Rubella - Causes, Symptoms and Treatment .MF .
Rubella (Rubeola) - a viral disease affecting only human, manifested melkopyatnistoy rash, slight inflammation of the upper respiratory tract and slight intoxication syndrome.
the first time in the literature mention of rubella is set back in the XVI century.In 1829 Wagner found the differences of the disease of measles and scarlet fever, and in 1881.- Rubella is highlighted as a separate disease.In 1938 - Japanese researchers have shown the nature of the infection by the virus infection volunteer.In 1941 - German scientist Gretta theorized about the teratogenicity of measles virus to the fetus during infection of the mother during pregnancy, which means it can cause congenital urodstvaa.In 1973 our domestic scientists proved this theory and obtained attenuation strains (ie devoid of virulence - not dangerous), with the subsequent creation of a vaccine.
Rubella virus belongs to the family of Togaviridae, toga (cloak) a double membrane cover its RNA molecule.On the surface of this membr
As has been said, is unstable in the environment the virus, and at room temperature can be maintained for several hours.Fast his death occurs when a change in pH (acid-alkaline) in an alkaline or acidic side.Just rubella virus is not resistant to temperature changes (when 56⁰S die), drying, UVI effect, disinfectants, ether and formalin.
risk of disease is great for those who had never been sick and was not vaccinated, this category of people fall children 2-9 years.For outbreaks characterized by seasonality - the winter-spring.Outbreaks occur every 10 years.After suffering a disease generated proof lifelong immunity, but according to some sources, it is still possible re-infection.
Causes of rubella infection:
virus source - the sick person with ostroprotekayuschih infection or subclinical form of the disease when the symptoms are not visible.Also, the source may be children with congenital rubella (mother with a history of pregnancy at the time) - they can be a source of infection for up to 3 years of his life (reported cases of viral shedding up to 18 years).Ill is dangerous for 5-7 days before the rash appears and for 7 days after her disappearance.
Ways of infection - airborne (during sneezing, coughing, crying, talking, sharp exhalation), transplacental (infection of pregnant women, with subsequent infection of the fetus).
favorable conditions for infection is the population density, ie organized groups, it follows from this conclusion that the patient isolation.
Symptoms of rubella
The incubation period (the time from the introduction of the pathogen and its vital functions in the body until the first symptoms) - 13-23 days, but these days people can be a source, because abjection occurs 5 days before the rash appearsand this period may not be preceded by anything, even may be absent catarrhal symptoms, and appear almost simultaneously with the rash.So that contamination may be of a "healthy" person at first sight.
During this period, the penetration of and attachment of the virus in the mucous of the upper respiratory tract, as its penetration into glublezhaschie tissue (due to neuraminidase) and spread through the lymphatic system - approaching prodormalny period or once a period of eruptions.
Prodrome - it may not be, and if there is, it can last from a few hours to 2 days.While the catarrhal phenomena are expressed to a lesser extent - malaise, temperature rises do37,5-38⁰S.There has been an increase in the lymph nodes in a day or two before the rash, in this state, the disease is about 1-3 weeks (the lymph nodes - the only thing that can give prodrome) mainly increased zadnesheynye and occipital lymph nodes, they are soft consistency, nespayanny with the surrounding tissuesand painless.
period rash - 3-4 days.Before skin rash often appears enanthema - pink spots on the soft palate, which may merge and move to the bow and the hard palate.After a rash on the mucous membrane occurs melkopyatnistaya rash all over the body, but mostly on the face, buttocks and extensor surfaces.The nature of the rash - melkopyatnistaya, relatively abundant, rarely fused and rapidly loses brightness of color.The appearance of the rash is due to spread of the virus by blood, simultaneous action of hemagglutinin (it causes adhesion of red blood cells) and dermatotropizma (selective loss of dermis layer of the skin) - as a result, the red blood cells stuck together as if zastreyut in the dermal layer.
rash of rubella
Light catarrhal symptoms, which may or may not be accompanying the temperature rise to 38⁰S.Adults may experience arthralgia (joint pain), accompanied by hyperemia (redness and swelling), but after recovery, these symptoms disappear.
period rekonvolistsentsy - recovery.During this period, all manifestations have subsided.But the patient can still infect others (uninfected / unvaccinated) for 7 days from the last eruption.
Congenital rubella is characterized by a triad of Gregg:
- cataracts (clouding of the lens) single or double-sided, often accompanied by microphthalmia.
- Heart defects (patent ductus arteriosus, pulmonary stenosis, valvular lesion or any cardiac septum);
- Deafness.In addition to these three characteristics, there may be other malformations: hydrocephalus, cleft soft and hard palate, neurological disorders (SSPE).Psolednee translated Teenage sclerosing panencephalitis - at the time of birth may not be determined, but this pathology in a few years will have an effect.This is due to the possibility of the virus long-term (years) remain in the body, despite the presence of high titers of specific antibodies.It is manifested in the first years of life and is characterized by intellectual disability progression and movement disorders.
cataract in congenital rubella
The above example shows the minimal changes, because otherwise the pregnancy may end in miscarriage or stillbirth spontaneous.Manifestation of teratogenicity extent will depend on the timing of pregnancy and most dangerous are 1-3 trimesters - the period of organogenesis, and therefore will defeat the system (ie, the central nervous system, gastrointestinal tract, etc.).In these cases, the chances of a live birth is minimal.
Teratogenicity (ability to cause congenital malformation or miscarriage) rubella virus is due to its tropism (directed action) to the embryonic tissues and unobstructed penetration through the placental barrier, and the development of congenital anomalies is due to inhibition of embryo cell division at the time of the formation of organs and systems.
1. Diagnosis Diagnosis is based on the nature of the rash, the timing of its occurrence, simultaneity and localization of lesions, epidemic situation.But do not rely on their own experience, because there are many other similar diseases with similar symptoms as measles, scarlet fever, pseudotuberculosis, enterovirus rash, chicken pox, meningococcal rash (but only in the early stages).The latter option is unforgivable to miss, if the parents or themselves ill adults decide to take on this responsibility, because mortality in this disease is 30%.
2. Virological method - is aimed at the detection of the virus itself, the method is effective only in certain periods: a study of blood and feces advisable during the stay of the virus in the blood of 7-14 days of infection (ie, before the rash!);nasopharyngeal secretions appropriate to take if there is an eruption.
3. Serological Methods - detects the presence of virus neutralizing antibodies by IHA and pH, as well as determine klassospetsificheskie antibody IgG, M and A - by ELISA.These methods are used in 1-2 days after the rash appears and for 20 hours and remain high for life virus-neutralizing and hemagglutination inhibiting antibodies.
- IHA (indirect hemagglutination reaction) and pH (neutralization reaction) - placed with paired sera in an interval of 10 days (ie 2 times the blood is taken and watch what changes have occurred), while there is an increase in antibody titer 4 times.
- RAC (complement fixation test) - is carried out for the detection of complement-fixing antibodies (they only have 3 years from the date of transfer of the disease) - their presence says about the recently adjourned illness or recovery period.
- ELISA (enzyme-linked immunosorbent assay) - defines klasospetsificheskie antibodies - immunoglobulins IgG, M and A. If the detected classes M and A - is talking about the initial stage of the infection process, the G - an acute period or period of convalescence (recovery) based on their avidity(antigen antibody bond strength - the stronger the bond, the infection was long ago).This method is used to determine the intensity of immunity when deciding whether vaccination and revaccination of adults.The same method is used for the diagnosis of congenital rubella - the absence of IgG excludes rubella.
Treatment Specific treatment is not developed, so use:
- bed rest for 3-7 days;
- nutrition, taking into account age features;
- Causal therapy with viratsidov (Arbidol, izoprinozin), immunomodulators (interferon viferon) and adjuvants (tsikloferon, anaferon).
- detoxification therapy - excessive drinking;
- symptomatic therapy (expectorants - a certain group is used in certain cough nature, ie can not be used simultaneously expectorants and antitussives), mucolytics, antipyretic, analgesic);
Complications of rubella
Arthritis, encephalitis, meningoencephalitis, otitis, pneumonia, exacerbation of chronic infections.
General measures in the outbreak of rubella infection are ineffective because of inapparent forms and virus isolation, long before the first symptoms.Nevertheless, it is isolating diseased 5-7 days after the onset of the rash and in contact with it - for 21 days.
When contacting the pregnant woman with a sick, its sensitivity is determined by serological methods and look for the presence of IgG - if they are, then the woman is considered to be immune - if not, the sample is repeated at 5 weeks and, if positive IgG offering abortion, but ifthe second time do not show anything - sample performed a third time in a month - interpretation of the exact same as in the second sample.
specific prophylaxis - is vaccination with live vaccine "Rudivaks" or a live combined vaccine against rubella / measles / mumps - «MMR-II».The first time is grafted at 12-15 months and 6 years revaktsinaruyut.Unvaccinated girls to be vaccinated should be done in 14 years.Contraindications: immunodeficiency, hypersensitivity to aminoglycosides and egg white (using MMR-II), acute illness or exacerbation of chronic;as vaccination is not administered for 3 months before pregnancy.In all other cases, vaccinate as possible after stabilization.
PS: account rubella epidvspyshki fatal, are now double-check - whether the strain that was used, or it is necessary to sound the alarm.Therefore, beware!
therapists Shabanova I.E