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The following text is from an archived Red Book® edition and may not reflect current recommendations or information. To view the current edition, click here.
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Section 3. Summaries of Infectious Diseases
Rubella
Clinical Manifestations
Etiology
Epidemiology
Diagnostic Tests
Treatment
Isolation of the Hospitalized Patient
Control Measures
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POSTNATAL RUBELLA. Many cases of postnatal rubella are subclinical. Clinical disease usually is mild and characterized by a generalized erythematous maculopapular rash, lymphadenopathy, and slight fever. The rash starts on the face, becomes generalized in 24 hours, and lasts a median of 3 days. Lymphadenopathy, which may precede rash, often involves posterior auricular or suboccipital lymph nodes, can be generalized, and lasts between 5 and 8 days. Conjunctivitis and palatal enanthem have been noted. Transient polyarthralgia and polyarthritis rarely occur in children but are common in adolescents and adults, especially females. Encephalitis (1:5000 cases) and thrombocytopenia (1:3000 cases) are rare complications. Maternal rubella during pregnancy can result in miscarriage, fetal death, or a constellation of congenital anomalies (congenital rubella syndrome).
CONGENITAL RUBELLA SYNDROME (CRS). The most commonly described anomalies associated with congenital rubella syndrome are ophthalmologic (cataracts, pigmentary retinopathy, microphthalmos, and congenital glaucoma), cardiac (patent ductus arteriosus, peripheral pulmonary artery stenosis), auditory (sensorineural hearing impairment), and neurologic (behavioral disorders, meningoencephalitis, and mental retardation). Neonatal manifestations of congenital rubella syndrome include growth retardation, interstitial pneumonitis, radiolucent bone disease, hepatosplenomegaly, thrombocytopenia, and dermal erythropoiesis (so called "blueberry muffin" lesions). Mild forms of the disease can be associated with few or no obvious clinical manifestations at birth. The occurrence of congenital defects is up to 85% if infection associated with maternal rash occurs during the first 12 weeks of gestation, 54% during the first 13 to 16 weeks of gestation, and 25% during the end of the second trimester.
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