Rubella in children
The content of the article:
- Causes and risk factors
- Forms of the disease
- Rubella symptoms in children
- Diagnostics
- Rubella treatment in children
- Possible complications and consequences
- Forecast
- Prevention
Rubella in children is a viral disease that is one of the most common childhood infections in the world.
According to medical statistics, more than 100,000 cases of congenital rubella in children are diagnosed in developing countries every year. The incidence is manifested mainly by individual outbreaks in organized groups (preschool and educational institutions, sanatoriums, hospitals). Rubella epidemic outbreaks in children are recorded with an interval of 10–20 years. In temperate latitudes, the incidence of rubella has seasonal fluctuations, with the peak incidence occurring in the spring and summer.
Most often, the disease is diagnosed in children aged 1-7 years. Up to 6 months, babies are usually protected by antibodies obtained from the mother, for this reason rubella is extremely rare in this age group. Both male and female children are equally susceptible to the disease.
With intrauterine infection, the rubella virus can cause damage to the endothelium of the vessels of the brain, the pia mater, ischemic changes in neurons in the fetus, which subsequently manifests itself as congenital malformations, impaired vision and hearing.
Causes and risk factors
Rubella in children is a contagious disease that produces persistent immunity. The causative agent is an RNA-containing Rubella virus belonging to the genus Rubivirus, the Togaviridae family, has no antigenic variants and is characterized by moderate hemagglutinating activity. It multiplies in cell cultures, is quickly inactivated under the influence of high (more than 55 ˚C) or low (-10 ˚C and below) temperatures, under the influence of ultraviolet radiation, as well as with conventional disinfectants, at room temperature it can remain viable for several hours.
The source of infection is a sick person and virus carriers. Infection of others is possible both during the incubation period and at the height of clinical manifestations (2-3 weeks after the appearance of skin rashes).
The transmission of the rubella virus is carried out mainly by airborne droplets, it is also possible to get infected by contact and everyday life (through hands and contaminated household items). When rubella is infected in pregnant women, transplacental transmission of infection to the fetus can occur. Children infected at the prenatal stage of development are a potentially stable reservoir for the spread of infection and shed the virus for as early as 19 months after birth with saliva, nasopharyngeal discharge, urine, and less often with feces.
The rubella virus is introduced into the human body through the mucous membrane of the upper respiratory tract, where it enters with the inhaled air. Also, the virus is able to enter the body through damaged skin. The infection spreads hematogenously (primary viremia), enters the regional lymph nodes, replicates in the system of mononuclear phagocytes, which is accompanied by the development of secondary viremia on the 7-9th day from the moment of infection. In this case, there is a wide dissemination of the virus in the tissues of the body, including the placenta. In this phase, the virus can be isolated from tissues and organs, biological body fluids (urine, cerebrospinal fluid, synovial fluid, breast milk, saliva). Viremia peaks before the onset of cutaneous manifestations and decreases soon thereafter.
Forms of the disease
Rubella in children is congenital and acquired, complicated and uncomplicated.
Acquired rubella in children can be typical, atypical, and subclinical (inapparent).
Depending on the characteristics of the clinical picture, congenital rubella proceeds:
- with damage to the nervous system;
- with congenital heart defects;
- with eye damage;
- with hearing impairment;
- mixed forms;
- residual (residual) phenomena.
Rubella symptoms in children
Acquired rubella in children in most cases has a mild to moderate course. The incubation period is 14-21 days after contact with the virus carrier.
The first signs of rubella in a child are usually skin rashes (exanthema) and an increase in regional lymph nodes, mainly posterior cervical, up to 1-2 cm in diameter. The pathognomonic sign of rubella is bilateral enlargement of the occipital lymph nodes.
In adolescent children, the onset of a rash is usually preceded by general weakness and fatigue, a moderate increase in body temperature, headaches, conjunctivitis without purulent discharge. Lacrimation, photophobia, hyperemia of the throat and posterior pharyngeal wall, runny nose, dry cough, decreased appetite (may be accompanied by nausea), muscle pain may also occur. Some patients have a petechial rash on the soft palate (Forchheimer's symptom).
The rashes appear as pink-red spots from 1 to 5 mm in diameter. In adolescents, the rash is more abundant than in young children, accompanied by itching, sometimes the elements of the rash merge with each other.
The rash first appears on the face and neck, during the day it spreads to the trunk and limbs, it is absent on the palms and soles. In some patients, rashes occur simultaneously on the face, trunk, and extremities. Already on the second day, the rash begins to subside and completely disappears on the third or fourth day. It may persist longer in adolescents.
Source: beremennost-po-nedeliam.com
Some children (more often adolescent girls) have arthralgia and arthritis of the interphalangeal and carpal-phalangeal joints, less often the elbow and knee joints are involved in the pathological process. Joint changes most often occur at the end of the exanthemic period and disappear over several weeks (less often - several months).
Sometimes there is an atypical course of rubella in children, in which there are no skin manifestations. In this case, subfebrile body temperature and occipital lymphadenopathy are signs of the disease.
Approximately 50% of children with a congenital form of the disease who become infected in the first two months of the prenatal period develop congenital malformations.
Children with congenital rubella tend to have unilateral or bilateral sensorineural hearing loss. In about 40% of patients, it is the only sign of the disease. Eye pathologies (infantile glaucoma, cataract, retinopathy pigmentosa) are diagnosed in 43% of children with congenital rubella, while in 80% the lesion is bilateral. In addition, congenital rubella can have the following manifestations:
- intrauterine growth retardation;
- prematurity;
- disorders of the central nervous system;
- behavior disorders;
- hypotension;
- hepatosplenomegaly;
- hepatitis;
- endocrine disorders (diabetes mellitus; thyroid pathology);
- anemia;
- thrombocytopenic purpura;
- osteoporosis;
- skin manifestations (spots resembling blueberries, which are areas of dermatoglyphic abnormalities).
Diagnostics
The diagnosis is established on the basis of the available typical clinical manifestations, data obtained during the collection of complaints and anamnesis, as well as laboratory diagnostics.
A general blood test is prescribed, according to the results of which a decrease in the number of leukocytes, relative lymphocytosis, the appearance of plasma cells (10-30%), the number of monocytes increases, and the erythrocyte sedimentation rate increases.
If necessary, an enzyme immunoassay, a complement fixation reaction, a hemagglutination inhibition reaction and radioimmunoassay are performed.
In the case of a high risk of complications, they resort to instrumental examination: X-ray diagnostics of the lungs, electroencephalography, echoencephalography, rheoencephalography. You may need to consult an otorhinolaryngologist, ophthalmologist.
Differential diagnosis is carried out with measles, enterovirus exanthema, drug rash.
To detect infection and determine the likelihood of fetal damage to pregnant women who have been in contact with patients with rubella, they resort to the RBTL method (lymphocyte blast transformation reaction). The study is recommended to be carried out no later than the 12th day after contact with the patient. Confirmation of infection of a pregnant woman before the 14-16th week is an indication for termination of pregnancy.
Rubella treatment in children
Rubella treatment in children is symptomatic, carried out at home. Shown bed rest. Hospitalization in a hospital is carried out with a severe course of the disease and the development of complications. Rubella patients should be isolated for a week after the onset of the rash.
If the skin manifestations of rubella in children are accompanied by itching, antihistamines are prescribed. With an increase in body temperature - antipyretic. If necessary, use antitussive drugs, vasoconstrictor nasal drops. In the presence of joint disorders, non-steroidal anti-inflammatory drugs are indicated in a short course. The main treatment can be supplemented by herbal medicine (tea made from black currant berries, lingonberries, rose hips, nettle leaves).
In congenital rubella with signs of an active infectious process, preparations of recombinant interferon are indicated. If meningoencephalitis is detected in a patient with this form of the disease, corticosteroids are used. If possible, correction of congenital malformations is carried out.
In the presence of neurological disorders, anticonvulsants and dehydration therapy are prescribed.
Rubella patients are shown a balanced soft diet. It is recommended to include dishes from fruits and vegetables in the diet, and exclude foods that cause the mucous membranes of the gastrointestinal tract, as well as having a high degree of allergenicity (chocolate, bright red fruits and vegetables, etc.).
Possible complications and consequences
The complicated course of rubella in children is usually caused by the addition of a secondary infection, bacterial or viral.
Among the complications that occur against the background of rubella in children, joint damage is most common (manifested by hyperemia of the skin, pain and swelling in the joint area). Thrombocytopenic purpura, myocarditis, encephalitis, meningitis, meningoencephalitis, subacute progressive panencephalitis, optic neuritis, bone marrow aplasia, acute polyradiculoneuritis are less common. The defeat of the central nervous system in rubella in children does not lead to demyelination. Against the background of encephalitis, myelitic disorders with trophic or pelvic disorders can be observed.
Rubella in newborns can be complicated by giant cell hepatitis, hemolytic anemia, an increase in the fontanelle, damage to the tubular bones, interstitial pneumonia. The congenital form of the disease is characterized by non-closure of the ductus arteriosus (with or without pulmonary artery stenosis), damage to the aortic valve, stenosis of the aorta, defects of the interventricular and interatrial septa, transposition of great vessels, deafness of varying severity, microcephaly, hydrocephalus, vestibular disorders.
Forecast
With the acquired form of rubella, the prognosis is favorable. It worsens with the development of complications from the central nervous system.
With a congenital form of the disease, the prognosis depends on the duration of pregnancy, at which the fetus was infected, and the existing disorders. Uncomplicated forms of the disease have a favorable prognosis for life, in some cases, such patients have developmental delays and neurological disorders. With a complicated course of congenital rubella, the prognosis is usually poor.
Prevention
The specific prophylaxis of rubella consists in vaccination; to inoculate children against rubella, a live rubella vaccine is used (usually the MMR vaccine is used - measles, rubella, mumps).
Source: medigo.com
Contact with rubella patients should be avoided, especially those who are pregnant or women planning to become pregnant. There are no special quarantine measures for rubella patients and contact persons. In rooms where rubella patients are located, it is necessary to carry out regular wet cleaning and disinfection, to ensure sufficient ventilation. In the case of a high risk of developing the disease, the use of immunoglobulins is recommended during the first week after contact with a patient with rubella.
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Anna Aksenova Medical journalist About the author
Education: 2004-2007 "First Kiev Medical College" specialty "Laboratory Diagnostics".
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
