Rubella, Togavirus
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Rubella (German measles) is a disease caused by the rubella virus. Rubella is usually a mild illness. Most people who have had rubella or the vaccine are protected against the virus for the rest of their life. Because of routine vaccination against rubella since 1970 , rubella is now rarely reported.
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Rubella, Togavirus
- 2. What is Rubella Rubella (German measles) is a disease caused by the rubella virus. Rubella is usually a mild illness. Most people who have had rubella or the vaccine are protected against the virus for the rest of their life. Because of routine vaccination against rubella since 1970 , rubella is now rarely reported.
- 3. History - Rubella Infection in early pregnancy leads to fetal death or abnormalities. The Teratogenic property of the infection was documented by an Australian ophthalmologist Norman Gregg in 1941.
- 4. Rubella ( German Measles ) Rubella is also called as 3 day Measles or German Measles. Family – Togaviridae Genus - Rubivirus In general belong to Togavirus group
- 5. Rubella Virus Rubella virus are ss – RNA virus Diameter 50 – 70 nm Spherical Virus carry hemagglutinin Virus multiply in the cytoplasm of infected cell. Virus can be recovered from nasopharynx, throat, CSF, urine.
- 6. Rashes First indicator of the disease. Minute pinkish, macular rash. First appear in face and spread rapidly to the extremities and trunk. Disappear altogether by 3rd day. 25% of rubella cases are with out rash (subclinical) Other Enterovirus infections can produce similar manifestations.
- 7. Main Clinical Events The clinical events occuring in the neonatal age is more important and divided into two major groups 1 Post Natal Rubella 2 Congenital Rubella
- 8. Source of infection There is no carrier state: the reservoir exists entirely in active human cases. The disease has an incubation period of 2 to 3 weeks. Acquired, (i.e. not congenital), rubella is transmitted via airborne droplet emission from the upper respiratory tract of active cases. The virus may also be present in the urine, faeces and on the skin.
- 9. Systemic events of Rubella Infection
- 10. Clinical findings Malaise Low grade fever Morbilliform rash Rash starts on Face Extremities Rarely lasts more than 5 days No features of the rash give clues to definitive diagnosis of Rubella.
- 11. Other manifestations and complications May produce transient Arthritis, in women in particular. Serious complications are Thrombocytopenia Purpura Encephalitis
- 12. Immunity - Rubella Antibodies appear in serum as rash fades and antibody titers raise Rapid raise in 1 – 3 weeks Rash in association with detection of IgM indicates recent infection. IgG antibodies persist for life. 2nd attack is very rare.
- 13. Immunity - Protects One attack of Rubella infection, protects for life Immune mothers transfer antibodies to off springs who are in turn are protected for 4 – 6 months.
- 14. Post natal Rubella Occurs in Neonates and Childhood Adult infection occurs through mucosa of the upper respiratory tract spread to cervical lymphnodes Viremia devlops after 7 – 9 day Lasts for 13 – 15 days Leads to development of antibodies The appearance of antibodies coincides the appearance of suggestive immulogic basis for the rash In 20 – 50 % cases of primary infections are subclinical
- 15. Diagnosis of Rubella in Adults Clinical Diagnosis is unreliable Many viral infections mimic Rubella Specific diagnosis of infection with 1 Isolation of virus 2 Evidence of seroconversion
- 16. Isolation and Identification of virus Nasopharyngeal or throat swabs taken 6 days prior or after appearance of rash is a good source of Rubella virus Using cell cultured in shell vial antigens can be detected by Immunofluorescence method.
- 17. Serology In Rubella Hemagglutination inhibition test for Rubella is of Diagnostic significance ELISA tests are greater importance A raise in Antibody titers must be demonostrated between two serum samples taken at least 10 days apart. Or Detection of Rubella specific IgM must be detected in a single specimen.
- 18. Epidemiology Rubella is world wide in distribution Occurs round the year, Epidemics occur every 20 – 25 years Infection is transmitted by respiratory route The use of Rubella vaccine has now eliminated both epidemic and endemic Rubella.
- 19. Treatment and Prevention Rubella is a mild self limited illness. No specific treatment or Antiviral treatment is indicated. However Laboratory proved and clinically missed Rubella in the Ist 3-4 months of pregnancy is associated with fetal infections.
- 20. Congenital Rubella Syndrome(CRS) Maternal viremia with Rubella infection during pregnancy may result in infection of placenta and fetus (vertical transmission). The growth rate of fetal cells are reduced. Results in fewer number of cells after the birth. Lead to deranged and hypo plastic organ development. Results in structural damage and abnormalities
- 21. Rubella infection – At various trimesters Ist trimester infections lead to abnormalities in 85 % of cases. and greater damage to organs 2nd trimester infections lead to defects in 16 % > 20 weeks of pregnancy fetal defects are uncommon However Rubella infection can also lead to fetal deaths, and spontaneous abortion. The intrauterine infections lead to viral excretion in various secretion in newborn upto 12-18 months.
- 22. Classical Triad of Rubella Classical Triad Cataract Cardiac abnormalities Deafness Other manifestations Growth retardation Rash Hepatosplenomegaly Jaundice Meningoencephalitis CNS defects lead to moderate to profound mental retardation. Congenital Rubella syndrome(CRS)
- 23. Other Neurological manifestions Problems in balance Motor skills in preschool children altered. A rare complication of encephalitis can occur in second decade with Congenital rubella syndrome may progress to death.
- 24. Diagnosis of Congenital Rubella Syndrome Demonstration of Rubella antibodies of IgM in a new born is diagnostic value. As IgM group do not cross the placenta and they are produce in the infected fetus,
- 25. Treatment, Prevention, Control No specific treatment is available CRS can be prevented by effective immunization of the young children and teenage girls, remain the best option to prevent Congenital Rubella Syndrome. The component of Rubella in MMR vaccine protects the vaccinated. Dose 0.5ml subcutaneous.
- 26. Thank you
Editor's Notes
- Viraemia, Enlargement of post auricular and posterior cervical lymph nodes in early 7days before the onset of rashes.
- The term morbilliform refers to a rash that looks like measles. The rash consists of macular lesions that are red and usually 2–10 mm in diameter but may be confluent in places
- thrombopenia refer to a disorder in which there is a relative decrease of thrombocytes, Purpura are red or purple discolorations on the skin Encephalitis is an acute inflammation of the brain.
- Immunofluorescence is a technique used for light microscopy with a fluorescence microscope and is used primarily on microbiological samples. This technique uses the specificity of antibodies to their antigen to target fluorescent dyes to specific biomolecule targets within a cell, and therefore allows visualisation of the distribution of the target molecule through the sample. Immunofluorescence is a widely used example of immunostaining and is a specific example of immunohistochemistry that makes use of fluorophores to visualise the location of the antibodies