Rubella: photos, symptoms, rubella treatment
- Ways of transmission of infection
- The mechanism of the development of rubella
- Symptoms of rubella
- Possible complications of rubella
- Syndrome of congenital rubella
- Treating rubella
- Preventive actions
One of the most common viral infections that occur primarily in childhood is rubella. This disease proceeds in mild form, practically without causing complications and ending with complete recovery. At the same time, infection of a woman during pregnancy is a serious enough threat to the health of her unborn child. In some cases, rubella causes congenital malformations and even leads to fetal death.
Rubella is a disease of a viral nature, in 1881 isolated into a separate nosological form. Its causative agent is the RNA genomic virus (ruby virus) from the family of tobawiruses, which has teratogenic activity (which disrupts the normal process of embryonic development). The rubella virus tolerates freezing well, for several hours it retains its aggressiveness at room temperature, quickly dies under the influence of ultraviolet radiation, heating and disinfectants.
The source of infection is a person with clinically expressed or erased rubella signs. Rubyvirus begins to be released into the environment one week before the onset of the rash and even for 5-6 days after the onset of the rash. The most dangerous in epidemiological terms are children with congenital disease. In this situation, the pathogen is excreted into the external environment along with saliva, urine and feces for several months (sometimes up to one and a half years).
Ways of transmission of infection
- Transplacental (especially in the first trimester of pregnancy);
- In young children, the virus can be transmitted from mouth to mouth through toys;
Women of active reproductive age (20-29 years) are especially susceptible to rubyvirus. Before the use of mass preventive vaccination against rubella, this disease was registered almost everywhere. At the moment of all outbreaks of infection, 83% are recorded in post-Soviet countries. This situation is explained by the lack of a program for broad immunization of the population. Every 3-5 years moderate incidences of morbidity occur, and every 10-12 - more intensive (usually in March-June). In the last decade, infections of adolescents and women of childbearing age have become more frequent.
The mechanism of the development of rubella
To date, the mechanism of the development of the disease has been studied insufficiently. The rubella virus penetrates the human body through the mucous membranes of the upper respiratory tract (in rare cases, through the skin). The causative agent spreads hematogenously, settling on the epithelial cells of the skin and in the lymph nodes, leading to the development of lymphadenopathy. As a rule, viremia ends immediately after the onset of rashes (at this time, antibodies that neutralize the virus are found in the patient's blood). They persist for life, causing persistent post-infectional immunity.
In pregnant women rubivirus affects the internal epithelium of the blood vessels of the placenta, it breaks the fetal nutrition, easily overcomes the placental barrier and becomes the cause of infection of the embryo. Infection of a woman in the first trimester of pregnancy leads to damage to the genetic apparatus of the future child's cells, slowing growth, disrupting the formation of organs and the subsequent development of congenital malformations.
Symptoms of rubella
The duration of the incubation period is 10-15 days.
Subsequent, catarrhal period, lasts 1-3 days. In children, the symptoms of the mucous membrane of the upper respiratory tract are observed quite rarely. Adults, as a rule, complain of photophobia, headache, a feeling of sore throat, runny nose, dry cough, loss of appetite, it is also possible lachrymation and fever to high marks. In some patients, physical examination reveals the reddening of the mucous membrane of the throat, the increase and soreness of the occipital and posterior lymph nodes (this condition may persist for 2-3 weeks).
Already on the first day of the disease, 70-90% of patients develop rashes on the background of skin itching. In children, they have the appearance of oval or round pink small patches of regular shape, towering above the surface of unchanged skin. In adult patients, rash elements often merge, forming erythematous fields.
Most often, the initial eruptions appear in the face area, on the scalp, behind the ears and around the neck. During the day the exanthema spreads to other parts of the body (extensor surfaces of the hands and legs, buttocks, back and stomach). It should be noted that on the soles and palms of the rash with rubella never appears. Often small single spots of pink are found on the mucous membrane of the mouth (so-called Forchheimer stains, or spotty hyperemia of the soft palate).
In 20-30% of cases, erythematous rashes are absent, which greatly complicates the diagnosis.
During the appearance of the rash, body temperature may be slightly elevated or within normal limits. In all areas, available palpation, enlarged lymph nodes are found, sometimes pain in the muscles and joints, hepatosplenomegaly syndrome (simultaneous increase in the liver and spleen), disruption of the digestive tract. Within 4 days the rash disappears completely and recovery comes.
Possible complications of rubella
- Accession of secondary bacterial infection (pneumonia, otitis media);
- Serous meningitis or encephalitis, characterized by a relatively favorable course (this complication can develop on the 4-7th day of the disease);
- Thrombocytopenic purpura;
- Intrauterine fetal death;
- Congenital malformations.
Syndrome of congenital rubella
Congenital rubella is a slow viral infection characterized by a prolonged interaction of the pathogen with the tissues of the body. The disease develops due to the transfer of rubyvirus in a vertical way from the sick mother to the fetus. In the event that the infection occurred before the 14-16 weeks of pregnancy, rubella often causes miscarriages, prematurity and development of severe intrauterine malformations, leading to an unfavorable outcome in the early neonatal period (neonatal period). Most often, infants with congenital rubella syndrome are diagnosed with heart disease, prenatal hypotrophy, prematurity, hepatosplenomegaly, damage to the visual organs, thrombocytopenic purpura. In 13% of cases in the first months of life there is a lethal outcome.
In the subclinical form of congenital rubella, occurring in 75-85% of cases, health problems appear in the distant postnatal period, and only dynamic medical supervision of this contingent of children allows to detect possible defects.
The diagnostic study includes the following laboratory tests:
- General blood test (increased ESR, lymphocytosis, leukopenia, possible detection of plasma cells).
- Serological examination of nasal mucus (RSK, RIA, IFA, RTGA).
- Determination of the concentration of antiviral immunoglobulins.
With an uncomplicated form of rubella, patients are given symptomatic treatment, which is usually done at home. Recommended bed rest, a plentiful drink, for the elimination of itching shows the use of antiallergic drugs (fenistil).
In severe (complicated) cases, antiviral and immunostimulating therapy is prescribed, and pathogenetic and symptomatic agents are prescribed. In this situation, it is necessary to prevent the development of edema and swelling of the brain. For this, corticosteroids, hemostatics and diuretics are used. In the final stage (the period of convalescence), patients are given nootropic drugs that improve cognitive (cerebral) functions.
To date, the primary task of specialists is to protect against infection of women of childbearing age. Fortunately, rubella is a small group of infectious diseases, the development of which can be prevented by vaccination. To do this, live poly- and mono-vaccines are used. The vaccine is given to children from the 15th to the 18th month of life. Girls who reached the age of 6 and 15 undergo revaccination, which allows them to avoid infection during pregnancy (immunity after vaccination persists for 20-25 years).
However, pregnant women are strictly prohibited from vaccination. It is also undesirable to plan pregnancy in the first 3 months after vaccination, since there is a possibility of post-vaccination infection of the fetus.
Patients with acquired rubella form should be isolated until full recovery. Children who are in groups are isolated for 10 days from the beginning of the rash. If a pregnant woman has rubella in the team or in the family, the isolation period is extended for 3 weeks.
In the room (ward), where the infected person is, constantly wet cleaning and airing should be carried out.
In the event that a woman waiting for a child is in contact with a sickened rubella, the issue of maintaining pregnancy is resolved after a two-time serological study, which necessarily includes the determination of the number of immunoglobulins of class G and M. If the titer of specific antibodies is stable, the contact of the pregnant woman with the source of infection is considered not dangerous.
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