and lymph, the rubella virus enters the lymph nodes and causes inflammation in them, as a result of which they increase in size. They can be felt under the skin.

In some patients, the liver and spleen increase in size, also due to the fact that the virus accumulates in them.

Severe rubella

The diagnosis of severe rubella is established in the presence of at least one complication:

Complication	Manifestations
Arthritis- inflammation of the joint associated with the penetration of the virus into the joint tissues.	After 1 - 2 days after the disappearance of the rash, the patient begins to be disturbed by pain and swelling in the joints. They are stored for 5 - 10 days.
Thrombocytopenic purpura- Decreased blood clotting due to the action of virus toxins.	Hemorrhagic rash- many small hemorrhages (bruises) on the skin. Uterine bleeding too heavy and long periods. Blood impurities in the urine. Increased gum bleeding taste of blood in the mouth.
Encephalitis- the penetration of the rubella virus into the brain and the development of inflammation.	Occurs in one in 5,000 to 7,000 patients. Encephalitis can develop with the rash or after it clears up: severe deterioration of well-being; headache; drowsiness, loss of consciousness, coma; convulsions; paralysis or partial loss of movement. Many patients whose rubella is complicated by encephalitis die.

Atypical (uncharacteristic) form of rubella

With this form of the disease, the patient is worried about a runny nose, cough, discharge from the nose, pain and a feeling of soreness in the throat, swollen lymph nodes. But there is no rash. Feeling normal - atypical rubella always proceeds in a mild form.
It is very difficult for a doctor to recognize the disease. Most often, such patients are diagnosed with ARI. Rubella can be suspected if, shortly before going to the doctor, the patient was in contact with the patient.

Subclinical (asymptomatic) form of rubella

This form of the disease is almost impossible to diagnose because it has no symptoms. It is believed that the subclinical form of rubella occurs 2 to 4 times more often than the typical form. The doctor can detect the disease only if he prescribes an examination to a person who has been in contact with the patient.

congenital rubella

Congenital rubella develops when the virus enters the child's body from a pregnant woman through the placenta.

Symptoms of congenital rubella:

congenital heart defects: open ductus arteriosus (communication between vessels, which is present in the fetus, but must be closed in the newborn), hole in interventricular septum, narrowing pulmonary artery.
Congenital malformations of the eyes: clouding of the cornea, chorioretinitis (inflammation of the retina), congenital cataract (clouding of the lens), microphthalmia (significant reduction in the size of the eyeball).
Microcephaly- pathological reduction of the skull, which does not allow the growth and development of the brain.
Mental retardation.
Congenital malformations of the organ of hearing: deafness.

The frequency of malformations in congenital rubella, depending on the gestational age at which the woman was infected:

3 - 4 weeks of pregnancy - defects are detected in 60% of newborns;
9 - 12 weeks of pregnancy - 15% of newborns;
13 - 16 weeks - 7% of newborns.

Advanced congenital rubella syndrome(complications that occur in some children):

thrombocytopenic purpura- a violation of blood clotting and the appearance of a rash on the skin in the form of many small hemorrhages;
hepatolienal syndrome - strong increase the size of the liver and spleen;
intrauterine growth retardation- general violation maturation of all organs and systems;
pneumonia- inflammation of the lungs caused by the rubella virus;
myocarditis- inflammation of the heart muscle;
myocardial necrosis- death of part of the heart muscle;
bone loss in the area of growth zones- as a result, bone growth is severely impaired or impossible;
decreased immunity;
diabetes;
encephalitis- inflammation of the brain.

Rubella Diagnosis

A typical form of rubella is diagnosed on the basis of examination and questioning of the patient. Signs that the doctor focuses on:

patient contact: during the questioning, the patient says that he was next to a patient with rubella;
combination of symptoms: rash + runny nose and discharge from the nose + cough + swollen lymph nodes.

Diseases similar in symptoms to rubella:

adenovirus infection- catarrhal disease, in which the lymph nodes increase;
enterovirus infection: enteroviruses can affect the intestines (acute intestinal infection), respiratory system (pneumonia, colds), skin and lymph nodes;
measles- a viral disease, which also manifests itself in the form of a rash on the skin;
Infectious mononucleosis- a viral disease in which there are signs of a cold, increase in the lymph nodes, liver, spleen;
pink lichen- a fungal disease in which spots appear on the skin;
hives- an allergic reaction in which red spots appear on the skin;
infectious erythema- red skin rash, which can occur in some patients with any infectious disease.

Instrumental and laboratory methods for diagnosing rubella:

Diagnostic method	essence
General blood analysis	Decreased general content white blood cells responsible for immunity and defensive reactions body - leukocytes. Among them, the proportion of lymphocytes that produce antibodies increases. This indirectly confirms the diagnosis of rubella.
Detection in the blood of antibodies that are produced in response to the introduction of the virus.	The analysis is carried out twice with an interval of 10 - 14 days. If the content of antibodies increases, then the diagnosis can be considered confirmed.
detection of the virus itself.	Today there are special techniques, but they are not used because of the high cost and the need for sophisticated equipment.
fetal ultrasound	It is used to detect malformations caused by the rubella virus.

Rubella treatment

With rubella, the body itself successfully copes with viruses, so antiviral medications are not assigned. Treatment is aimed at eliminating the symptoms of the disease.

During rashes and fever, bed rest is prescribed. No special diet is required.

Medications used for rubella:

Anti-inflammatory drugs(Paracetamol, Nurofen, Aspirin). They are used if the disease leads to a violation of the general condition, an increase in body temperature.
Antiallergic drugs. They help to cope with the allergization of the body caused by the virus.
Chloroquine (Delagil). This drug suppresses immune responses. It is used in the development of complications in the form of arthritis. Inflammation of the joint with rubella is supported by antibodies released in the body. If the immune system works too intensively, then it is not the virus itself that leads to joint damage, but the action of these antibodies.
Glucocorticoids (drugs of hormones of the adrenal cortex). Used for thrombocytopenic purpura. They help eliminate severe inflammatory reactions.
Heparin- a drug that reduces blood clotting and fights purpura. It is used in more severe cases, when glucocorticoids do not help well.

Treatment of encephalitis caused by rubella virus:

hospitalization in a hospital;
strict bed rest;
constant surveillance;
drugs that improve cerebral circulation;
ascorbic acid: protects organs and tissues, blood vessels from damage;
group vitaminsB: help restore the normal function of the nervous system;
anticonvulsants with convulsions;
resuscitation, if the patient falls into a state of clinical death.

Rubella prevention

Vaccines

A vaccine that contains a live attenuated virus is used to prevent rubella. Its main purpose is to prevent congenital rubella. Injections are given to expectant mothers - girls aged 14 - 15 years (this practice is accepted in Russia, and in some countries the vaccine is administered at the age of 10 - 14 or even 9 - 11 years).

After the introduction of the vaccine, strong immunity against rubella is formed in 95% of girls. The immune responses that occur in the body after vaccination are not yet well understood. But there is not a single case known when the vaccine would cause rubella in a girl or in her child in the future.

The rubella vaccine has virtually no complications. Only some people develop allergic reactions to its introduction.

Contraindications for vaccination:

in adult women, as it can cause congenital rubella in the fetus during pregnancy;
during pregnancy;
you should not plan pregnancy in the next 3 months after vaccination.

Rubella prophylaxis when a patient is identified

If a person is diagnosed with rubella, then he should be isolated until such time as a week will pass since the onset of the rash. After that, it becomes non-infectious.
In the focus where the disease was detected, it is not necessary to carry out disinfection, because the virus quickly dies in the environment.

Rubella prognosis

Most often favorable. With rubella encephalitis, half of the patients die. Congenital malformations caused by rubella do not recover with age.

What is rubella measles?

Many believe that rubella is a "mutant" virus that resulted from the combination of two viruses - measles and rubella, namely, the result of vaccination with the measles, rubella and mumps vaccine. But this is absolutely not the case, everything is much simpler, and this has nothing to do with vaccinations.

Rubella measles is another name for rubella. This term was retained for this disease due to the fact that earlier rubella was considered one of the varieties of measles. And only in 1881 it was recognized as a separate pathology, at the suggestion of the Austrian scientist I. Wagner, who studied the differences between measles, scarlet fever and measles rubella. The virus itself was isolated only in 1961.

In the literature, you can also find the name rubella "German Measles", and so it was called due to the fact that it was German doctors who, back in the 16th century, described the symptoms of the disease with a red rash.

Indeed, the symptoms of measles and rubella are somewhat similar, only rubella is much easier, but for pregnant women, the rubella virus is much more dangerous than the measles virus. Yes, and the causative agents of these two diseases are completely different, they are united only by their attitude to RNA-containing viruses, but they belong to different species, genera and even families.

Rubella is also called rubella(from Latin rubella - red), the causative agent of the disease has the same name - rubella virus (Rubella virus ).

Even in the literature you can find the name rubella "The Third Disease", which is due to the fact that scientists have compiled a list of all diseases that were accompanied by rashes on the body, and rubella was at the third number.

Why do children and adults get rubella despite mass vaccination (vaccinations)?

Rubella belongs to childhood infections. And earlier it was believed that adults rarely get sick with this disease. Indeed, before the introduction of mass vaccination against rubella (until 1969-1971), even during pandemics of this infection, children and adolescents, as well as pregnant women, were mostly sick young age. And this is due to the fact that almost all people had rubella in childhood, just not everyone showed symptoms of this disease, because more than half of the children have asymptomatic course this infection or it is so easy that you do not have to go to the doctors. And after suffering rubella, 99% of people develop lifelong immunity, that is, such people never get rubella again. Therefore, rubella was rare in adults, and only those who, due to their individual characteristics, were not susceptible to infection in childhood or were “home” children (they had little contact with other children) fell ill.

With the introduction of mass vaccination against rubella, children really practically stopped getting rubella, and they also stopped registering rubella pandemic(mass infection of almost the entire population).

This mass vaccination was expected to completely stop the circulation of the virus in nature, because it is rapidly destroyed in the environment.

However, this did not happen, because there are always people who do not have post-vaccination immunity from rubella, so children still continue to get rubella, despite mass vaccination, for various reasons:

refusal to vaccinate , is especially relevant in last years;
contraindications to vaccination (immunodeficiencies, including HIV, oncological pathologies, intolerance to vaccinations in the form of anaphylactic shock, Quincke's edema and other reactions, life threatening);
individual immunity to the vaccine - lack of formation of antibodies to rubella vaccine strains;
violation of the technique of storage and administration of the vaccine , while vaccination can be considered invalid;
developing immunity to the vaccine strain pathogen (attenuated rubella virus), but sometimes he is missing when meeting with a "wild" strain (the causative agent of the disease), so even vaccinated people in isolated cases can get rubella, but the infection is mild and without complications, even in adults .;

But many years after the start of mass vaccination, epidemiologists were faced with another problem, immunity after vaccination is not 100% stable, as after a disease, and rarely persists for life, it fades after 5, 8, 10, 15, 20 or more years (individually). So an adult by the age of 20-30 remains without anti-rubella immunity, therefore, childhood infections among the adult population are relevant in our time. That is rubella "aged" and to some extent ceases to be a purely childhood disease.

Doctors are trying to solve this problem, so at the age of 13-14, teenagers are recommended to be tested for the presence of antibodies to rubella, and if they are absent, they are additionally vaccinated. So in particular, girls of 14 years old and young women planning a family are prepared for future pregnancy. But, unfortunately, only a small part of the subjects undergo this vaccination, therefore, in our time, gross pathologies of newborns are observed due to rubella transferred during pregnancy, and cases of the disease among adults are becoming more frequent.

Still, there is no way without vaccination, but it must be carried out correctly.

Why do adults have a hard time with rubella, unlike children?

Adults are indeed much more difficult to tolerate rubella than children.

Let's define what are features of rubella in adults:

1. More pronounced intoxication syndrome (high body temperature, malaise, weakness, headache, and so on).
2. The rash has a large intensity and prevalence.
3. Frequent complications:

arthritis (inflammation in the joints);
decrease in platelet levels;
brain damage (encephalitis, meningoencephalitis).

Complications in adults are much more common than in children. All these conditions, as well as damage to the fetus in pregnant women, are manifestations of a chronic infection.
4. Half of adults, like children, carry rubella asymptomatic or oligosymptomatic which explains the lack of timely diagnosis.

The fact that adults have a hard time enduring childhood infections has been confirmed by observations for many decades, and why this happens, scientists cannot answer exactly, since the pathogenesis (development mechanism) has not yet been fully studied.

But there are a number of factors that presumably contribute to a more severe course in adult childhood infections:

But in addition to harm to the baby, the mother may also have complications of rubella:

Interesting! Immunoglobulins are of a protein nature, so any person should receive enough protein, which is building material not only for muscles, but also for immunity.

There are several types of immunoglobulins:

Class A immunoglobulins - These are antibodies that are responsible for local immunity and are found in large quantities in breast milk. It is rarely used in the diagnosis of various diseases.
Class M immunoglobulins - the production of these antibodies is a sign acute process infectious disease, they appear on the first day of illness, their number decreases with an increase in the level of immunoglobulins G.
class immunoglobulinsG- antibodies of a past disease, including a chronic infectious process. The appearance of these antibodies indicates the onset of recovery, past pathology in the past or the presence of post-vaccination immunity.
class immunoglobulinsD- antibodies of local immunity and autoimmune processes.
Class E immunoglobulins - allergic reaction antibodies.

Used to diagnose rubella serological reactions for the presence immunoglobulin classG, M and A.

When is a rubella antibody test ordered?

Confirmation of the diagnosis of rubella, for this, the analysis is prescribed after the rash and after 3 weeks;
differential diagnosis rubella with other childhood infections;
examination contact persons;
the question of the need for vaccination at the age of 14 years;
pregnancy;
early miscarriages or stillbirths;
suspected congenital rubella in children.

What's happened negative result for rubella?

Negative for rubella- this is the absence of immunoglobulins G and M to rubella in the blood serum or their level is less than 5 U / ml, which indicates that the person being examined does not have immunity against rubella at all and the patient is not sick with it at the time of the examination. For such a person, the doctor will recommend vaccination (except for pregnant women). Vaccination is especially relevant for women planning pregnancy and children of 14 years old (primarily girls) in order to avoid the development of infection during pregnancy.

What is the norm of immunoglobulinsG to rubella?

by the most the best option is the presence of immunoglobulins G, in the absence of immunoglobulins M. This means that a person has antibodies to rubella as a result of an illness or vaccination. With such results, the patient is not shown a rubella vaccine, and women can become pregnant with peace of mind.

The concentration of immunoglobulins in blood serum to rubella *.

*Some laboratories provide their own reference values, depending on the equipment and units of measurement. How to interpret the results is usually indicated in the returned results.

Deciphering the analysis for rubella:

Absence of immunoglobulinsG and M to rubella- there is no immunity to rubella, if such a result was obtained during pregnancy, and the patient was in contact with a patient with rubella, then the study is repeated twice more with an interval of 2 weeks. If there was no obvious contact, then the pregnant woman is advised to refrain from visiting public places and contact with children's groups.
The presence of immunoglobulinsG in the absence of immunoglobulins M- Immunity to rubella.
Definition of a positive result for immunoglobulinsG and M characteristic of rubella. If such a result is obtained in a pregnant woman, she is recommended to terminate the pregnancy.
The presence of immunoglobulin M in the absence of immunoglobulinsG- possible infection, the period before the onset of symptoms of the disease, for the reliability of the result, it is necessary to repeat the analysis after 14-21 days.

Rubella avidity, what is it and when is this examination prescribed?

Avidity for immunoglobulinsG- this is a special index that determines the ratio of new and old immunoglobulins G. Using this analysis, it can be assumed when a person has had rubella. This analysis is relevant for pregnant women with a high level of immunoglobulin G (more than 100 IU / ml), in this case it is not clear whether the woman had rubella long before pregnancy, or immediately during or before pregnancy.

Interpretation of results:

Avidity for immunoglobulins G over 70%- a person has had rubella for a long time, more than 6 months;
Avidity from 50 to 70%- unreliable result, it is necessary to retake in 2 weeks;
Avidity less than 50%- the infection was transferred recently, less than 3 months ago.

Avidity less than 50% during pregnancy indicates a high risk of fetal rubella, in which case termination of pregnancy is recommended, but the future parents have the last word.

When is a PCR test prescribed for rubella?

Can rubella and other childhood infections cause infertility in men and women?

Childhood infections and infertility in men.

Many people, having watched TV shows and heard a lot of life stories, think that all childhood infections in men lead to infertility. But in fact to male infertility can only lead to mumps or mumps. Rubella and other infections do not carry such complications, at least there are no facts.

Yes, and mumps does not lead to infertility in all boys, There are risk factors for the development of infertility after mumps:

mumps is transferred at the age of puberty of a boy (10-17 years old), less often in adult men;
there is a complicated course of infection with damage to the testicles (orchitis);
severe illness.

As we can see, not all boys with mumps fall under these risks, so you can dispel the myth that mumps in boys and men = infertility for life.

Yes, and infertility as a result of mumps is also not a sentence, there are methods of treatment, and such men can also have their own children.

Childhood infections and infertility in women.

Rubella and other childhood infections reproductive health women are not threatened, at least not directly.

Rubella is dangerous during pregnancy, can lead to miscarriages, requires termination of pregnancy, even later dates leading to complicated childbirth. It is spontaneous and medical abortions due to rubella that can cause secondary infertility in women, and not the infection itself.

Photo, what does rubella look like, its first signs and symptoms?

This is how they look fresh rubella rash in adults. The rash usually spreads throughout the body quickly (within a few hours or one day).

Congenital rubella can lead to blindness in a child.

And this is what it might look like child with deformities and multiple congenital pathologies(malformations of the intestines, reproductive system, skull bones, organs of vision and other severe anomalies) as a result of rubella transferred by the mother during pregnancy.

Rubella.

Measles.

As we can see, rubella and measles rashes are very similar. These diseases differ in how the elements of the rash appear and how the elements of the rash disappear.

Table. How to distinguish rubella from measles?

Rubella	Measles
Rapid spread of rash (up to 24 hours).	Gradual spread of rashes (over several days).
The elements of the rash do not merge with each other.	The rash is often confluent (small rashes combine into large spots).
The rash disappears completely in a few days, leaving no traces behind.	After 4 days, measles rashes begin to gradually fade, peeling and dark spots remain in their place, which can persist for quite a long period.
With rubella, rashes on the mucous membranes of the mouth are rarely observed.	For measles, rashes in the mouth are typical.

And this is what rashes on the mucous membranes of the oral cavity look like with rubella ( enanthems ).

In children under 1 year of age it is necessary to differentiate rubella rash from atopic dermatitis (diathesis).