Rubella symptoms in children
Rubella - infectious disease of viral nature, quite common viral infectious disease in children manifested melkopyatnistoy rash, slight inflammation of the upper respiratory tract, enlarged lymph nodes under the form of acquired or congenital malformations of the infection.After an incubation period occurs without symptoms and lasts from five to twelve days, suddenly there is a high fever.Fever may persist three - five days.At this time, the child may become irritable, and in some cases, testing convulsions induced fever.On the fourth or fifth day of the disease the temperature drops sharply, and a rash appears on the body.
rash consisting of small, red, flat spots, each of which is about two millimeters in diameter, can quickly spread to the neck and face, as well as on the hands and feet.The rash often subsides in one to two days, and in some cases may persist for only a few hours.By the time the rash appears, the child usually feels better, his temperature is normal and he is no longer contagious.H
etiology. Pathogen rubella - a virus belonging to the Togaviridae (family Togaviridae, the family Rubivirus..).Virions are spherical particles with diameters of 50-70 nm nucleocapsid contain coated double membrane diameter of up to 30 nm, wherein the molecule is RNA.On the surface of the viral particles are arranged studs (fluff) of size 6-8 nm, enclosing a haemagglutinin.Agglutinate erythrocytes of pigeons and geese, have hemolytic properties.Unlike other Togaviridae comprises neuraminidase.Pathogenic for some species of monkeys.Able to reproduce in many cell cultures, but cytopathic effect is not all.It has a tendency to long-term chronic infection.
Induces the formation of specific neutralizing, complement-fixing, haemagglutinating antibodies.The virus is relatively unstable and rapidly killed by heating (at 56 ° C) for drying, changes in pH (below 6.8 or above 8.0), under the influence of ultraviolet rays under the influence of ether formalin disinfectants.However, in the frozen state keeps infectious properties for several years.
Epidemiology. incidence of rubella in recent years significantly decreased, and in 2009 was 1.14 per 100 thousand. Population.The share of children aged under 17 years accounted for 77%.
and only natural reservoir and source of rubella virus is a sick person, but to establish the source is not always possible, since more than half of rubella occurs in asymptomatic or abortive form.The source of rubella can be a child born to an infected mother.It is known that children with congenital rubella infection can be the source of the virus before the age of three, but the cases of virus isolation are described in congenital rubella for 18 years.
The pathogen is transmitted by airborne droplets and transplacental ways.
rubella there is a high sensitivity, the skidding infection in staff sick 80-90% non-immune individuals.Children first 6 months of life insensitive to rubella virus by maternal antibodies.The highest incidence is recorded among children aged 2-9 years.Most often the disease occurs in winter and spring.After this illness remains stable lifelong immunity.However, RE submittedBerman and VKVaughan (1992), at 3-10% immune children can re-rubella.
Rubella only seen in children, especially those aged between six months and two years, and is more common in spring and autumn than in other seasons.The disease does not pose a serious threat to health;afterwards there are no complications.Treatment is focused on relief of symptoms until they are available.
pathogenesis. Rubella virus enters the body through the mucous membranes of the upper respiratory tract.It then penetrates into the regional lymph nodes.On the mucous membranes and lymph nodes in the viral replication occurs, which clinically manifested catarrhal syndrome and lymphadenopathy.Later comes the viremia, the intensity of which is negligible.Hematogenically the virus spreads throughout the body, fixed in lymphoid cells, causing focal dermatitis.
antibodies appear 2-3 days after the rash.This leads to an end of viremia, formation of immune recovery.
clinical picture. During rubella release:
1. The incubation period - 13-23 days.
2. prodromal period - from several hours to 1-2 days.
3. rashes period - 3-4 days.
4. The period of convalescence.
prodromal period there is not constant, lasts from a few hours to 1-2 days, characterized by lethargy, a slight runny nose, cough.Overall condition is violated is not enough.The body temperature of low-grade or normal.Determined increase zadnesheynyh and neck lymph nodes.
rashes period characterized by the appearance of rash on the background of weakly expressed signs of intoxication, moderate or weak catarrhal symptoms of the upper respiratory tract, and low grade fever.
melkopyatnistaya rash appears simultaneously on different parts of the body.The preferential localization rash - face, extensor surfaces, buttocks.Rash on the first day bright enough, the size of 2-4 mm in diameter, individual elements can fuse (reminiscent of measles).On the second day of the rash fades, it can acquire a dot form (reminiscent of scarlet fever).The rash disappears after 2-3 days, leaving no pigmentation, and peeling.
Immediately before the skin rash may appear enanthema.She is represented by separate pink spots on the soft palate, some of them merge, move on to the bow and the hard palate.The mucous membrane of the cheeks and gums is not changed.
Lymph nodes are increased by at least 24 hours prior to skin rashes, and are in such a state for a week or more.Mostly increases zadnesheynye and occipital lymph nodes.But can increase parotid, submandibular, popliteal, axillary lymph nodes.They are elastic consistency, mobile, sometimes painful.
Catarrh of the mucous membranes of the upper respiratory tract and conjunctiva there is impermanent, is weak, lasts 2-3 days.
Symptoms of intoxication also occur impermanent, expressed slightly, quickly disappear.
Body temperature may be normal or low grade, saved 1-3 days.
Defeat other bodies for the acquired rubella is unusual, but in adolescents and adults can show signs of arthritis: arthralgia, swelling and induration at the joints, effusion in them.These changes are saved from a few days up to 2 weeks and disappear without a trace.
During one of the epidemics of 8% of the boys complained testalgii (Behrman RE, VK Vaughan, 1992).
convalescence period with rubella usually proceeds smoothly.Complications are rare.The most serious of them - encephalitis, meningoencephalitis, or encephalomyelitis (one case in the 5000-6000 cases).Besides, can develop laryngitis with stenosis of the larynx, ear infections, pneumonia, nephritis, polyarthritis (mostly recorded in older children, adolescents and adults), secondary autoimmune thrombocytopenia.~
Congenital rubella. When the disease rubella (typical or atypical forms) pregnant women the virus infects the bloodstream through the epithelium of the chorionic villi, the endothelium of the blood vessels of the placenta formed emboli entered the bloodstream of the fetus, infecting germ cells.As a result, stops the development of the fetus, spontaneous miscarriage, stillbirth, or birth of a child with severe developmental defects - congenital rubella syndrome (CRS).Manifestations of teratogenic effects of rubella virus depends on the timing of pregnancy, the most dangerous in this respect are the first three months - the period of organogenesis.When infected pregnant in the gestation congenital rubella appears isolated or systemic malformations, as well as stigma dizembriogeneza.When the disease or contact a pregnant woman at 24-27 weeks of gestation in fetuses and dead newborns may show meningoencephalitis, myocarditis, hepatitis, pneumonia and / or dysplastic changes in various organs.
established that at the time of birth of CRS detected in only 15-25% of infants born to mothers who have had rubella during pregnancy.But after a few years of severe congenital abnormality is determined already at 50-90% of children.This is due to the ability of rubella virus to persist in the body, despite the presence of high titers of specific antibodies in the blood and cerebrospinal fluid.In this congenital rubella becomes chronic, the most severe manifestation of which is the development of subacute sclerosing panencephalitis (SSPE).
Symptoms that may be present at birth include intrauterine growth retardation, low weight at birth .tela.Described in 1941 by Gregg triad of congenital anomalies involves a combination of heart defects, eye and hearing loss.
the part of the eye may occur cataracts (unilateral or bilateral), microphthalmia, retinopathy, glaucoma, corneal opacity.
heart disease with congenital rubella may be different: a patent ductus arteriosus, pulmonary stenosis, aortic, aortic valve defects and atrial-ventricular septa mezhzhelu.
Deafness is registered in 50% of infants with congenital rubella, another 30% of patients it develops later.
In addition, there may be other malformations:. Micro- and hydrocephalus, cleft soft and hard palate, spina bifida, cryptorchidism, hypospadias, hydrocele, pyloric stenosis, biliary atresia, a congenital hepatitis, etc. Usually malformations are combined.
Neurological disorders of varying severity are recorded in 80% of patients with CRS (mental retardation, motor disorders, hyperkinesis and seizures, focal symptoms, schizophrenia syndrome, and others.).The most difficult runs SSPE, manifestations of which may appear in the first years of a child's life followed the progression of intellectual impairment and movement disorders.
In connection with the polymorphism of clinical manifestations of congenital rubella diagnosis requires laboratory confirmation.
Given the leading syndrome "blotchy rash" acquired rubella must be differentiated with the following diseases:
criteria for the diagnosis of acquired rubella are:
Mitigirovannaya measles occurs in children who have received in the incubation period, immune globulin or blood products.The first symptoms appear after 14-21 days after contact with measles patients.
mitigirovannoy Clinical manifestations of measles and rubella in many ways similar: both diseases occur easily, accompanied by a low grade temperature of the body, the slim, simultaneously manifesting a rash.However, measles, unlike rubella can be spot-Belsky Filatova-Koplik (optional feature for this form of measles) and light pigmentation, and no increase in the occipital and zadnesheynyh lymph nodes.
main value in the diagnosis of these two diseases has a history of epidemic: an indication of contact with measles patients and administering blood products or immune globulin.
In scarlet fever, as well as with rubella rash appears simultaneously on 1 2 th day of illness, has melkopyatnisty (Punctate) character.
Differences scarlet fever from measles is to have angina (often with overlays), intoxication, characteristic changes in the language ( "raspberry" tongue), favorite rash localization (mostly on the sides of the trunk, in the natural folds of the missing in the nasolabial triangle), appears later krupnoplastinchatogo peeling.Scarlet fever, unlike rubella increased submandibular instead occipital lymph nodes.When no scarlet fever cough, runny nose.
When pseudotuberculosis, as well as with rubella rash can wear patchy.However, unlike rubella characteristic for pseudotuberculosis prolonged intoxication and fever, enlarged liver and spleen, presence of diarrhea (optional feature), a favorite localization rash (in the hands, feet, head).If not found pseudotuberculosis isolated increase in neck lymph nodes.Often pseudotuberculosis marked arthralgia, myalgia, abdominal pain.
pseudotuberculosis final diagnosis is made by laboratory tests: complete blood count (leukocytosis, neutrophilia, shift leukocyte left, increased erythrocyte sedimentation rate), serological tests (increase in titer revealing specific antibodies).
Enterovirus rash and rubella have many common manifestations: a one-time occurrence and the complete disappearance of the spotted rash, mild fever, intoxication and catarrhal syndrome.
However, enterovirus rash unlike rubella is often accompanied by multiple organ lesions (-brain syndrome, myocarditis, splenomegaly, myalgia, diarrhea, etc.), For her uncharacteristically isolated increase in neck lymph nodes.
chickenpox and rubella should be differentiated only if there is a prodromal rash spotty nature of varicella.Prodromal rash varicella occurs among full health or subfebrile background, it is not accompanied by catarrh of the upper respiratory tract.The typical rash with blisters appear within a few hours (or at the end of the first day).From this point on the assumption of rubella can be removed.
acquired forms of cytomegalovirus infection is characterized by the presence of rubella systemic lymphadenopathy, hepato- and splenomegaly, prolonged fever.If CMV infection rash can be polymorphic (along with spotty papular elements are present, urticaria, haemorrhagic), it appears on the 3-5th day of illness.In addition, when CMV infection can be sialadenitis.
acquired acute toxoplasmosis rubella differs from the more severe, the presence of fever, hepato- and splenomegaly, lack of catarrh of the upper respiratory tract, the timing of appearance of rash (4 7th day).
Trichinosis rubella differs from more severe, the presence of intense muscle pain, puffiness and swelling of the face, marked eosinophilia, lack of increase in neck lymph nodes, catarrh of the upper respiratory tract.
Trichinosis is diagnosed on the basis of epidemiological data - eating for 1-6 weeks before the first signs of raw or insufficiently cooked pork disease bushmeat.
Leptospirosis is characterized by the presence of rubella expressed intoxication and fever, muscle pain, rash onset dates (3- 6 th day), frequent polymorphism rash (together with spotty can be papular, urticaria and hemorrhagic elements), the presence of hepato-and splenomegaly, frequent renal disease, there may be jaundice, lack of an isolated increase in neck lymph nodes.The final diagnosis of leptospirosis is made by laboratory findings: blood anaize - leukocytosis, neutrophilia;urinalysis - proteinuria, cylindruria, red blood cell;Detection of specific antibodies.
In infectious mononucleosis, unlike rubella, has angina (often with overlays), systemic lymphadenopathy, hepato- and splenomegaly, an eruption may be polymorphic (along with spotty papular elements are present, urticaria, haemorrhagic), tend to merge.For infectious mononucleosis is characterized by prolonged fever and moderate intoxication.The rash in this disease most often appears on the 3-5th day.For infectious mononucleosis characterized hematological syndrome: absolute lymphocytosis, monocytosis, the presence of atypical mononuclear cells.