rubella ophthalmic manifestations , class for ophthalmic assistant nystagmus strabismus cataract SN hearing loss mental retardation

1. RUBELLALatin meaning-little red
DR. ANITA KUMARI
ANTERIOR SEGMENT FELLOW
SCEH, LAHAN

2. INTRODUCTION
• Also known as German measles/3 days fever
• Occurs worldwide
• Caused by Rubella virus
• Rubella virus – SS-RNA virus
- diameter 50-70nm
- enveloped , spherical
• 1st isolated in 1962 by Parkman n Weller
• AN Attenuated vaccine developed in 1967
• Congenital rubella syndrome described by Gregg
in 1941

4. PATHOGENESIS
• Respiratory transmission of virus
• Spread from person to person via droplets shed
from respiratory secretions of infected person
• Replicates in nasopharynx n regional lymph
node
• Viremia 5-7 days after exposure with spread
throughout body
• Transplacental infection of fetus during viremia

5. CLINICAL FEATURES
• General symptoms- appears after 14-21 days
after infection
• Rash (maculopapular)–face – trunk- limbs n
fades & disappears after 3-5 days
• Stuffy & running nose
• Headache, Mild fever, aching joints
• Red inflammed eye
• Lymphadenopathy occurs before rash

7. Congenital rubella syndrome-
- Rubella virus passes through placenta & move
through the fetal circulation
- Infection may affect all organs & more severe
in early gestation
- It may lead to fetal death, spontaneous
abortion n preterm delivery

8. • Deafness(sensorineural) –most common
• Ocular- congenital cataract, corneal clouding
glaucoma, microphthalmia, salt pepper
retinopathy, strabismus
• Cardiac defects- patent ductus arteriosus,
ventricular septal defect, pulmonic stenosis
• Neurologic abnormalities- microcephaly,
mental retardation
• Others- bone lesions, splenomegaly, hepatitis
• Greater risk of developing diabetes mellitus

10. Salt pepper retinopathy

11. MANAGEMENT
• Investigation
- Diagnosis by typical rash & lymph node
enlargement clinically
- Presence of IgM antibodies indicates recent
rubella infection
- Isolation of rubella virus from clinical
specimen(nasopharynx, urine, blood,CSF)
- Viral culture
- Polymerase chain reaction(PCR)

12. Treatment
• Mild self limiting illness
• No specific or antiviral t/t needed
• Increased fluid intake n rest
• Good ventilation

13. PREVENTION
• Rubella vaccine is given to children at 15
months of age as a part of MMR n again
between 3-6 yrs of age
• Vaccine is live attenuated n confers lifelong
immunity
• Vaccine contains human albumin, neomycin,
sorbitol n gelatin

14. Contraindications of vaccine
- h/o anaphylactic reaction to neomycin
- h/o severe allergic reaction to any component of
the vaccine
- immunosuppression
- Woman known to be pregnant or attempting to
become pregnant.
- Pregnancy should be avoided for 4 weeks after
rubella or MMR vaccine

15. COMPLICATION
• Arthralgia or arthritis upto 70% (adult, rare in
children)
• Encephalitis
• Thrombocytopenic purpura
• Orchitis ,neuritis, progressive panencephalitis
• Ocular-conjunctivitis>epithelial
keratitis>retinitis

16. Thank you