Rubella - Causes, symptoms and treatment. MF.

Rubella( Rubeola) is a viral disease that affects only a person, manifested by a small-spotted rash, minor inflammation of the upper respiratory tract and a slight intoxication syndrome.

For the first time, in the literature the mention of rubella was established as far back as the 16th century. And in 1829, Wagner established the differences between this disease and measles and scarlet fever, and in 1881,- Rubella is allocated as a separate disease. In 1938, Japanese researchers proved the viral nature of the infection by infecting a volunteer. In 1941 - the German scientist Grett put forward a theory of the teratogenicity of the measles virus on the fetus during infection of the mother during pregnancy, that is, it can cause congenital ugliness. In 1973, our domestic scientists proved this theory and attenuated strains were obtained( ie, lacking virulence - not dangerous), with the subsequent creation of a vaccine.

Rubella virus

The rubella virus belongs to the family of tobawirus, toga( raincoat) covers its double membrane with its RNA molecule. On the surface of this membrane are thorns( villi) - they contain hemagglutinin, and there is also neuraminidase. Infectiousness, in comparison with other acute droplet infections( measles, whooping cough, and also in comparison with chickenpox) is small due to relative instability in the external environment( even despite the double membrane membrane).But for non-immune individuals, the susceptibility is 90%!

As already mentioned, the virus is unstable in the external environment, and at room temperature can persist for several hours. Its rapid death occurs when the pH( acid-base medium) changes to the alkaline or acidic side. Similarly, the rubella virus is not resistant to temperature changes( kills at 56 ° C), drying, UVI action, disinfectants, ether and formalin.

The risk of morbidity is great for those who have never been sick and have not been vaccinated, under this category of people are children 2-9 years old. For outbreaks, the seasonality is characteristic - winter-spring. Epidemic outbreaks are repeated every 10 years. After the transferred disease, a stable lifelong immunity is formed, but according to some data, it is still possible to re-infection.

Causes of rubella infection:

The source of the virus is a sick person, with a sharp infection or even a subclinical form of the disease, when symptoms are not visible. Also, the source can be children with congenital rubella( from a mother who was sick at the time of pregnancy) - they can be sources of infection for up to 3 years of their life( cases of virus isolation up to 18 years have been recorded).The patient is dangerous for 5-7 days before the onset of the rash and within 7 days after its disappearance.

Routes of infection - airborne( during sneezing, coughing, screaming, talking, sudden exhalation), transplacental( infection of a pregnant woman, followed by infection of the fetus).

Favorable conditions for infection are crowded population, ie organized collectives, this leads to the conclusion about isolation of the patient.

Symptoms of rubella

The incubation period( from the moment of introduction of the pathogen and its vital activity in the body to the first symptoms) is 13-23 days, but even these days a person can be a source, since the excretion occurs 5 days before the onset of the rash, andthis period may not be preceded by anything, even catarrhal manifestations may not be present, but appear almost simultaneously with a rash. So, infection can also be from a "healthy" at first glance.

During this period, the virus penetrates and binds to the mucous membranes of the upper respiratory tract, as it penetrates into the demented tissues( due to neuraminidase) and spreads through the lymphatic system - the normal period or the rash period immediately begins.

The prodromal period - it may not be, and if there is, it can last from a few hours to 2 days. At the same time, catarrhal phenomena are expressed to the least extent - malaise, the temperature rises to 37.5-38 ° C.There is an increase in lymph nodes a day or two before the rash, in this condition the disease is about 1-3 weeks( lymph nodes - this is the only thing that can give out a prodromal period), mainly increases the posteroderma and occipital lymph nodes, they are of a soft consistence, unsaved with surrounding tissuesand painless.

The period of rashes - 3-4 days. Before the skin rashes often appears enanthema - pink spots on the soft palate, which can merge and move to the arches and the hard palate. After a rash on the mucous there is a small-spleen rash on the entire surface of the body, but mostly on the face, extensor surfaces and buttocks. The character of the rash is fine-sparse, relatively abundant, rarely merges and rapidly loses brightness. The appearance of the rash is explained by the spread of the virus by blood, the simultaneous action of hemagglutinin( it causes glutinous erythrocyte adhesion) and dermatotropism( selective lesion of the skin dermis layer) - as a result, the glued erythrocytes seem to get stuck in the skin layer.

Rash with rubella

Light catarrhal manifestations, which may not be, accompanied by a rise in temperature to 38 ° C.In adults, arthralgia( joint pain) accompanied by hyperemia( redness and swelling) can be observed, but after recovery, these symptoms disappear without a trace.

The period of reconvalescence - recovery. During this period, all manifestations are on the wane. But the patient can still infect others( unhealthy / unvaccinated) for 7 days from the last rash.

Congenital rubella is characterized by the Gregg triad:

1. cataract( clouding of the lens) is one- or two-sided, often accompanied by microphthalmos.
2. Heart defects( uncontrolled arterial duct, pulmonary artery stenosis, damage to the valvular apparatus or any cardiac septum);
3. Deafness. Along with these three signs, there may be other malformations: hydrocephalus, non-softening of the soft and hard palate, neurological disorders( PSPE).The following is translated as Teenage Sclerosing Panencephalitis - at the time of birth it may not be defined, but in a few years this pathology will make itself felt. This is due to the possibility of the virus for a long time( years) to stay in the body, despite the presence of high titres of specific antibodies. It manifests itself in the first years of life and is characterized by the progression of impairment of the intellect and motor disorders.

Cataract with congenital rubella

The above example indicates minimal changes, because otherwise the pregnancy may result in spontaneous miscarriage or stillbirth. The manifestation of the degree of teratogenicity will depend on the timing of pregnancy and the most dangerous are considered 1-3 trimesters - this is the period of organogenesis, and lesions will therefore be systemic( ie CNS, GIT, etc.).In these cases, the chances of live birth are minimal.

Teratogenicity( the ability to cause congenital malformations or miscarriages) of the rubella virus is due to its tropism( directional action) to the embryonic tissues and unobstructed penetration through the placental barrier, and the development of congenital anomalies occurs as a result of inhibition of embryonic cell division at the time of organ and system formation.

Diagnosis of rubella

1. The diagnosis is based on the nature of the rash, the timing of its appearance, the simultaneous rash and localization, epidemic situation. But do not rely on your life experience, because there are many other similar diseases with similar symptoms: measles, scarlet fever, pseudotuberculosis, enterovirus exanthema, chickenpox, meningococcal eruptions( but only in the initial stages).The last option to miss is unpardonable, if parents or otherwise ill adults decide to take on this responsibility, because lethal with this disease reaches 30%.

2. Virological method - is aimed at the detection of the virus itself, the method is effective only in certain periods: the study of blood and feces is advisable during the time of the virus in the blood from 7-14 days of infection( ie before the appearance of a rash!);Separated nasopharynx is advisable to take when there is a rash.

3. Serological methods - determines the presence of virus neutralizing antibodies with the help of RNGA and PH, and also determine the class specific antibodies IgG, M and A - by ELISA.These methods are used 1-2 days after the onset of rash and on day 20, and remain high-life virus-neutralizing and inhibiting haemagglutination antibody.

- RNGA( indirect hemagglutination reaction) and pH( neutralization reaction) - are put with paired sera in an interval of 10 days( ie, 2 times the blood is taken and see what changes have occurred), while the antibody titer increases 4 times.
- RSK( complement fixation reaction) - is performed on the detection of complement-binding antibodies( they are only 3 years after the disease was transferred) - their presence indicates a recently transferred disease, or a period of recovery.
- ELISA - determines the cluster specific antibodies - IgG, M and A immunoglobulins. If classes M and A are detected, this indicates an initial period of the infectious process, G - an acute period or a period of convalescence( recovery) depending on their avidity(the strength of antigen binding to the antibody - the stronger the bond, the older the infection was).This method is used to determine the intensity of immunity in deciding the question of vaccination of adults and revaccination. The same method is used to diagnose congenital rubella - the absence of IgG excludes rubella.

Treatment of rubella

Specific treatment is not developed, therefore use:

1. bed rest for 3-7 days;
2. high-grade food, taking into account age features;
3. Etiotropic therapy with the use of viricides( arbidol, isoprinosine), immunomodulators( interferon, viferon) and immunostimulants( cycloferon, anaferon).
4. detoxification therapy - plentiful drink;
5. symptomatic therapy( expectorant - a certain group is used for a certain character of cough, ie, it is not possible to apply expectorant and antitussive at the same time), mucolytics, antipyretic drugs, analgesics);

Complications of rubella

Arthritis, encephalitis, meningoencephalitis, otitis, pneumonia, exacerbation of chronic infections.

Rubella prophylaxis

Common measures in the foci of rubella infection are ineffective due to the presence of inapparent forms and virus isolation long before the appearance of the first symptoms. But nevertheless, the diseased is isolated for 5-7 days from the moment of the appearance of the rash, and those in contact with it - for 21 days.

When a pregnant woman contacts a patient, her susceptibility is determined by serological methods and looks at the presence of IgG - if they are, the woman is considered immune, if not, the sample is repeated after 5 weeks and, if the result is positive, IgG is offered an abortion, but ifthe second time they do not find anything - they conduct the test for the third time in a month - the interpretation is the same as for the second sample.

Specific prophylaxis is the vaccination with live Rudivax vaccine or live MMR-II combined rubella / measles / mumps vaccine. The first time vaccinated in 12-15 months, and revaccinate at 6 years. Unvaccinated girls should be vaccinated at the age of 14.Contraindications: immunodeficiency, hypersensitivity to aminoglycosides and egg protein( when using MMR-II), acute disease or exacerbation of chronic;also inoculation is not administered 3 months before the onset of pregnancy. In all other cases, you can vaccinate after stabilizing the condition.

PS: registered rubella epidemia with fatal outcome, now recheck - whether the strain that was before, or it is necessary to sound an alarm. Therefore, be vigilant!

Doctor therapist Shabanova IE