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Pediatric Rubella Differential Diagnoses

  • Author: Elias Ezike, MD; Chief Editor: Russell W Steele, MD  more...
Updated: Dec 18, 2014
Contributor Information and Disclosures

Elias Ezike, MD Consulting Staff, Beaumont Pediatric Center, PLLC

Elias Ezike, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.


Jocelyn Y Ang, MD, FAAP, FIDSA Associate Professor, Department of Pediatrics, Wayne State University School of Medicine; Consulting Staff, Division of Infectious Diseases, Children's Hospital of Michigan

Jocelyn Y Ang, MD, FAAP, FIDSA is a member of the following medical societies: American Academy of Pediatrics, Infectious Diseases Society of America, Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Chief Editor

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, Southern Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

Leonard R Krilov, MD Chief of Pediatric Infectious Diseases and International Adoption, Vice Chair, Department of Pediatrics, Winthrop University Hospital; Professor of Pediatrics, Stony Brook University School of Medicine

Leonard R Krilov, MD is a member of the following medical societies: American Academy of Pediatrics, American Pediatric Society, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Society for Pediatric Research

Disclosure: Nothing to disclose.


Leslie L Barton, MD Professor Emerita of Pediatrics, University of Arizona College of Medicine

Leslie L Barton, MD is a member of the following medical societies: American Academy of Pediatrics, Association of Pediatric Program Directors, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

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Number of rubella cases per year.
Number of congenital rubella syndrome cases per year.
Deaths from rubella per year.
Image in a 4-year-old girl with a 4-day history of low-grade fever, symptoms of an upper respiratory tract infection, and rash. Courtesy of Pamela L. Dyne, MD.
Table 1. Reported Cases of Rubella, Deaths From Rubella, and Number of Cases of Congenital Rubella Syndrome in the United States From 1969-2007[4, 5, 6, 7]
YearNumber of CasesNumber of DeathsCases of Congenital Rubella Syndrome
Table 2. Clinicopathologic Abnormalities in Congenital Rubella
Abnormality Common/UncommonEarly/DelayedComment
Intrauterine growth retardationCommonEarly...
Cardiovascular system
Patent ductus arteriosusCommonEarlyMay occur with pulmonary artery stenosis
Pulmonary artery stenosisCommonEarlyCaused by intimal proliferation
Coarctation of the aortaUncommonEarly...
Ventricular septal defectUncommonEarly...
Atrial septal defectUncommonEarly...
CataractCommonEarlyUnilateral or bilateral
RetinopathyCommonEarlySalt-and-pepper appearance; visual acuity unaffected; frequently unilateral
Cloudy corneaUncommonEarlySpontaneous resolution
GlaucomaUncommonEarly/DelayedMay be bilateral
MicrophthalmiaCommonEarlyCommon in patients with unilateral cataract
Subretinal neovascularizationUncommonDelayedRetinopathy with macular scarring and loss of vision
Hearing lossCommonEarly/DelayedUsually bilateral; mostly sensorineural; may be central in origin; rare when maternal rubella occurs >4 months' gestation; sometimes progressive
MicrocephalyUncommonEarlyMay be associated with normal intelligence
Intracranial calcificationsUncommonEarly...
Encephalographic abnormalitiesCommonEarlyUsually disappear by age 1 y
Mental retardationCommonDelayed...
Behavioral disordersCommonDelayedFrequently related to deafness
Chronic progressive panencephalitisUncommonDelayedManifest in second decade of life
HypotoniaUncommonEarlyTransitory defect
Speech defectsCommonDelayedUncommon in absence of hearing loss
Blueberry muffin spotsUncommonEarlyRepresents dermal erythropoiesis
Chronic rubelliform rashUncommonEarlyUsually generalized; lasts several weeks
Dermatoglyphic abnormalitiesCommonEarly...
Interstitial pneumoniaUncommonDelayedGeneralized; probably immunologically mediated
JaundiceUncommonEarlyUsually appears in the first day of life
HepatitisUncommonEarlyMay not be associated with jaundice
ThrombocytopeniaCommonEarlyTransient; no response to steroid therapy
Hemolytic anemiaUncommonEarlyTransient
Altered blood group expressionUncommonEarly...
Immune system
Thymic hypoplasiaUncommonEarlyFatal
Radiographic lucenciesCommonEarlyTransient; most common in distal femur and proximal tibia
Large anterior fontanelUncommonEarly...
Endocrine glands
Diabetes mellitusCommonDelayedUsually becomes apparent in second or third decade of life
Thyroid diseaseUncommonDelayedHypothyroidism, hyperthyroidism, and thyroiditis
Growth hormone deficiencyUncommonDelayed...
Genitourinary system
Polycystic kidneyUncommonEarly...
Table 3. Age-Specific CD4+ T-lymphocyte Count and Percentage of Total Lymphocytes as a Criteria for Severe Immunosuppression in Persons with HIV
 Age Range
< 12 mo1-5 y6-12 y≥13 y
Total CD4+ T-lymphocytes< 750/mcl< 500/mcl< 200/mcl< 200/mcl
CD4+ T-lymphocytes (as % of total lymphocytes)< 15%< 15%< 15%< 14%
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