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FINDINGS: The infection is asymptomatic in 25-50% of cases. Children usually present with the rash, while adults usually have 1-5 days of mild prodromal symptoms (low-grade fever; cervical adenopathy; rhinitis, pharyngitis, conjunctivitis, cough, headache, arthralgias, and malaise) preceding the rash. The rash typically begins on the head and spreads to the extremities. When present, the rash usually lasts 1-5 days. Rare complications include arthritis, thrombocytopenia, myocarditis, and encephalitis. [CCDM, p. 464-8; ID, p. 1187] Adenopathy in postnatal rubella may last for several weeks and commonly affects the posterior cervical, posterior auricular, and suboccipital nodes. The maculopapular rash is not confluent. Fever, if present, usually resolves by the second day of the rash. Other occasional findings are runny nose, conjunctivitis, and splenomegaly. [PPID, p. 1922-3] Rubella virus can cause conjunctivitis and uveitis. [Guerrant, p. 1556, 1577] PREVENTION: Hospitalized or institutionalized patients should be isolated with care taken not to expose pregnant, non-immune employees. Patients should be excused from school or work for 7 days after onset of the rash. 90% of babies are affected with congenital rubella syndrome (deaf, blind, mentally retarded, etc.) when the mothers are infected in the first trimester of pregnancy. [CCDM, p. 464-8] "A history of previous rubella infection is unreliable and should not be considered indicative of immunity to rubella. Although birth before 1957 is generally considered acceptable evidence of rubella immunity, a dose of MMR has been recommended for those health care personnel that do not have laboratory evidence of immunity." [Guidelines for Infection Control in Health Care Personnel. CDC. 1998] |
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