Rubella disease treatment symptoms diagnosis

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 you on alter-zdrav.ru about 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:

1. critical increase in body temperature;
2. severe muscle pain and headaches;
3. general malaise, loss of appetite;
4. sore throat, dry cough;
5. runny nose;
6. fear of light, inflammation of the conjunctiva of the eye;
7. hyperemia of the pharynx;
8. 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:

1. normal body temperature or its slight increase;
2. rarely joint or muscle pain;
3. dyspepsia;
4. an increase in the size of the spleen and liver;
5. joint swelling and pain;
6. the size of the spot does not exceed 4-5 mm, there is no liquid filling;
7. 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.

1. cerebral edema, meningitis, encephalitis;
2. disturbances in the functioning of the heart;
3. damage to the nervous system, convulsive conditions, loss of coordination, decreased intellectual abilities;
4. development of secondary infection (sore throat, pneumonia, 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.

1. improper formation of cranial bones;
2. cataract;
3. heart pathologies;
4. diabetes;
5. hearing impairment or complete deafness;
6. jaundice, hepatitis;
7. hydrocephalus, microcephaly;
8. developmental anomalies of the soft and hard palate;
9. premature birth or stillbirth;
10. 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 that require immediate and specific treatment have similar rashes.
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. Drinks made from rose hips, apples, or just still water are especially good;
4. Nonsteroidal anti-inflammatory drugs will relieve joint and muscle pain. Diclofenac, ibuprofen.
5. Immunomodulators stimulate the production of human interferon, which leads to the suppression of the proliferation 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.

What is rubella? We will discuss the causes, diagnosis and treatment methods in the article by Dr. P. A. Aleksandrov, an infectious disease specialist with 11 years of experience.

Definition of disease. Causes of the disease

Rubella (Rubeola) is an acute viral disease. It is formed when the rubella virus enters the body, affecting the epithelial tissue of the upper airways, groups of regional lymph nodes and skin.

Clinical characteristics: syndrome of general infectious intoxication, small-spotted exanthema, generalized lymphadenopathy, pharyngitis and mild conjunctivitis. The development of the disease in typical (childhood and adolescence) age is characterized by a mild, benign course.

Etiology

species - causative agent of rubella (Rubella virus)

The disease syndromes were first described in 1740 by F. Hofmann (Germany). The virus was isolated only in 1961. This was done by several independent scientists: T.X. Weller, P.D. Parkman, F.A. Neva.

The virion (viral particle) of the pathogen is spherical in shape. The genetic material is made of single-stranded RNA, covered with a capsid and an external lipid contour, on the surface of which spikes are localized (with their help the virus attaches to cells). There are three proteins in the structure of the virus: C, E1 and E2. E1 (hemagglutinin) and E2 (protective antigen) are glycoproteins (or spikes) localized in the outer covering of the virion. They have a single serotype.

The virus is capable of destroying and gluing together human red blood cells (hemolytic properties); due to the presence of neuraminidase, it affects nervous tissue.

Very unstable in the environment: susceptible to ultraviolet radiation, when dried and exposed to disinfectants (anti-microorganism agents) it dies instantly. It preserves well at low temperatures. Cultivation of the virus in cell cultures is possible. [4]

Epidemiology

Purely anthroponosis. The source of infection is an infected person (not excluding a patient with an atypical form of rubella). The infected person is contagious from the last week of incubation until the first week after the rash appears. Isolation of infectious virions in children with congenital rubella infection (congenital rubella syndrome - SVK) possibly up to two years. The highest level of risk of CRS appears to be in those areas where young women do not have herd immunity to this disease (after vaccination or previous rubella). Before rubella virus vaccinations were introduced, approximately four out of every thousand newborns were born with CRS.

Transmission of the infection is carried out by airborne droplets (aerosols), as well as vertically - transplacentally (if a woman gets rubella during pregnancy). Theoretically, infection from recently vaccinated people is possible (although in fact this is a rare case, mainly occurring in people with severe immunodeficiency).

In recent decades, due to a large-scale vaccination campaign, rubella and CRS have been virtually eliminated in a number of developed and some developing countries.

A mother who has been vaccinated or has had measles has immunity to the disease, which she passes on to her child. Therefore, such children have innate immunity, which subsequently declines and disappears by about six months (i.e., over time, children become susceptible to infection). Rubella mainly affects children who tolerate the disease relatively well, and adolescents. Now this disease often occurs in adults; its course is much more severe and, generally, atypical. The reason for this is the refusal of most people to undergo preventive vaccination.

The seasonal nature of the disease is spring and winter. After suffering the infection and completing the full course of vaccination, persistent lifelong immunity occurs (in some cases, after vaccination, revaccination is required in adulthood, which is especially important for women of childbearing age who have not had rubella). [5]

Rubella symptoms

Incubation period: from 11 days to 24 days.

The acute nature of the disease at the beginning (i.e., the manifestation of the main syndrome occurs on the first day from the onset of infection). In an adult, the development of the disease can sometimes be delayed due to the characteristics of the immune system.

Rubella syndromes include:

1. general infectious syndrome with manifestations of intoxication (usually moderate);
2. finely spotted rash;
3. enanthems - rashes on the mucous membranes (Forchheimer's spots);
4. conjunctivitis (moderate);
5. generalized lymphadenopathy - enlarged lymph nodes (GLAP);
6. damage to the respiratory tract (pharyngitis);
7. enlargement of the spleen and liver (hepatosplenomegaly).

The onset of the disease is characterized by mild malaise, tolerable headaches, mild chills, joint and muscle pain, sleep disturbances (insomnia), and loss of appetite. Body temperature is often subfebrile (37.1-38°C). A sore throat, mild dry cough, nasal congestion/runny nose, photophobia occurs. At the end of the first day, a rash appears on the skin, with the advent of which the severity of the general infectious syndrome and the inflammatory process of the mucous membranes significantly increases.

During the examination, small spots are found that appear everywhere (except for the soles and palms). In adult patients they may be maculopapular. A pale pink rash with thickening in the face in the form of a “butterfly” and in the shoulder girdle, sometimes in the area of ​​the elbow bends is called Pastia's sign (while the skin color remains unchanged). Often a person with rubella looks like he has been “scalded by boiling water.” The rash fades within 3-4 days without peeling or pigmentation.

Groups of occipital, posterior cervical and parotid (regional) lymph nodes are enlarged and slightly painful. Sometimes enlargement of the spleen and liver is detected.

During pharyngoscopy, moderate hyperemia of the mucous membrane of the oropharynx (redness due to blood flow) can be noted; enanthema can be detected on the mucous membrane of the soft palate - small spots with a pale pink color (Forchheimer's spots).

The following cases of rubella are distinguished:

1. "Suspicious" - acute illness with one or more typical clinical signs of infection;
2. "Likely" - acute illness with clinical signs of rubella, epidemiologically associated with another episode of this infection (suspicious or confirmed);
3. "Confirmed" - laboratory proven disease, previously classified as a “suspicious” or “probable” case. This laboratory-confirmed case may have an erased, atypical form.

It happens that laboratory testing is not possible. “Probable” rubella is then classified as “confirmed”.

The final diagnosis of rubella can only be established by studying the results of laboratory tests (clinical confirmation of the diagnosis; establishing a connection with other episodes of this infection that are confirmed in the laboratory).

A fairly rare type of rubella at present is congenital rubella infection (CRS), which occurs when the fetus becomes infected inside the mother's womb. The consequences of this are quite sad: spontaneous abortion in the early stages, fetal death during pregnancy, and the birth of a child with CRS are possible. The frequency and severity of damage to the fetus is influenced by the period of pregnancy at which the infection entered the body (in the first four weeks of pregnancy - severe damage - up to 60% of cases; at three months - up to 15%; at four months - up to 6%; from the fifth month, the risk of CRS is 1.7%). Birth defects associated with CRS include heart disease, eye diseases (decreased visual acuity, cataracts, nystagmus (involuntary oscillatory movement of the eyes), microphthalmia (atrophy of the eyeball), congenital glaucoma), stabismus (strabismus), hearing loss, long-term mental retardation. [3] [6]

Pathogenesis of rubella

The entry gate for the rubella virus is the epithelium of the upper respiratory tract. This is how it penetrates into the human body and is localized, accumulates and multiplies in regional lymph nodes. After the virus breaks into the blood, viremia appears (spread of the virus throughout the body). Due to the epitheliotropic properties of the rubella virus, rashes occur, persistence (long-term residence of microorganisms) in the lymph nodes causes their hyperplasia, and possible damage to platelets.

M class antibodies begin to form and persist in the bloodstream 1-2 days after the onset of the disease.

At the time of rubella infection during pregnancy (in women without immunity!), the virus enters the epithelial layers of the chorionic villi, as well as the endothelial cells of the blood vessels of the placenta. This, in turn, causes prolonged ischemia (decreased blood supply) to the organs and tissues of the fetus. Violation of the cell cycle leads to the development of chromosomal abnormalities, which causes death or severe malformation of the fetus (the gestational age at which the infection occurred plays an important role). [4] [7]

Classification and stages of development of rubella

The following systematization of rubella is based on the classification according to A.P. Kazantsev.

Based on the clinical form of the disease, rubella is:

1. typical;
2. atypical (no rash);
3. inapparent (subclinical forms, mainly only by detection of antibodies);

1. with congenital heart disease;
2. with damage to nerve structures;
3. with damage to the auditory pathway;
4. with eye damage;
5. mixed.

There are three degrees of severity of rubella:

The residual (remaining after the disease) manifestation of congenital rubella is considered separately.

Complications of rubella

1.arthropathy (arthralgia and arthritis) - symptoms appear 1-2 days after the rash disappears, lasts 5-10 days, is accompanied by joint disorders (swelling and pain), goes away without a trace;

2. thrombocytopenic purpura (Werlhof's disease) - a large hemorrhagic exanthema (rash) of the petechial type, the possibility of bleeding gums, hematuria (the presence of blood in the urine) cannot be excluded;

3. encephalitis - five days after the appearance of the rash, there is an exacerbation of pain in the head, convulsions, meningeal and focal symptoms, coma;

4. serous meningitis. [4] [5]

Diagnosis of rubella

Laboratory diagnostics:

1. a detailed clinical blood test (leukopenia, relative lymphocytosis and monocytosis, the appearance of plasma cells less than 20%, sometimes a small number of atypical mononuclear cells, ESR is normal or increased); if a complication develops, then corresponding changes occur.
2. clinical urine test (hematuria);
3. serological diagnosis (detection of antibodies belonging to classes M and G in the blood serum using ELISA, establishing the presence of avidity of class G antibodies, rubella virus using the polymerase chain reaction method - PCR) - is the standard of laboratory diagnostics;
4. It is permissible to carry out diagnostics using the PCR method from material from nasopharyngeal mucus, cerebrospinal fluid, and urine.

When complications develop, they resort to appropriate diagnostic methods in relation to a specific situation.

Laboratory testing of pregnant women (especially those who have not been vaccinated and have not had rubella) is subject to separate consideration, since the disease is most dangerous for them. According to the Sanitary Rules, pregnant women who were in the source of infection must consult a doctor to monitor their health and undergo a dynamic serological examination (determine the presence of IgM and IgG antibodies). [7]