Dermatologic Manifestations of Rubella Clinical Presentation
- Author: Peter C Lombardo, MD; Chief Editor: Dirk M Elston, MD more...
Studies on children at the New York Willowbrook State School in 1963, shortly after the isolation of the rubella virus, have shown that the disease is spread by nasal droplet infection and has an incubation period of 14-19 days, with onset of a rash usually on the 15th day. The disease can be spread from a few days before to 5-7 days after the appearance of the exanthem. The virus can be detected in the pharynx from 7 days before until 7 days after the rash. A viremia was detected from 7 days before until the day of the rash, and the virus was present in the stool from 4 days before until 4 days after the rash. Isolating the virus from children with subclinical infections was also possible.
Patients are most contagious when the rash is erupting. Rarely, the virus may be shed from the pharynx up to 15 days after the appearance of the rash, in rapidly diminishing amounts, and it is very difficult to detect by culture after 5-7 days. Patients are not considered clinically contagious after 7 days.
Infection usually confers lifelong immunity, but reinfection is occasionally detected serologically after the natural disease or a vaccination upon reexposure to the virus and rarely results in clinical disease.
In children, a prodrome may not be present. The rash may be the first manifestation. In adults, fever, sore throat, and rhinitis may be present. The exanthem begins as discrete macules on the face that spread to the neck, the trunk, and the extremities. The macules may coalesce on the trunk. Appearance of the rash corresponds with the appearance of the rubella-specific antibody. The exanthem lasts 1-3 days, first leaving the face, and may be followed by desquamation. On occasion, a nonspecific enanthem (Forchheimer spots) of pinpoint red macules and petechiae can be seen over the soft palate and the uvula just before or with the exanthem. Note the images below.
The hallmark of rubella is the generalized, tender lymphadenopathy that involves all nodes, but which is most striking in the suboccipital, postauricular, and anterior and posterior cervical nodes. It is most prevalent at the time of appearance of the exanthem but may precede it by a week. The tenderness that accompanies this lymphadenopathy subsides rapidly; however, the enlargement may last days or weeks.
Although less common in children, in adults, polyarthralgia and even polyarthritis may occur and rarely may persist longer than 2 weeks. It may resemble rheumatic fever or rheumatoid arthritis, with small and large joints being involved bilaterally with or without swelling. The swelling can be very marked. Fifty percent of women may have arthralgias, and 10% have arthritis, 3 days post rash with the natural infection or within 2-6 weeks after a vaccination.
Rarely, recurrent episodes of inflammation of the fingers, the wrists, and the knees can continue for more than a year. Very rarely, a syndrome of low-grade fever, chronic fatigue, and myalgias can persist for months or years. The pathogenesis of the arthritis is not known. The virus can be isolated from joint effusions in acute and recurrent cases. Peripheral blood mononuclear cells may harbor the rubella virus in chronic arthritis. Test results for rheumatoid arthritis are negative.
Rubella is an RNA virus classified as a Rubivirus in the Togaviridae family.
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