LABORATORY OF DERMATOVENEROLOGY

MEDICAL FACULTY OF PATTIMURA UNIVERSITY

RUBELLA

Natalia Luturmas
SUPERVISOR :
dr. Hanny Tanasal, Sp.KK
 INTRODUCTION
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 German measles, 3-day measles.

 Epidemic disease; worldwide distribution.
 Short prodrome; rash of 2- to 3-day
duration.
 Enlargement of cervical, suboccipital, and
 postauricular glands.
 High risk of fetal malformations with
 congenital infection (microcephaly,
 congenital heart disease, and deafness),
 particularly in the first trimester.

10/09/2018
 EPIDEMIOLOGY

In the United States, in 1964-1965 rubella was an endemic

disease, more than 20,000 babies were born with
disabilities, 10,000 cases of miscarriage and stillbirths at
birth.

WHO, ± 236,000 cases of congenital rubella occur every year in

developing countries and increase 10 times in the event of an
epidemic. The risk of rubella transmission from mother to fetus is if
a pregnant woman is infected when her pregnancy is <12 weeks,
the risk of fetus is 80-90%.

Indonesian : From 2010 to 2015, it was estimated

that there were 23,164 cases of measles and 30,463
cases of rubella.
 Togaviridae
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The virus is thermolable, quickly becomes inactive at 37 ° C

and at a temperature of -20 ° C and is relatively stable for
ETIOLOGY months at a temperature of -60◦C

 5 of 9 classes of
arthropods cause Transmission of this virus occurs mainly through direct contact or
local and systemic droplets with nasopharyngeal secretions from the patient. Viruses
reactions are usually isolated in tissue culture.
associated with
their bites :

Rubella virus is only present in humans

 Pathogenesis
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oral droplet, In the nasopharynx,

the virus remains until The highest
from the 6 days after the onset
nasopharynx or of eruption there are infectivity occurs
respiratory also in the lymph at the end of
nodes, urine, the incubation
route cerebrospinal fluid,
breast milk, synovial period
Ab and pulmonary fluid.
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History
The prodrome is characterized by low-grade fever,
myalgias, headache, conjunctivitis, rhinitis, cough, sore
throat, and lymphadenopathy

(2)

Symptoms that may last up to 4 days and often resolve

with appearance of rash

(3)

Up to 50% of children with primary rubella infection

may have a subclinical infection
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 The existence of Koplik’s Spots in the mouth

are typical symptoms of rubella. When
prodromal symptoms disappear and the
rash begins to appear, some patients will
appear enanthem which consists of small
red macules in the soft palate and uvula
(Forschheimer Spot). This condition is not
diagnostic for rubella.
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in pregnant women:
 a. Adenopathy (typical) especially the

back ear, occipital and back neck

lymph nodes.
 b. Headache

 c. Sore throat

 d. Rash,
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 Serology:
 - IgM: Detected in 1-5 days after the
rash appears and stays up to 1-4
weeks. Titer drops, not detected after
6-12 weeks.
 - IgG: Can be detected in 1-3 days
after symptoms appear, last a lifetime
 Manifestations of Fetus and Neonate
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 a. Transients:
 1. Intrauterine growth retardation (IUGR)
 2. Thrombocytopenia purpura (25%)
 3. Hemolytic anemia
 4. Hepatosplenomegaly
 5. Ikterik
 6. Radiolucent bone disease (20%)
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Developmental (abnormalities develop since the child

becomes an adult) :
 1. Sensorineural deafness (80%)

 2. Mental retardation (55%)

 3. Insulin-dependent diabetes (20%)

 4. Interstitial pneumonia
 Diagnosis
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 The definitive diagnosis is made by serology, which is

an increase in antibody titers 4 times in HAIR
(Haemaglutination Inhibition Test) or the discovery of
IgM antibodies specific to rubella. Antibody titers begin
to increase 24-48 hours after the eruption arises and
reach a peak on days 6-12. In addition to primary
infection, rubella-specific IgM antibodies can also be
found in reinfection. In pregnancy, 1-2 weeks after the
onset of the rash can be examined for IgM-
immunoassay serology (with a sample from the throat or
urine) 2 times with a 1-2 week interval. If you get an
increase in titers 4 times, consider pregnancy
termination
Treatment
 No specific therapy
 Symptom-based treatment
 Immunoglobulin does not prevent rubella virus
infection only in pregnant woman who has been
exposed to rubella will not consider termination of
pregnancy under any circumstances( IM
administration of 20 mL of immunoglobulin within
72 h of rubella exposure)
Prevention
 Rubella vaccine contains live attenuated rubella virus grown in human
diploid cells (RA 27/3). combined with measles and rubella (MR) or
measles, mumps, and rubella (MMR) formulations, tetravalent measles,
mumps, rubella, and varicella (MMRV) vaccine.
 One dose induces seroconversion in 95% of persons >1 year of age.
rubella vaccination in the United States is a first dose of MMR vaccine at
12–15 months of age and a second dose at 4–6 years.
 Indication: children >1 year of age, adolescents and adults without
documented evidence of immunity, individuals in congregate settings (e.g.,
college students, military personnel, child care and health care workers),
and susceptible women before and after pregnancy.
 women known to be pregnant should not receive an RCV. In addition,
pregnancy should be avoided for 28 days after receipt of an RCV. In
follow-up studies of 680 unknowingly pregnant women who received
rubella vaccine, no infant was born with CRS. Receipt of an RCV during
pregnancy is not ordinarily a reason to consider termination of the
pregnancy.
 Prognosis
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 The child's prognosis for rubella is good; while

congenital rubella prognosis varies according to the
severity of the infection. Only about 30% of infants
with encephalitis appear to be free from
neuromotor deficits, including autistic syndrome.
 THANK YOU

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