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Rubella

Rubella — the acute infectious disease which is characterized dot or a menocelis, a hyperplasia of occipital and cervical lymph nodes, moderate general intoxication, hematologic reaction.

Etiology. The activator — RNA-viruliferous, sensitive to action of chemical agents and temperatures.

Epidemiology. A source — the sick person. The infection mechanism — airborne. Not only children, but also adults are ill. Flashes often occur among adults, especially in organized collectives. Also transplacental way of a transmission of infection takes place.

Patognez. The activator gets aerogenno into a mucous membrane of upper respiratory tracts, then into blood, causing development of a virusemia. It possesses tropism to embryonal fabric, causing in the first 3 months of pregnancy persistent infection of an embryo, disturbance of its pre-natal development (embryopathy). During the post-natal period shows tropism to lymphatic fabric with characteristic defeat of lymph nodes. The postponed disease leaves durable immunity.

Clinic. The pre-natal rubella leads to emergence of an embryopathy (malformations of a brain, an organ of sight and hearing, heart, skeleton). The nanocephalia, Gregg's syndrome (a cataract, deafness, heart diseases), etc. are possible. Infection of a fruit during later periods of pregnancy causes forming of a fetopathy: hemolitic anemia, Werlhof's disease, hepatitis, damages of bones, lungs.

Incubation interval at post-natal infection — 15 — 21 put the Disease begins gradually with a prodromal stage lasting from several hours till 1 — 2 days. Its manifestations: feeling of the general weakness, indisposition, moderate headache, weak catarral phenomena. A typical symptom of a rubella — swelling of zadnesheyny, occipital and other lymph nodes which increase to the sizes of a large pea, a plotnovata are painful to the touch. Sometimes the prodromal stage remains unnoticed. In these cases the disease begins with rash. Rash at a rubella happens korepodobny (makulo-papular) and scarlatiniform (punctulate). It appears on a face, a neck and in several hours extends on all body. Rash is most plentiful on extensor surfaces of extremities, on a back and buttocks, its emergence can be followed by an itch. At part of patients the enantema in a pharynx is noted. Body temperature is moderately increased or remains normal. General state, as a rule, not heavy. At part of patients the disease proceeds without clinical symptoms or subclinically (ephemeral rash, a short-term hyperplasia of lymph nodes). At adults the disease can heavier proceed, body temperature sometimes reaches 39 °C, at part of patients the severe headache, muscle pain is noted. Rash at a rubella keeps 2 — 3 days, later disappears without pigmentation and a peeling.

In blood in an incubation interval the small neutrophylic leukocytosis, in a rash stage — a leukopenia, a lymphocytosis and a significant amount of plasmocytes is found.

Except an embryopathy and a fetopathy, spontaneous abortions and still births which can be considered as complication of a rubella at pregnant women other complications are exclusively rare. Among them the heaviest is krasnushny encephalitis and encephalomyelitis.

Differential diagnosis. Most often the rubella should be differentiated with measles. The rubella differs in less expressed catarral phenomena in upper respiratory tracts, lack of spots of Velsky — Filatova — Koplika and staging of rash, increase in occipital, zadnesheyny and other lymph nodes, smaller brightness of the rash having weak tendency to merge and not leaving pigmentation and a peeling.

Scarlet fever unlike a rubella is characterized by quinsy, "the flaring pharynx", existence of a pale nasolabial triangle, "crimson" language, a macrolaminar peeling of skin, a leukocytosis and an eosinophilia.

Tonsillitis, fever, hepatolienal syndrome at a universal lymphadenopathy are inherent to an infectious mononucleosis and listeriosis, a leukocytosis with the increased maintenance of mononuklear.

Makulezny rash at a toksiko-allergic dermatosis arises in connection with reception of medicines, use of biological products (serum, gamma-globulin, a vaccine, etc.), contact with other allergenic substances (chemical, food, etc.), is characterized by displays of an allergy (a skin itch, hypostases, damage of joints, a blood eosinophilia, etc.).

Tick-borne rickettsioses are followed by plentiful makulopapulezny rash, however differ from a rubella in feverish reaction, existence of primary affect in the form of a dark infiltrirovanny stain on site of a sting of a tick, an originality of the epidemiological anamnesis (natural focal infections). Specific serological methods have essential diagnostic value.

 
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