GERMAN MEASLES

(RUBELLA/THREE-DAY MEASLES)
DEFINITION

- An acute contagious disease characterized

by mild constitutional symptoms, and a
rose-colored macular eruption which
sometimes resemble measles and at other
times, scarlet fever. It causes, mild feverish
illness associated with rashes and aches in
joints and has a teratogenic effect on the
fetus.
 Can affect anyone of any age and is
generally mild disease, rare in infants or
those over the age of 40.
ETIOLOGY

 RubellaVirus (Family – Togaviridae; Genus –

Rubivirus

 Pseudoparamyxovirus (an RNA virus)

INCUBATION PERIOD

 From exposure to the appearance of the

rash, the incubation period is usually 14 -21
days
SOURCE OF INFECTION

 Secretions
of nose, throat of infected
persons harbouring the organism
MODE OF TRANSMISSION
 Direct contact with nasopharyngeal
secretions
 Air droplets
 Transplacental transmission in congenital
rubella
 Infants with congenital rubella shed large
quantities of the virus through their
pharyngeal secretions and urine, which
serve as sources of infection to other
contacts.
PATHOGENESIS
Maternal
viremia
Placental
infection
Fetal
viremia
Disseminated
infection
involving
many fetal
organs
COURSE OF THE DISEASE

1. CLASSIC CONGENITAL RUBELLA SYNDROME

 Intrauterine growth retardation; infant has
low birth weight
 Thrombocytopenic pupura known as
“blueberry muffin” skin
 Lethargy and hypothermia
COURSE OF THE DISEASE

INTRAUTERINE INFECTION
• May result in spontaneous abortion
• Birth of a live child who may have one or
multiple birth anomalies such as:
• - cleft palate, hare lip, talipes, and eruption
of teeth
• - cardiac defects (patent ductus arteriosus,
atrial septal defect)
COURSE OF THE DISEASE

-eye defects (glaucoma, retinopathy,

micropthalmia, unequal-sized eyeballs)
-ear defects (deafness usually bilateral,
abnormally-shaped ears)
- neurologic (microcephaly, mental
retardation, psychomotor retardation,
behavioural disturbances, vasomotor
instability)
COURSE OF THE DISEASE
PERIOD OF INVASION

12-24 hrs before the rash appears there may

be:
 slight malaise
 Fever below 101°F (38.3°C)
 Mild catarrhal symptoms
COURSE OF THE DISEASE

 Sore throat
 Swelling
and tenderness of the
suboccipital, postauricular, and postcervical
glands
COURSE OF THE DISEASE
PERIOD OF ERUPTION
 Rash appears first on the face and spreads
rapidly over the body
 Fine pink macules which gradually blend on
the second day and become a diffuse
erythema resembling scarlet fever
 eruption fades within 48-72 hours

PERIOD OF CONVALESCENCE
 Convalescence is rapid
CLINICAL MANIFESTATIONS
 1. PRODROMAL PERIOD
• low-grade fever
• Headache
• Malaise
• Mild coryza
• Conjuctivitis
• Post-auricular, sub-occipital and posterior
cervical lymphadenopathy w/c occurs on
the 3rd to the 5th days after onset
CLINICAL MANIFESTATIONS
 2. ERUPTIVE PERIOD

• a pinkish rash on the soft palate (

FORCHHEIMER’S SPOT), an exanthematous
rash that appears first on the face,
spreading th neck, arms, trunk and legs
• Eruption appears after the onset of
adenopathy
• Children usually present less or no
constitutional symptoms
CLINICAL MANIFESTATION

• Rash may last for 1-5 days and leaves no

pigmentation nor desquamation
• Testicular pain in young adults
• Transient polyarthralgia and polyarthritis
may occur in adults and occasionally in
children
FORCHHEIMER’S SPOTS
DIFFERENTIAL DIAGNOSIS

 Neutralizing antibody test

- Blood specimen is obtained
 Hemagglutination Inhibition Antibody Test
(HI)
 Rubella must be distinguished from:
• Measles
• Infectious mononucleosis
COMPLICATIONS

 Encephalitis
 Neuritis
 Arthritis
 Arthralgia
 Increases the incidence of abortion and
stillbirths
PERIOD OF COMMUNICABILITY

1 week before and 4 days after the onset of

the rash, but is at its worst when the rash
is at its peak
 Highly
communicable infants with
congenital rubella may shed virus for
months after birth
TREATMENT/ PREVENTIONS
 Treatment is essentially symptomatic

PREVENTIONS:
 Administration of live attenuated vaccine
(MMR)
 Pregnant woman should avoid exposure to
patients infected with the rubella virus

TREATMENT/PREVENTION

 Administration
of immune serum globulin
one week after exposure to rubella
 Preventspread of infection by minimizing
contact with visitors
NURSING MANAGEMENT
 The patient should be isolated.
 The patient should be advised to rest in bed
until fever subsides.
 The patient’s room must be darkened to avoid
photophobia.
 The patient must take a mild liquid but
nourishing diet.
 The patient eye’s should be irrigated with
warm normal saline to relieve irritation.

NURSING MANAGEMENT

 The ears must be taken care of. Do not

apply heat or cold compress unless
ordered.
 Good ventilation is necessary.
 The spread of infection and complications
must be prevented.
 Encourage fluid intake.
COMMON NURSING DIAGNOSIS

 Impaired social interaction

 Knowledge deficit
 Impaired physical mobility
 Impaired skin integrity
 Pain
 High risk for infection