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April 28, 2012
The rubella is a viral infectious disease which is shown in the form of the rash which is very quickly extending on integuments. Lymph nodes of the patient at the same time increase, small increase of body temperature is observed. Most often this disease affects children from one to seven years. Babies to six-months age get sick with a rubella seldom or never in view of existence at them of immunity which is transferred to the baby from mother. After the child had a rubella, immunity forms lifelong. For the first time differences of a rubella from other diseases were described in 1829.
Causative agent of a rubella
The causative agent of this disease is the RNA-genomic Rubivirus Togaviridae virus. A source and the reservoir of a virus is people who it is sick with a rubella in clinically expressed form, or transfers its erased form. Approximately in seven days prior to emergence in the patient with a rubella of the person of rash he begins to allocate a virus. This process continues also on an extent from five to seven days after rash was shown.
The virus is transmitted in the airborne way. Infection, as a rule, occurs at long and rather close communication with the sick person. Infection with a transplacental way is also possible that most often occurs in the three first month of pregnancy.
Infection with a virus occurs through mucous upper respiratory tracts, also it can get through skin. After that the virus gets to lymph nodes where gradually there is its accumulation. Already in an incubation interval the virus extends on all body.
The rubella belongs to infections which, perhaps, will be liquidated in the next years. Before there was a possibility of vaccination, and to children began to do rubella inoculations, the disease met very often. Today raising of an incidence which happens periodically are characteristic of a rubella. So, each three-five years are fixed moderate jumps of an illness, and here more intensive raising of an incidence takes place approximately once in ten-twelve years. Besides, a peculiar age shift of incidence is very often fixed recently: the rubella develops at people of advanced age – school students, and also the women staying in the genital period. The number of the patients with a rubella of people considerably increases during the spring and summer period.
Features of a rubella
The rubella at children is rather slight illness. But at the same time the rubella at adults proceeds much more difficult. So, if at the adult the rubella develops, symptoms of a disease are shown by fever which proceeds the long period, a joint syndrome. Perhaps also development of organ pathology.
Serious problem is also inborn rubella. If there is an infection with a rubella of the pregnant woman, emergence of very heavy complications is possible, and as a result the child is born with serious defects. If the woman caught an infection in the first trimester of pregnancy, then inborn defects at a fruit develop approximately in 90% of cases. During the different periods of pregnancy the virus unequally influences the developing fruit. Such influence most seriously affects those bodies which actively develop in the infection period.
The Krasnushny infection can provoke abortion, a still birth, and also death of the newborn in the neonatal period. A syndrome of an inborn rubella at the child it is shown by inborn uglinesses.
The rubella at children and adults has an incubation interval, identical on duration: it lasts from ten to twenty five days. Further the catarral period at a rubella at children is generally not expressed. At the similar course of a rubella symptoms of a disease are shown already with the advent of a dieback. At the same time the rubella at adults in this period proceeds much more difficult. At the person body temperature can increase, in especially serious cases it rises to critically high figures. The patient complains of the expressed indisposition, mialgiya, headaches, a small appetite. As the catarral phenomena there is small cold, dryish cough, feeling of irritation in a throat. The person also notes emergence of a photophobia and dacryagogue. During survey the doctor often finds redness of a mucous membrane of a pharynx, and also conjunctivitis in the patient. At a rubella at adults and children the hyperadenosis and their morbidity is noted. The last especially touches occipital and zadnesheyny lymph nodes. The lymphadenopathy at a rubella can proceed about three weeks, and the catarral period lasts no more than one-three days. After that the dieback period begins. On supervision of doctors, this symptom of a rubella which is considered the main syndrome of a disease is shown at most of patients at once, in the first day of an illness. At children of rash appear much more more often than at adults. Rash at a rubella consists of the pinkish or reddish small spots of a round or oval form having smooth edges. Spots appear on not changed integument, over a skin surface they do not tower. But if rash at adults very often merges, then at a rubella at children of similar merge is practically not observed. In certain cases before emergence of spots at a rubella symptoms of a disease are shown by a severe itch of skin. As a rule, the first spots arise on a neck and a face of the patient, and also behind ears and on head skin under hair. After that for days rash develops already on other sites of skin, and, in this case no pattern of its distribution is noted.
Typical picture of rash at a rubella – its arrangement on buttocks, a back, and also on extensor surfaces of legs and hands. There is no dieback on palms and the patient's soles. Sometimes in parallel with a dieback on mucous membranes of an oral cavity there is an enantema which is shown by small single spots. At a rubella at adults rash happens more plentiful and proceeds much longer, than at children. The part of patients has a merge of rash, at some people rash does not arise in general. At such features of course of a rubella sometimes to establish the diagnosis rather difficult.
During presence of a dieback the patient can have an insignificant increase of body temperature, or it remains normal. Accurately lymph nodes which during this period are increased and painful are defined. Besides, at a rubella symptoms of a disease are sometimes shown by painful feelings in muscles and joints. The dispeptic phenomena at which there is an increase in a spleen and liver are in certain cases possible. At the women having a rubella polyarthritis symptoms can be shown. As a rule, the period of a dieback proceeds no more than four days. Fading of rash can be rather fast, and, it disappears, without leaving marks.
Thus, the rubella at adults proceeds similar to a rubella at children. However at adult patients symptoms of an illness are expressed more brightly, and the course of an illness much heavier.
Diagnosis of a rubella
At statement of the diagnosis it is important to pay attention to differential diagnosis, first of all. The rubella needs to be distinguished from scarlet fever, measles, ekzanty, having allergic genesis, and also from enteroviral infections. For this purpose specialists pay attention to existence of the symptoms of a rubella described above, perform careful inspection and poll of the patient. Diagnosis can sometimes be at a loss in view of absence of rash or its draining.
It is very important that each pregnant woman who had contact with patients with a rubella passed full medical examination.
In the course of inspection of the patient the laboratory blood analysis for the purpose of definition of corresponding changes (a leukopenia, a lymphocytosis, increase of SOE) is surely conducted.
Also at suspicion on a rubella serological diagnosis is carried out. But in this case only retrospective confirmation of the diagnosis is possible.
Complications of a rubella
At a rubella manifestation of complications is observed rather seldom. However as complication of a disease otitis, pneumonia, arthritis, quinsy sometimes develop, in more exceptional cases there can be a Werlhof's disease. As a rule, complications of an illness are shown owing to accession of consecutive bacterial infections. Very seldom at adult patients encephalitis, an encephalomeningitis and encephalomyelitis can develop. Any of these diseases proceeds very hard.
At a rubella at the pregnant woman the disease does not constitute danger to it. However the rubella is extremely negatively displayed on a fruit, causing malformations and a number of diseases which develop vnutriutrobno.
Treatment of a rubella
If at the patient the uncomplicated form of an illness takes place, then to it appoint mainly symptomatic treatment which is possible in conditions out of a hospital. As a rule, at a rubella patients do not need active therapeutic actions. Generally treatment of a rubella provides observance of a bed rest, implementation of all rules of hygiene, reception of vitamin complexes. If there are complications of a rubella, the patient needs hospitalization. In this case treatment by analgetics, sulfanamide means is possible. Sometimes also antibiotics are appointed.
At detection of a rubella at the pregnant woman at whom duration of gestation makes less than 28 weeks the illness is considered the indication to abortion. On Bol late durations of gestation immunoglobulin intramusculary is entered, and all measures directed to protection of a fruit are taken.
Prevention of a rubella
As measures of specific prevention of a rubella vaccination is applied by live vaccines which except the causative agent of a rubella include also viruses of measles and parotitis. Rubella inoculation can be also carried out using a monovalent vaccine. Vaccination is carried out at a certain age: rubella inoculations are received without fail by children during from 15 to 18 months, and also girls of 12-14-year age. By use of broad vaccinal prevention it was succeeded to lower considerably an incidence of a rubella in a number of the countries of the world.
According to the long-term practices concerning a question of vaccination, the most effective scheme of vaccination use of double immunization of children (the first time rubella inoculation is made to the child of 12-16 months, the second time – in six years) is considered Later the revaccination of girls at teenage age and women in their genital period is carried out.
As preventive measures in the centers of disease outbreaks some rules are applied. So, it is important to isolate the patient with a rubella till fifth day from that moment when it had a rash. In child care facilities at isolated cases of a rubella quarantine is not declared. Means of the emergency prevention of dl of children and pregnant women which had contact with patients with a rubella is protivokrasnushny immunoglobulin.
Women who stay in the first trimester of pregnancy should be isolated surely from the sick person for the ten-day period from the beginning of his disease. If the illness nevertheless arose at the woman in the first three months of pregnancy, it is recommended to be interrupted. Children who were born with an inborn form of this infection are put on dispensary accounting.
Section: Infectious diseases