RUBELLA | SYMPTOMS AND DIAGNOSIS
Rubella is a viral infection, highly contagious, which typically affects children. Rubella is usually a benign infection, but it can cause serious complications if acquired during pregnancy.
WHAT IS RUBELLA?
Rubella is a viral infection that usually causes fever and reddish spots in the body, calls rash . Man is the only host of this virus.
Rubella is a disease that is becoming less and less common, especially after the intensification of immunization campaigns in recent years. In Brazil, there are no cases of rubella reported since 2009.
TRANSMISSION OF RUBELLARubella is transmitted by the airways through spit (saliva droplets), as with most airborne transmission of viral infections. Rubella virus is highly contagious and is usually spread by sneezing, coughing, kissing, cutlery or even through conversations if there is enough time and close contact with droplets.
The incubation period rubella, ie the time interval between the contamination and the onset of symptoms, is on average 14 to 18 days. However, since the infected individual becomes contagious one to two weeks before becoming clinically apparent infection. This means that a few days after being infected, and before any symptom, the patient is capable of passing the virus to others.
In many cases, rubella infection is so weak that goes unnoticed, which does not, however, the patient infect others. For this reason, many individuals with rubella can not identify who the contaminated.
Rubella virus normally invades the body via the airways, but five to seven days after the infection is already spread all over the body, it may be found in blood, urine, lung, cerebrospinal fluid, skin, etc.
After the appearance of the rash, the transmission rate begins to drop, leaving the patient to be infectious 5 or 7 days later.
SYMPTOMS RUBELLAIn most people, rubella has few or no symptoms. This is particularly true in children, who often have a very weak rubella frame.
In those who developed symptoms, these arise 2 to 3 weeks after being contaminated. The initial symptoms of rubella are nonspecific, similar to any viral infection, with fever, body aches, headache, sore throat, runny nose and prostration. A more careful physical examination may reveal lymph nodes (swollen lymph nodes) in the neck and behind the ears, which are very characteristic of rubella.
After 1-3 days of nonspecific symptoms, rash (rash) appears rubella, which are small diffuse red spots, as pictured alongside. The rash usually starts on the face and down to the rest of the body within hours. Lasts about 3 days and then disappears. Besides the skin, the rash can also occur on the palate (roof of the mouth). At this stage, one joint pain and conjunctivitis frame is also common.
The rash disappears faster, but the lymph nodes and joint pain can still last a few days. Children recover faster than adults, which may keep joint pain for up to a month.
As I said, most people do not develop symptoms after contact with the virus. Even those who develop symptoms of rubella, virtually all improve spontaneously. Rarely, on average one every 6000 cases, the virus can affect the brain, leading to what we call viral encephalitis, a serious framework and with high mortality.
Children with rubella should stay at home until the rash disappear completely, to avoid contamination of colleagues. As rubella is a disease that is about to be eradicated, all cases must be reported to the health department.
The diagnosis of rubella is usually done through the clinical picture. The differential diagnosis should be done with parvovirus and scarlet fever (read: scarlet | Symptoms and treatment ), which have a very similar rash.
Four days after the appearance of the rash, the body already has antibodies against rubella, which allows for serology laboratory to confirm the disease. As this stage most people are already cured or healing process, and as there is no specific treatment for rubella, his laboratory confirmation is usually unnecessary (except in pregnancy. I explain below).
In serology there are two types of antibodies: IgM and IgG antibodies. The first to appear is IgM, which is the antibody attacks the virus. The IgM rubella usually longer be detectable on the 4th day of rash and remain positive for up to eight weeks. After curing, the second type of antibody arises, the IgG antibodies against rubella. The antibody is an IgG indicates that the patient has the disease and is now cured and immunized. So who's with rubella IgM positive features. Anyone who has had rubella or been vaccinated presents IgG reagent.
After curing, the IgG antibodies provide a new episodes of immunization against rubella. Therefore, rubella only caught once in life. Are rare and mild cases of reinfection. The patient may have contact again with the rubella virus, but IgG titers rise rapidly, preventing the patient develop the disease a second time.
Explained the interpretation of rubella serology in more detail in this article: RUBELLA IGG and IGM | RUBELLA DIAGNOSIS IN PREGNANCY
There is no treatment for rubella. But that's not a problem since more than 99% of patients are cured spontaneously. Generally prescribe antipyretics and analgesics to relieve symptoms until the patient has fully recovered.
Congenital rubella syndrome
The big concern for rubella is the infection of pregnant women. In children and adults the disease is mild, in the developing fetus it can be catastrophic.
If rubella is acquired during the first trimester, the risk of malformations is higher than 80%. Besides the morphological defects, 1 in 5 infected women suffering abortion at this stage. The congenital rubella syndrome is characterized by cataracts, deafness, heart defects, liver damage and neurological injury, including delayed mental development. In many countries abortion is allowed in rubella cases in the 1st quarter.
Newborns with congenital rubella can spread the virus for up to one year, being necessary to prevent their contact with other pregnant women not immunized.
Infections contracted after the 20th week brings little risk of malformations, but there is still the chance of transmitting the virus to the fetus. Usually these children are born underweight, but no defects in the formation.
In pregnant serology gains much importance. All pregnant women should be tested for rubella; if IgG negative, must be doubled in relation to the care contacts with persons with symptoms of viral infection.
Women who are IgG Reagent are not at risk to catch rubella during pregnancy.
The rubella vaccine is comprised of live attenuated viruses, and is therefore contraindicated in pregnancy. However, in 2006 a health ministry study showed that in 26,000 women inadvertently vaccinated because they ignore the fact that they were pregnant, had no case of congenital rubella. So not vaccine pregnant women known, but if there is a vaccination by mistake, the risk of complications is low (read: VACCINE IN PREGNANCY ).
Every woman of childbearing age should conduct a serological test to know their immune status against rubella. Those with negative results (negative IgG) is to apply the vaccine. Patients who have positive IgG are immunized and are not at risk of having rubella. No need to vaccinate people who already have IgG antibodies.
It's okay to get the vaccine while breastfeeding. Also it's okay to be revaccinated. If during a vaccination campaign one does not remember to have received the vaccine once in their lives, or do not know their immune status, it can be vaccinated. This guidance applies to men and women between 20 and 39 years.
A single dose of rubella vaccine is effective to create permanent immunization in over 95% of cases.
Like any vaccine with live virus, it also should not be taken by people with active or immunocompromised febrile illness.