Signs and symptoms of rubella. How long does a rubella rash last?

Diseases such as rubella, measles, chickenpox, scarlet fever have been known since ancient times. They belong to infectious processes that are highly contagious. These diseases can strike a person at any age, but most often occur in children. Childhood infections are widespread throughout the world. Currently, the incidence of these pathologies has decreased, since mandatory vaccination has been introduced into pediatric practice. However, they are still dating. One of the pathologies that parents and doctors often encounter is the so-called “measles rubella” in children. This disease can be suspected by high fever and rashes on the baby’s skin. Previously, when these symptoms appeared, a diagnosis was made: rubella measles in children. In modern medicine, this concept is not used, since it combines two different infections.

Epidemiological characteristics of the disease

Rubella is one of the common viral infections that is known in all countries. Its incidence depends on a number of factors. First of all, this is age: most often it occurs in children between 2 and 9 years old. In addition, the incidence increases significantly in winter and spring. You can become infected with rubella only through direct contact with a virus carrier. Routes of transmission: airborne, parenteral, vertical (from mother to child). Due to the fact that the infection is transmitted while staying with a sick person, another factor is the terrain. In large populated areas, the rubella virus spreads much faster than in villages. The disease is not dangerous for people with normal immunity and goes away within a few weeks without leaving any consequences. However, the rubella virus has a harmful effect on the body of pregnant women, which is transmitted to the fetus. The terrible consequences of infection are early miscarriages and developmental defects in children infected in utero in the second and third trimesters.

Cause of rubella

To have an idea of ​​how rubella begins in children, you need to know about the reasons for its appearance. This disease has a specific etiology. The causative agent of rubella is a virus of the Togaviridae family. It is characterized by low stability in the external environment. The virus dies under the influence of high temperature and chemical compounds. This explains why rubella cannot be transmitted through household items. The pathogen has a spherical shape, the genetic information about the virus is in the form of RNA. The infection is a highly contagious disease, however, there are factors that contribute to the rapid development of rubella. First of all, this is a weakening of the immune system. Also, the risk of illness increases when staying in poorly ventilated areas.

Actions of infection in the body

Signs of rubella in children do not appear immediately. This is preceded by an incubation period, during which the virus exerts its effect on the body. The place through which it penetrates is called the entry gate of infection. Most often they are the respiratory tract. The virus enters the nasal or oral cavity by inhaling air that contains it. It then settles on nearby lymph nodes and multiplies. When its concentration becomes sufficient, it penetrates the blood vessels and spreads throughout the body. This condition is called viremia. The virus remains in the blood for 10-14 days, this time coincides with the incubation period and the first week of manifestations of the disease. The immune system then produces antibodies that neutralize the pathogen. Due to the fact that the virus has a tropism for the tissues of the lymph nodes and skin, the main signs of rubella in children are observed in these organs. After an illness, a strong immunity is formed, so secondary infection with this virus is impossible.

Symptoms and signs of rubella in children

This disease can occur either with a pronounced clinical picture or asymptomatically. This course of infection is called viral carriage and occurs in people with good immunity. Signs of rubella in children are most often obvious, since at this age the protective forces are not yet fully formed. This is especially true for children under 3 years of age. In order not to miss the disease, parents often ask the question: “What does rubella look like in children?” You should know that the virus does not manifest itself in any way for the first 2-3 weeks, at which time antibodies begin to be produced. Symptoms of “measles rubella” in children (as the infection was previously called) arise acutely with a rise in body temperature and signs of catarrhal inflammation of the upper respiratory tract. There is a sore throat, nasal congestion, and general weakness. Subsequently, skin rashes appear. First of all, they appear on the head, then descend to the upper half of the body, after which they spread throughout the body. The rash disappears after 3 days, leaving no defects on the skin surface.

Differences between rubella in young children

Signs of rubella in children under one year of age are somewhat different from the symptoms observed in older children. This is due to an unformed immune system. Infants suffer the disease more severely, so signs of rubella in children under one year of age cannot be immediately recognized. Intoxication syndrome comes first for them, that is, general weakness, fever, tearfulness, and vomiting may occur. Children often refuse to breastfeed, are capricious or, conversely, apathetic. The characteristic symptoms of rubella in children under 1 year of age may manifest themselves partially, for example, only a rash or only catarrhal symptoms. In some cases, the disease at this age can become chronic.

Methods for diagnosing rubella

Only an infectious disease specialist can make a diagnosis of rubella. To do this, you need to know whether the child had contact with a virus carrier, whether he attends kindergarten, or whether any of his relatives were sick. Rubella can be suspected by its characteristic clinical symptoms (rash, signs of a cold, swollen lymph nodes). In addition, it is necessary to detect the causative agent of the disease; for this, swabs are taken from the nose and throat and a bacterioscopic analysis of the resulting material is performed. In modern laboratories, immunological research is also carried out, thanks to which it is possible to obtain a titer of antibodies to the virus, and also to find out whether the child has had this infection or not (by the presence of IgG).

What diseases should rubella be differentiated from?

Rubella is often confused with infectious diseases such as measles, scarlet fever or chicken pox. In order to make a correct diagnosis, it is necessary to know the differences between the symptoms of these pathologies. It should be remembered that the first sign of rubella is enlargement of the submandibular, parotid or posterior cervical lymph nodes. It can be observed already in the incubation period. Another feature is the rubella rash in children. It is distinguished by the fact that it has very small sizes (up to 3 mm), a rounded shape and does not have a tendency to merge. This distinguishes it from the rash seen with scarlet fever and measles. With chickenpox, vesicles appear filled with clear liquid, leaving crusts behind. With rubella, the rash disappears without a trace. The virus can only be definitively detected through laboratory testing.

How to treat rubella in children of different ages?

Despite the fact that rubella is an infectious disease of viral etiology, it does not require specific treatment. This is explained by the fact that when it manifests itself, the body begins to produce antibodies that can cope with the problem on their own. Nevertheless, children, regardless of age, need to strengthen their immunity during illness. For this purpose, vitamins are prescribed. Symptomatic treatment of rubella includes the use of antipyretics and antihistamines. During illness, it is necessary to maintain a hospital or home regime to avoid the spread of infection.

Prevention of rubella in children

In recent years, the incidence of rubella has decreased significantly, thanks to timely prevention. To avoid infection, mandatory vaccination is carried out for all children at the age of 1 year, and then at 7 and 15 years. Secondary prevention includes: maintaining immunity, declaring quarantine when a disease is detected (in kindergartens, schools, medical institutions), and ventilation of premises.

Rubella- an acute viral disease that occurs with short-term fever, macular or maculopapular rash and enlarged cervical lymph nodes.

The occurrence of rubella disease

The rubella virus belongs to the togaviruses (family Togaviridae, genus Rubivirus).

Virions are spherical particles with a diameter of 60-70 nm, rare villi 8 nm long are located on the surface, and contain RNA. Unlike other togaviruses, the rubella virus contains neuraminidase. The virus is pathogenic for some species of monkeys. It is capable of multiplying on many cell cultures, but has a cytopathic effect only on a few, in particular on the BNK-21 culture (hamsters). The rubella virus agglutinates the red blood cells of pigeons and geese and has hemolytic properties. In the external environment, the virus is unstable, quickly dies when dried, when pH changes (below 6.8 and above 8.0), under the influence of ultraviolet rays, ether, formaldehyde and other disinfectants.

Course of the disease Rubella

The infectious period begins 2 days before the rash, the peak of contagiousness decreases with the extinction of the rash. Neurological manifestations in these cases can occur on the 3-4th day of the rash, but sometimes precede them. CNS lesions in congenital rubella can be caused by direct exposure to the virus, as confirmed by its isolation from the cerebrospinal fluid. Encephalitis due to acquired rubella is rare, usually in young children, and is characterized by a severe course and high mortality. In this case, the rubella virus cannot be isolated. The infectious-allergic nature of encephalitis is assumed. It has also been established that the rubella virus can cause progressive panencephalitis.

Morbidity: 396 per 100,000 population (2001).

Source of infection- a sick person or carrier. The patient is contagious 2-3 days before the first symptoms appear and during 7 days of illness. Susceptibility to infection is high. Airborne route of spread. People of all ages get sick. Congenital rubella with transplacental transmission from a sick mother to the fetus; such newborns are dangerous as a source of infection throughout the year.

For acquired rubella - contact with a patient 11-21 days before the onset of the disease.

Symptoms of Rubella disease

On the first day of illness, a roseolous or roseolous-papular rash appears on an unchanged skin background, mainly on the extensor surfaces of the limbs around the joints. After 2-3 days, this rash disappears without a trace. Moderate increase in body temperature, mild catarrhal symptoms, spotty hyperemia of the soft palate, enlarged and moderately painful cervical, parotid and occipital lymph nodes. On the 4-7th day of illness, a complication may develop in the form of serous meningitis or encephalitis with a relatively favorable course. Sometimes rubella panencephalitis progresses with an increase in neurological symptoms in the form of ataxia, convulsive seizures, and depression of consciousness.

When a woman becomes infected with measles in the first 8-10 weeks. pregnancy, intrauterine fetal death or severe disruption of the embryogenesis process often occurs with the formation of gross developmental anomalies in the form of Gregg's triad: eye lesions (cataracts, retinopathy, glaucoma, chorioretinitis, microphthalmia), deafness and malformations of the cardiovascular system (patent ductus arteriosus, interatrial defects). and interventricular septum, hypoplasia of the pulmonary arteries). Possible malformations of the central nervous system - micro- and macrocephaly. Therefore, if measles develops in the first trimester of pregnancy with typical seroconversion, termination of pregnancy is recommended. If the fetus becomes infected after 16 weeks. During pregnancy, the risk of congenital deformities is lower, single developmental defects develop, and sometimes meningoencephalitis occurs.

Diagnosis of rubella disease

The virus is isolated using the classical virological method - inoculating nasal mucus onto embryonic tissue. Anti-rubella antibodies are detected and their titer in RSC and neutralization increases by 4 times or more.

Rubella should be differentiated from measles, enterovirus infections, scarlet fever, secondary syphilis, and allergic skin rashes.

Treatment of rubella disease

There is no specific therapy. The main measures should be aimed at eliminating edema and swelling of the brain (corticosteroids, Lasix, cryoplasma), nootropic drugs are used during the period of convalescence.

Prevention of rubella disease

Patients with acquired rubella are isolated until complete recovery, but not less than 5 days from the onset of the disease. It is recommended to isolate the first sick person in a child care facility for up to 10 days from the onset of the rash. In some cases (if there are pregnant women in the family or team), it is advisable to extend the separation period to 3 weeks.

The impact on the transmission mechanism of rubella consists of ventilation and wet cleaning of the room or ward where the patient is located.

Contact children under the age of 10 who have not had rubella are not allowed to be sent to closed children's institutions (sanatoriums, orphanages, etc.) within 21 days from the moment of separation from the patient.

Specific prevention. The live attenuated vaccine "Rudivax" is used, as well as the combined vaccine against measles, mumps, rubella - "MMR". In order to prevent congenital rubella, girls aged 12-16 years should be vaccinated, followed by revaccination of seronegative ones before a planned pregnancy.

Pregnant women cannot be vaccinated: pregnancy is undesirable for 3 months. after immunization against rubella (the possibility of post-vaccination damage to the fetus cannot be ruled out). Administration of the rubella vaccine is accompanied by the production of specific antibodies in 95% of immunized individuals.

In case of contact of a pregnant woman with a patient with rubella, the question of maintaining pregnancy should be decided taking into account the results of a 2-fold serological examination (with the obligatory determination of the quantitative content of specific immunoglobulins of classes M and G). If a pregnant woman has a stable titer of specific antibodies, contact should be considered not dangerous.

Today we will talk about another acute infectious disease mainly of childhood - rubella, its symptoms and treatment, methods of diagnosis, prevention of morbidity, and we will tell the site about the possible complications of rubella.

What kind of disease is rubella, what causes it, photo

Rubella (rubeola) is a fairly common disease of viral etiology, which is manifested by such characteristic signs as an increase in the volume of lymph nodes and the presence of a rash.

Due to the fact that rubella was in third place in the list of pathologies that cause a rash on a child’s body, it is often called the “third disease.” The first description of this disease took place in 1740, and evidence of a viral origin was recorded only in 1938.

Rubella virus has a protein shell covered with peculiar villi, with the help of which it attaches to healthy cells of the human body. The virus contains molecules of ribonucleic acids and is capable of gluing together destroyed red blood cells. Among other things, the rubella virus quickly dies when exposed to the environment.

Mostly children are susceptible to the disease, but there are cases of infection in unvaccinated groups of adults. Infection is especially dangerous for pregnant women, since virus molecules easily penetrate the placental barrier and interfere with the normal division of developing embryonic cells, causing various abnormalities.

Divided by type of origin.

1.Congenital type determined by the disease of the baby in the womb. The safest period is considered to be the second trimester. In other cases, there is a high chance of stillbirth. Children born with this disease pose a danger to others within a couple of months.
2. Acquired type. This is the entry of the rubella virus into an already born person. Breastfed babies are virtually unable to become infected until they are one year old, as they gain immunity through their mother's milk.

Methods of transmission, ICD 10 code for rubella

The most common route of transmission is airborne transmission. It is also dangerous to have direct contact with an infected person, use of his personal belongings, or exposure to nasopharyngeal discharge.

Outbreaks of the disease occur periodically, but only among the unvaccinated population and more often in the cold season.

The ICD 10 rubella code is B06.

Symptoms of rubella, signs of the disease in children and adults

The course of the disease is divided into several stages, each of which has individual symptoms and manifestations.

1. Incubation period called the initial stage of the disease, which does not reveal itself by external signs, but is dangerous for others. The duration of the course is on average two to three weeks.

2. Catarrhal or prodromal period. In children, the initial stage of rubella practically does not manifest itself at all. Adult patients endure this period of rubella quite hard:

• critical;
• severe muscle pain and headaches;
• general malaise, loss of appetite;
• sore throat, ;
• runny nose;
• fear of light, inflammation of the conjunctiva of the eye;
• hyperemia of the pharynx;
• pain when affecting the posterior cervical and occipital lymph nodes. This is the only symptom that unites the catarrhal period in children and adults.

The duration of this period is usually no more than 3-4 days.

3. Appearance of a rash is an important symptom on which specialists base their diagnosis. Rashes in children are brighter and more numerous than in adults. In rare cases, before the rash, there may be a feeling of severe itching or a complete absence of the rash.

Rubella rash - how it manifests itself

There are exanthema and enanthema.

Exanthema- this is the formation of oval pinkish spots on the skin. The spots are formed due to the destruction of surface capillaries and do not rise above the skin. The rash appears alternately:
- neck, face, scalp, area behind the ears.
- in the area of ​​the elbows and under the knees, buttocks, back surface.

In children, exanthema is characterized by the appearance of clear, separately located spots and a longer duration. In adults, the rash often merges into one spot, but disappears faster.

Enanthema This is the appearance of a rash on the oral mucosa.

Symptoms of this period of rubella:

• normal body temperature or its slight increase;
• rarely joint or muscle pain;
• dyspepsia;
• an increase in the size of the spleen and liver;
• joint swelling and pain;
• the size of the spot does not exceed 4-5 mm, there is no liquid filling;
• There is no rash on the feet and palms.

The brightness of this period varies and depends on the individual indicators of the body. Usually the rash does not last longer than 4-5 days, but the danger of infecting others continues.

4. Recovery period. At this time, all symptoms and signs of the disease disappear. From the moment the rash disappears, the person secretes the virus within a week.

Features of rubella in adults

Prevention of rubella in children and adults

The main preventive measures are only routine or emergency vaccination with live or semi-live viruses. Routine vaccination applies to children aged one year and then six years. Girls are re-vaccinated by age 13.

Children and women who have been in contact with a person with rubella, children and women during pregnancy are given emergency vaccination by administering immunoglobulin.

Complications of rubella, consequences

In children, there are practically no consequences of rubella.

Adults with rubella have a more severe and severe course of pathology and a high level of complications.

• cerebral edema, meningitis, encephalitis;
• disturbances in the functioning of the heart;
• damage to the nervous system, convulsive conditions, loss of coordination, decreased intellectual abilities;
• development of secondary infection (angina, etc.).

Rubella during pregnancy

A pregnant woman who has rubella may experience virtually no symptoms of the virus, but in any case this will have a negative impact on the health of the unborn child. It is especially sad if rubella develops in pregnant women in the first trimester, when the fetus is rapidly growing and developing.

• improper formation of cranial bones;
• cataract;
• heart pathologies;
• diabetes;
• or complete deafness;
• jaundice, hepatitis;
• hydrocephalus, microcephaly;
• developmental anomalies of the soft and hard palate;
• premature birth or stillbirth;
• malfunctions of the nervous system. One of the most common phenomena is the presence of adolescent sclerosing panencephalitis, which is diagnosed 2-3 years after birth. And it manifests itself with such characteristic signs as weakness of intellect and impairment of the motor system.

Fetal malformations due to rubella infection

Diagnosis of rubella - methods

1. Characteristic rash. Based on this method, it must be remembered that a number of other serious diseases have similar rashes that require immediate and specific treatment.
2. Before the rash appears, it is possible to examine stool and blood.
3. If a rash is present, nasopharyngeal discharge is used as laboratory material.
4. The serological blood test method ELISA is necessary to detect special antibodies that indicate the presence of immunity, a recent infection or the incubation period of the disease.
5. Other diagnostic methods are used in the presence of complications or when their development is suspected. Such methods include examination of the lungs, brain, and consultations with specialists according to indications.

After an illness or vaccination, immunity is formed, which is manifested in the production specific antibodies of the IgG type. With high numbers of this indicator, re-infection does not threaten a child or adult.

Antibodies IgM To virus rubella are normally absent in blood serum. At the height of the disease or only after it, IgM class antibodies are found in the patient’s blood.

In a weakened state, the titer of IgG antibodies decreases, which often happens during pregnancy. Therefore, when planning pregnancy, special attention is paid to this indicator. If the test result of both titers is negative, a woman planning to conceive is recommended to undergo vaccination. In special cases, vaccination is prescribed before 10-12 weeks of pregnancy.

Treatment of rubella in children and adults

Hospitalization of the patient occurs only in case of severe disease. Almost always, recovery occurs on its own, thanks to the formed immunity, which remains for life. Therapy in most cases is symptomatic, that is, aimed at alleviating the condition.

1. Compliance with bed rest, especially for the catarrhal period;
2. Eating healthy foods that are easy to digest;
3. Drink plenty of fluids to speed up the elimination of toxins. Especially good are apples or just still water;
4. Nonsteroidal anti-inflammatory drugs will relieve joint and muscle pain. Diclofenac, ibuprofen.
5. stimulate the production of human interferon, which leads to the suppression of the reproduction of viral cells. Arbidol, anaferon, genferon.
6. Remedies for runny nose or stuffy nose. Nazol, Nazivin, Otrivin, Sanorin, Tizin.
7. Antipyretic. In most cases, paracetamol-based products are used for children, and aspirin for adults. It is also possible to use ibuprofen. Ibuklin, efferalgan. Medicines can be in the form of tablets, syrups or suppositories.

Treatment for congenital anomalies has not yet been developed. It is possible to alleviate the child's condition in some conditions through surgery. These are defects of the cardiovascular system and pathologies of vision and hearing. But there is no 100% guarantee of the child’s recovery.

An important point is the process of increasing immunity and adaptation to the social environment, since most children have mental retardation, which can only be corrected, not treated.

Rubella is an acute viral infection with predominantly mild tolerability. It refers to widespread (global) diseases that affect most of humanity. The causative agent is togavirus from the family Togaviridae.

Rubella pathogens are unstable in the environment. At room temperature they remain viable for several hours. When boiled, they die within a few seconds; they are quickly inactivated under the influence of conventional antiseptics, drying, and direct sunlight.

There are four forms of rubella:

• congenital;
• atypical;
• inhardware;
• acquired.

Causes

The source of infection is a person with rubella. Rubella viruses are released into the environment along with microparticles of mucus from the nasopharynx and sputum. Most often, infection occurs through direct contact with a carrier of the virus.

Among the main routes of infection:

• contact (through contact with infectious material);
• intrauterine path (through the circulatory system from mother to fetus);
• airborne route.

The incubation period of infection is quite long. On average it is 2-3 weeks. But others can become infected from a sick person only during a certain period of time: seven days before the first symptoms appear and about 5 days after they pass.

The human body's susceptibility to rubella is extremely high - in most cases it is 100% (we are talking about unvaccinated people who have not encountered the virus before). People who have previously had rubella develop strong immunity, so re-infection is excluded.

Rubella affects the greatest number of people in winter and early spring - at this time the virus is most aggressive. This is due to favorable weather conditions, a sharp change in air temperature and a massive decrease in immunity.

In the typical course of rubella, an infected person begins to shed pathogens 7-10 days before the rash appears. Viruses are most intensively released from the patient’s body in the first five days of the rash period. The release of pathogens stops after two to three weeks from the onset of the rash.

In inapparent and atypical forms of rubella, pathogens are released from the body of an infected person less intensely and over a shorter period of time. However, these forms of rubella pose the greatest epidemiological danger, since they occur in adults several times more often than the typical course of the disease and usually remain unrecognized.

Children with congenital rubella also pose a significant epidemiological danger. With congenital rubella, viruses are contained not only in mucus from the nasopharynx and sputum, but also in urine and feces. They can be released into the environment for 1.5-2 years.

The main mechanism of spread of rubella is airborne. Infection can also occur through contact and household contact (much less often, mainly in children's groups (through toys). It does not have significant epidemiological significance.

Most often, preschool children, schoolchildren, adolescents and socially active adults suffer from rubella. Children aged two to nine years are most often affected. During the first two to three years of life, children, as a rule, do not yet attend preschool institutions, so their risks of infection and disease are several times lower compared to children of senior preschool and primary school age. Most adolescents and adults are immune to rubella because they acquired the infection in childhood.

Children born to mothers who have specific immunity are also temporarily immune to rubella in the first six months of life.

The main targets for the rubella virus are the structures of the lymphatic system, skin, mucous membranes of the respiratory tract, synovial tissue of the joints, and during pregnancy, the placenta and fetal tissues.

Symptoms and signs

After entering the human body, the rubella virus goes into short-term hibernation. It begins to actively attack the immune system in the first days after the rash appears. In adults, the first symptoms resemble a mild cold.

During the incubation period, the rubella virus penetrates the mucous membranes of the body and attaches to their surface. Soon after this, it also settles in the submucosal tissues. The virus then quickly spreads through the lymphatic system. There is a significant increase in the cervical lymph nodes; when they are palpated, the patient experiences pain.

From this moment, the disease enters a prodromal period, the duration of which ranges from several hours to two days. The incubation period ends with the appearance of rashes.

The characteristic rash is the first and key sign of rubella. It first appears on the skin of the face and behind the ears. Subsequently, the rashes spread to the scalp, after which they affect the entire surface of the body. Elements of the rash may also occur in a different sequence.

The rashes have a round or oval shape. Their color varies from pink to red. The size of each speck is from 2 to 3 millimeters. The rash does not rise above the skin and looks more like stains from spilled paint. Upon manual examination, the rash appears smooth to the touch.

In some cases, rubella is accompanied by a confluent rash. In this case, solid red fields appear on the body. Because of this symptom, the disease can be difficult to distinguish from scarlet fever or measles, which can subsequently lead to a false diagnosis.

But there is a visible difference: with confluent rashes, the patient’s face and body look the same as with measles, while the limbs are covered with a rash that is similar to scarlet fever. It is important to know that the rash with rubella is slightly larger in diameter than with scarlet fever, and slightly smaller than with measles.

In adults, rashes are more pronounced than in children. They completely cover the body, with the spots being as close to each other as possible. Often they combine into one large spot. Entire erythematous areas may appear on the skin of the back and buttocks.

In some patients, rubella passes without a rash, with weak or moderate manifestations of intoxication and catarrhal syndromes (atypical course). According to some data, rubella without a rash occurs in 30-50% of patients, according to others, this is a very rare form of the disease, and more often such a diagnosis is the result of an insufficiently thorough examination of the patient.

The course of rubella in children and adults, including pregnant women, is not significantly different. Asymptomatic forms of rubella are recorded in adults more often than in children. The condition of children changes a day before the rash appears. They are capricious a lot, get tired quickly, and may complain of discomfort and general malaise.

In children, rubella can occur in completely different ways:

• with the presence of rash and fever;
• exclusively with a rash;
• with the simultaneous presence of rash, fever and catarrhal symptoms.

In childhood, severe forms of rubella and moderate rubella are diagnosed 10 times less often than in adult patients.

One of the first symptoms of the virus is damage to the mucous membrane of the nasopharynx. In combination with the rash or long before it, enanthema appears on the mucous membrane - a dermatous change in the form of pale pink spots. This phenomenon is also called Forxheimer's spots. In children, this symptom is usually mild.

With rubella, the patient is accompanied for some time by an elevated body temperature (no more than 38 degrees Celsius). It indicates two things at once: the inflammatory process in the body and the fight of the immune system against infection. There is no need to artificially lower the temperature if it does not rise above 38.5 degrees.

Rubella is invariably accompanied by a deterioration in general health. The patient is concerned about the standard manifestations of an infectious disease:

• malaise;
• headache;
• weakness;
• drowsiness;
• body aches.

In some cases, changes appear in the blood test - slight leukopenia and lymphocytosis may occur.

Rubella can also manifest itself in an atypical (erased) form. The patient is not bothered by the rash or other manifestations of intoxication. The only symptoms are a sore throat and fever. Due to its uncharacteristic symptoms, the erased form of rubella is often confused with a sore throat or acute respiratory infection. In this case, the disease can only be detected using laboratory tests.

Despite the absence of a rash, a patient with atypical rubella still spreads the virus. This is the most common cause of epidemics and outbreaks of infection in groups.

Rubella in pregnant women: symptoms of congenital rubella

Rubella is especially dangerous for pregnant women. It often leads to catastrophic events:

• frozen pregnancy;
• miscarriages;
• stillbirth;
• formation of fetal development pathologies.

The virus most threatens a pregnant woman and child in the first trimester of pregnancy. It enters the fetus through the placenta. After this, it gradually affects all tissues and organs that are just beginning to form, which leads to their improper development.

The degree of damage to the fetus depends on the form in which the disease occurs. Often a woman can only be bothered by catarrhal manifestations: runny nose, sneezing, lacrimation. But the fetus may suffer much more at this time. Therefore, any symptoms during pregnancy, even the most minor ones, are a reason to consult a doctor and get the necessary tests.

The shorter the pregnancy, the greater the likelihood of serious complications. For example, at 3-4 weeks it is 58-62%, and at 14-15 it is already 8%. The nervous system of the fetus most often suffers: hearing, vision, conditioned reflexes. Congenital heart defects, underdevelopment and diseases of the gastrointestinal tract often occur.

At 9-12 weeks from the moment of conception, rubella can lead to the most terrible consequences. As a rule, during this period it entails miscarriage or intrauterine fetal death. Even if the pregnancy can be maintained, the possibility of its normal course in the future is almost excluded.

In the last weeks of pregnancy, the baby’s organs are already fully formed, therefore, the rubella virus does not pose such a serious danger to his life and health.

Depending on which organs and systems of the fetus were affected by rubella viruses, congenital rubella syndrome can clinically manifest itself as disorders from:

• hearing organs - complete or partial, uni- or bilateral deafness, and deafness may not appear immediately, but several years after birth;
• organs of vision - one- or two-sided cataracts, microphthalmia, glaucoma, chorioretinitis, pigmentary retinopathy;
• heart - pulmonary artery stenosis, aortic valve defects, atrial or ventricular septal defect, ductus arteriosus disease;
• musculoskeletal system - open anterior source, osteoporosis of tubular bones, joint diseases;
• nervous system - microcephaly, meningoencephalitis, impaired consciousness, diseases of the language apparatus and psychomotor reactions, mental retardation, convulsive syndrome;
• endocrine system - diabetes mellitus and diabetes insipidus, hypothyroidism, thyroiditis, growth hormone deficiency;
• genitourinary system - cryptorchidism, hydrocele, cereal buds, prostate diseases;
• gastrointestinal tract and abdominal organs - pyloric stenosis, hepatitis, hepatosplenomegaly.

In addition to the listed disorders, characteristic signs of congenital rubella syndrome are low birth weight of the child, thrombocytopenic purpura, hemolytic anemia, interstitial pneumonia, inguinal hernia, and various dermatoglyphics anomalies.

Visual impairment manifests itself in different ways. With cataracts, clouding of the crystal is observed (in one or two eyes). The eyeball may increase or decrease in size. In general, vision diseases are recorded in 85% of cases.

Heart or arterial defects are diagnosed in 98% of newborns with “minor” rubella syndrome. The remaining 22% are hearing pathologies (most often complete or partial deafness). It is usually accompanied by disorders of the vestibular apparatus.

More serious damage to organs and systems is called “major” rubella syndrome. Children often experience dropsy of the brain - hydrocephalus. The main symptom is a significant enlargement of the skull, which is caused by the accumulation of fluid inside it. Sometimes the opposite disease can develop - microcephaly, which is characterized by a decrease in the volume of the brain and skull.

In the presence of such congenital pathologies, doctors' prognoses are disappointing. Infants are often diagnosed with severe mental disorders, and in the future - developmental delays. The congenital form of rubella also leads to disorders of the musculoskeletal system, convulsions, and paralysis.

If a woman has had rubella in late pregnancy, the likelihood of visible disorders in the child is significantly reduced, but is not completely eliminated. Instead, the infection may become chronic. In this case, the pathology is difficult to detect at birth - it appears later and can periodically worsen.

Diagnostics

The most reliable laboratory methods for diagnosing rubella are virological and molecular biological (PCR) analysis. The virological method is based on the isolation of viruses from swabs from biological fluids:

• saliva;
• blood;
• feces;
• urine, etc.

The virus can be detected by infecting a cell culture. The PCR method allows you to detect viral DNA in all of the above-mentioned biological fluids. Both methods can be applied to patients with both acquired and congenital forms of rubella.

However, the virological method is almost never used in practice due to its complexity and high cost. The PCR method is mainly used to diagnose congenital rubella. In newborns and children under 1.5-2 years of age, the material for research is blood and nasopharyngeal swabs; urine analysis is less often performed.

In the perinatal period, from the 11th week of gestation, the amniotic fluid of the pregnant woman is examined, and from the 22-23rd week, amniotic fluid and umbilical cord blood are examined. These materials for analysis can be obtained by amniocentesis and cordocentesis.

In clinical practice, the most widely used serological methods for diagnosing rubella are blood tests for antibodies to the virus. The presence of specific antibodies indicates that at the time of blood collection the patient’s body is fighting this disease.

The study results are assessed taking into account the characteristics of the body’s immune response to the penetration of viruses. This allows us to differentiate the acute process from immunity and reinfection. Using this analysis, it is also possible to diagnose intrauterine infection of the fetus.

It has been established that with acquired rubella, specific antibodies to the virus appear in the blood from the first days of the disease. This means that you can go to the doctor immediately after the first symptoms appear. After all, the sooner a diagnosis is made and a treatment regimen is prescribed, the better. This is especially true for pregnant women.

Antibodies reach their highest concentration in the patient’s blood three to four weeks after infection. After this, their level gradually decreases. Finally, antibodies cease to be detected only after three months, that is, they can be detected in the blood even after complete recovery.

Regardless of the form of rubella infection, specific antibodies in low concentrations are found in a person’s blood for life. Acquired immunity is developed, which eliminates the possibility of re-infection. Cases of reinfection are still known to medicine, but they are caused by problems with the immune system and they happen extremely rarely.

The atypical (latent) form of rubella is usually asymptomatic, so examination by a therapist is pointless. In this case, a reliable diagnosis can only be established based on the results of a blood test.

Serological research methods are also the most informative for screening women during pregnancy and during its planning. It is best to be examined in advance, because an infection that is detected during pregnancy can already cause irreparable harm to the child.

In this case, a positive result for the presence of antibodies to the virus excludes the possibility of having a child with congenital rubella syndrome. After all, if the mother has specific immunity, it is transmitted to the fetus. In this case, the possibility of infection of the fetus is excluded. Immunity to infection persists during the first six months of a child’s life.

A negative result implies planning a pregnancy after immunization (vaccination).

The most informative methods for diagnosing intrauterine rubella are the results of serological studies obtained before the 12th week of gestation. Thanks to them, it is possible to determine as accurately as possible the degree of damage to the fetus by the virus. If there is a high risk of having a child with severe disabilities, termination of the pregnancy may be indicated.

Negative results of an antibody test necessitate dynamic monitoring of a pregnant woman. Periodic blood tests and the use of medications that are aimed at preventing infection are required.

If a woman at any stage of pregnancy who has never had rubella and has not been vaccinated is found to have a twofold or more increase in antibodies, it means that an acute process of infection is developing in her body. This also indicates a high probability of fetal damage.

Treatment of rubella

In uncomplicated cases, treatment of rubella is limited to a gentle regimen, the prescription of antipyretic and desensitizing drugs. The infection leads to general intoxication of the patient’s body, so treatment should be aimed at removing toxins from the body.

If complications develop, drug treatment of the concomitant disease is used. In adults, rubella most often causes:

• encephalitis;
• arthritis;
• thrombocytopenic purpura;
• meningoencephalitis.

In this case, treatment is carried out in accordance with the protocol of medical care that should be provided for these syndromes. Both tablets and intravenous and intramuscular injections can be prescribed.

Specific antiviral treatment for rubella has not been developed. Indeed, soon after infection, the human immune system begins to develop specific protection, which as a result overcomes rubella.

There is data on the use of donor immunoglobulin in pregnant women and recombinant α-interferons for congenital rubella. These methods are aimed at creating artificial immunity to the virus. However, scientists did not find a significant effect in the treatment of congenital rubella syndrome with these drugs.

You can overcome rubella faster with the help of a special diet. It helps prevent complications and improve well-being during illness. First of all, you need to exclude from your diet foods that are difficult to digest: fried and fatty foods, spicy dishes, etc.

Give preference to fermented milk products and lean meat (preferably boiled). Eat plenty of fresh fruits and vegetables, as well as herbs. During the illness, you should avoid foods that cause gas formation: flour and sweets.

To avoid complications, you need to forget about bad habits: cigarettes and alcohol. They irritate the mucous membranes of the nasopharynx and esophagus, which are already depleted from exposure to infection. In addition, combining medications and alcohol is contraindicated.

As a rule, complete recovery occurs within 3-4 weeks. The patient is prescribed bed rest. Most of the symptoms of the disease are caused by the activity of the virus. To quickly cleanse the body of toxins, you need to drink a lot of water (1.5-2.5 liters per day).

Which doctors should I contact additionally?

If the patient still experiences complications, you should immediately contact a specialist of the appropriate profile. In this case, treatment will be aimed at eliminating the concomitant disease. Problems can be both internal and cosmetic.

In most cases, rubella is accompanied by a rash, which may leave traces. To fix the problem, you need to contact a cosmetologist. Traces of rashes can be removed using laser resurfacing.

If you are concerned about nasopharyngeal diseases, make an appointment with an otolaryngologist (ENT). A pulmonologist deals with respiratory problems.

Sometimes the patient has individual intolerance to the infection. In case of a severe allergic reaction of the body, especially in children, it is necessary to consult an allergist.

Prevention

Today, the only way to prevent congenital rubella syndrome is to prevent the disease in the mother. Firstly, it is necessary to implement generally accepted sanitary and hygienic measures. Among them:

• isolation of patients;
• ban on attending collective or group events;
• sanitary education work, etc.

Unfortunately, they are ineffective and practically do not protect the pregnant woman from infection, although they reduce the likelihood of infection. Preventing rubella disease in pregnant women and, accordingly, congenital rubella syndrome is possible only through specific prevention by creating artificial active immunity at the population level.

According to WHO, in countries where a mandatory rubella vaccination program has not been adopted, the incidence of births of children with congenital rubella syndrome is four cases per 1000 children. At the same time, only those children who were born alive are included in the statistics, not counting miscarriages and missed pregnancies caused by intrauterine rubella.

These figures are several orders of magnitude higher compared to countries where routine vaccinations against this disease are carried out.

Specific prevention of rubella is carried out mainly with live rubella vaccines. Vaccines obtained using a weakened strain of the rubella virus Wister RA 27/3 have proven themselves to be effective. They stimulate the humoral and secretory immune response.

Antibodies appear two to three weeks after the vaccine is administered, immunity is formed in 95% of vaccinated individuals and remains strong for 15-20 years. Live rubella vaccines cannot be used during pregnancy, since their administration causes short-term damage to the body by the virus. This can lead to fetal damage and the birth of a child with congenital rubella syndrome. Pregnancy can be planned no earlier than three months after the vaccination. In three months, the body will be cleared of excess antibodies and will be ready to bear a child.

A full effect in the prevention of congenital rubella syndrome can be achieved only with routine vaccination of boys and girls in childhood and mass immunization of both teenage girls and boys aged 15 years.

This is an acute disease caused by the rubella virus. It is characterized by the appearance of small rashes, enlarged lymph nodes and a moderate increase in temperature. If the infection occurs in a pregnant woman, intrauterine damage to the fetus is possible. In this case, urgent medical attention is required.

Infection occurs by airborne droplets. The incubation period ranges from 15 to 24 days. Rubella in children is usually mild. The main symptoms are skin rash and swollen lymph nodes. The child's health remains satisfactory.

The disease is more severe in adults. They are worried about fever, headache, muscle pain. The lymph nodes are significantly enlarged.

Complications may develop:

• encephalitis;
• meningitis;
• pneumonia;
• arthritis and others.

When a virus enters the body, antibodies appear in the blood. After illness, strong immunity remains. Antibodies to the pathology remain for life, protecting a person from re-infection.

The congenital form of the disease is especially dangerous. If the mother has an infection during pregnancy, children are born with developmental defects. They secrete a virus and are therefore dangerous to others.

Vaccination against the disease is included in the National Calendar.

Causes and signs of the disease

Infection is caused by a virus. The incidence increases in winter, but in closed communities (for example, barracks for military personnel) outbreaks of an epidemic nature are possible. Children aged 1 to 7 years are most often affected. The causes of rubella are contact of an unvaccinated person with a sick person or a virus carrier.

The first signs of rubella appear 16 to 18 days after infection. Their appearance is preceded by an incubation period, during which the virus multiplies in the lymph nodes and penetrates the blood.

A rash is the first symptom of the disease. It first appears on the face and spreads throughout the body within a few hours. The rash is small, spotty, pink, lasts 1 – 2 days. At the same time, a slight runny nose, cough and conjunctivitis occur.

A characteristic sign of the disease is enlargement of the lymph nodes, especially the occipital and posterior cervical ones. When palpating them, pain may appear.

The body's condition practically does not deteriorate. Dangerous complications develop in isolated cases. The usual form of the disease does not require medication.

The patient is contagious starting from about 10 days after infection (a week before the end of the incubation period and the appearance of the rash). The end of viral shedding occurs a week after the appearance of the rash. Children with a congenital form of the disease are sources of infection for up to 1 year or more.

Symptoms of the disease

The incubation period of the disease ranges from 15 to 24 days (usually 16 to 18 days). A week before the end of this period, the patient becomes a source of infection, and contact with him can cause illness.

Then the symptoms of rubella appear - a rash, a slight increase in temperature. Before the rash, some patients experience a slight runny nose and cough, as well as pink spots on the mucous membrane of the cheeks and palate.

First, a rash appears on the face, then it spreads to the entire skin. Its manifestations are especially clearly visible on the back, buttocks and extensor surfaces of the joints. At the same time, the lymph nodes in the neck and in the back of the head enlarge. Based on these characteristic symptoms, the doctor can easily make a diagnosis.

Symptoms of the disease in children do not require the use of specific medications. They have virtually no complications. Help is to create peace and isolation from healthy children.

Symptoms of the disease are more pronounced in adults. They often experience severe headaches, joint and muscle soreness, and fever. The disease is severe and may be accompanied by complications.

To prevent this infection, vaccination is used.

Rubella during pregnancy

Rubella is most dangerous during pregnancy in the first trimester of pregnancy. If the mother suffered the disease before 8 weeks, the risk of developing congenital defects in the fetus is very high. Contact of an unvaccinated woman with an infectious agent can lead to miscarriage.

The virus causes infection in pregnant women. Characteristic signs of congenital infection are deafness, heart disease, and cataracts. There may also be the following consequences: damage to the nervous system, thrombocytopenia, hepatitis, pneumonia, pathology of the bones and urinary system, mental retardation. In some cases, the appearance of signs of the congenital form of the disease is observed with the further growth of the child. It releases viruses into the external environment for at least a year after birth.

If the mother was vaccinated on time, antibodies circulate in her blood. They provide immunity, including in children up to six months.

Pathology in pregnant women is a dangerous disease. If it develops in the first 3 months, indications for termination of pregnancy may arise. For diagnosis, antibody levels are re-determined at intervals of 10–20 days. If their number increases, this indicates a mother’s illness.

Measles rubella

Measles and rubella are diseases caused by different viruses. However, the elements of the rash are similar. Based on this, rubella measles is sometimes isolated. This disease is transmitted by airborne droplets.

The disease is accompanied by skin rashes, enlarged occipital and posterior cervical lymph nodes and mild fever. The increase in temperature lasts no more than 3 days, hence one of the names - “three-day measles”. The patient's condition hardly worsens.

Unlike measles, with the measles form of the disease the rash appears within a few hours. The elements themselves are smaller than with measles. These are pale pink spots that do not merge with each other. They are located on the back, gluteal region, and the outer surface of the limbs. The rash disappears after 2–3 days, leaving no traces. Very rarely, slight pigmentation, dusty flaking or minor itching occurs. In some patients, the rash does not appear. Only a doctor can distinguish measles from rubella.

A method to avoid infection is vaccination. It allows the body to acquire strong immunity that protects against disease.

Diagnosis of the disease

The disease has a characteristic clinical picture, on the basis of which rubella is diagnosed. Data on contact with the patient, the type of rash, enlarged lymph nodes, mild fever and minor catarrhal symptoms are taken into account. The disease is mild, without respiratory or other disturbances.

A blood test determines a decrease in the number of leukocytes and an increase in the number of lymphocytes. The number of plasma cells increases up to 10–15% - this is a rather specific sign of the disease. With the development of encephalitis, the number of neutrophilic leukocytes increases.

An enzyme immunoassay for antibodies is performed. Detection of IgM confirms the diagnosis. Another laboratory analysis is the detection of an increasing amount of antibodies using a direct hemagglutination reaction.

If an intrauterine form of the disease is suspected, the pregnant woman is re-examined using RPGA.

Differential diagnosis is carried out with the following diseases:

• measles;
• enteroviral exanthema;
• drug rash (eg, ampicillin rash).

Treatment of rubella

The virus enters the nasopharynx through airborne droplets. The incubation period of the disease is about 17 days. Then characteristic rashes and enlarged lymph nodes appear. The child's body tolerates the disease well. Therefore, treatment of rubella in children consists of bed rest for the duration of the rash. No medications are prescribed.

Treatment of rubella in adults is carried out using symptomatic drugs - antipyretics and analgesics. In severe cases, when encephalitis develops, the patient is hospitalized, detoxified, and symptomatic medications are prescribed.

For the congenital form, no treatment has been developed. Symptomatic correction of developmental defects is carried out. However, the affected child remains disabled for life. This is the danger of the disease for pregnant women.

A vaccine is used to prevent complications. It builds immunity by stimulating the production of protective antibodies. This helps to avoid infection, which is dangerous for the expectant mother and her baby.

Children are vaccinated at 1 year of age. Revaccination (repeated administration of the drug) is necessary at the age of 6 years. If the girl has not been vaccinated, the vaccine against the disease is administered when she reaches fertile age (the time of the start of menstruation). It is necessary to explain to the child's parents the possible dangers of refusing vaccination.

Vaccination against the disease is safe, side effects after it are extremely rare and do not pose a threat to health.

Disease prevention

In rare cases, the disease can cause complications from rubella: encephalitis, meningitis, pneumonia or arthritis. In adults, the disease is severe, with high fever and intoxication syndrome. Infection in pregnant women is very dangerous.

Prevention of rubella is mandatory vaccination in childhood. It is carried out using the Rudivax vaccine or combination drugs (Priorix, MMR), which also protect against measles.

To prevent the spread of infection, the sick person is isolated from the moment the disease is diagnosed, and is allowed into the team 5 days after the rash disappears. Disinfection is not carried out, children in contact are not separated.

Particular attention is paid to pregnant women who have not been vaccinated previously and who had contact with the patient during the 1st trimester of pregnancy. They do a blood test for pathology. If the disease is confirmed, the issue of termination of pregnancy is decided. If they decide to continue the pregnancy, regular ultrasound examinations are recommended in the future for early detection of fetal malformations.

If a woman is vaccinated, then her blood contains antibodies that are transmitted to the fetus and protect the child in the first six months of his life. In this case, contact with the patient at any stage of pregnancy is not dangerous.

Video about rubella