Rubella: Overview

("3-day measles)

Contagious viral infection

may cause adenopathy, rash, and sometimes
constitutional symptoms, which are usually mild and
brief
Infection during early pregnancy can cause
spontaneous abortion, stillbirth, or congenital defects
Diagnosis is usually clinical
Cases are reported to public health authorities
Treatment is usually unnecessary (Supportive)
Vaccination is effective for prevention

Rubella: Signs/Symptoms
PRODROMAL SYMPTOMS
Unusual in young children but are
common in adolescents and adults.
The following signs and symptoms
usually appear 1-5 days before the onset
of rash:
Eye pain on lateral and upward eye movement
Conjunctivitis, Sore throat, Headache, General
body aches, Chills, Anorexia, Nausea
LOW-GRADE FEVER- usually not higher than
38.5C (101.5F)
LYMPH NODES - Tender lymphadenopathy
(particularly posterior auricular and suboccipital
lymph nodes)
MOUTH - Forchheimer sign (an enanthem
observed in 20% of patients with rubella during
the prodromal period; can be present in some
patients during the initial phase of the
exanthem; consists of pinpoint or larger

Rash
The synonym "3-day measles" derives
from the typical course of rubella
exanthem
starts initially on the face and neck
spreads centrifugally to the trunk and
extremities within 24 hours.
begins to fade on the face on the second day
disappears throughout the body by the end of
the third day

The exanthem of rubella consists of a

discrete rose-pink maculopapular rash
ranging from 1-4 mm
Rash in adults may be quite pruritic

Rubella: Differential Dx
Differential diagnosis includes measles, scarlet fever, secondary syphilis, drug
rashes, erythema infectiosum, and infectious mononucleosis as well as echovirus
and coxsackievirus infections. Infections with enteroviruses and parvovirus B19
may be clinically indistinguishable.
Some of these conditions can be distinguished from rubella as follows:
Measles: Rubella is differentiated from measles by the milder, more evanescent rash, milder
and briefer constitutional symptoms, and absence of Koplik spots, photophobia, and cough.
Scarlet fever: Within a day of onset, scarlet fever usually causes more severe constitutional
symptoms and pharyngitis than does rubella.
Secondary syphilis: In secondary syphilis, adenopathy is not tender, and the rash is usually
prominent on the palms and soles. Also, laboratory diagnosis of syphilis is usually readily
available.
Infectious mononucleosis: Infectious mononucleosis can be differentiated by its more
severe pharyngitis, more prolonged malaise, and atypical lymphocytosis and with EpsteinBarr virus antibody testing

Rubella: Key Points

Rubella causes a scarlatiniform rash and often low-grade fever,
malaise, conjunctivitis, and lymphadenopathy (characteristically
involving the suboccipital, postauricular, and posterior cervical nodes)
Most cases are mild and complications are few except for rare cases of
encephalitis and the risk during early pregnancy that infection can
cause spontaneous abortion, stillbirth, or congenital defects
Laboratory diagnosis is strongly encouraged for all suspected cases
for public health purposes; serologic or PCR testing can be done
Screen women of childbearing age for rubella antibodies and
immunize those susceptible, providing conception is prevented for
28 days afterwards
Vaccination is contraindicated during pregnancy