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Appendices

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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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CLINICAL MANIFESTATIONS

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 complications. Maternal rubella during pregnancy can result in miscarriage, fetal death, or a constellation of congenital anomalies (congenital rubella syndrome [CRS]).

Congenital Rubella Syndrome The most commonly described anomalies/manifestations associated with CRS 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 CRS 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 maternal infection 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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ETIOLOGY

Rubella virus is an enveloped, positive-stranded RNA virus classified as a Rubivirus in the Togaviridae family.


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EPIDEMIOLOGY

Humans are the only source of infection. Postnatal rubella is transmitted primarily through direct or droplet contact from nasopharyngeal secretions. The . . . [Go to Full Text]


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