Rubella

RUBELLA (rubeola), an acute contagious infectious disease, characterized by the appearance on the skin of pale pink fine-spotted rash similar to measles (measles rubella) or similar in nature of the rash and clinical picture to scarlet fever (scarlet fever rubella). In measles rubella, catarrhal phenomena of the mucous membranes of the respiratory tract are noted, but differing from measles exclusively in mild course usually without subsequent complications. At present, rubella is considered a completely independent disease. A child infected from a patient with rubella contracts this disease regardless of whether he has previously had measles or not. Similarly, a person who has had rubella contracts measles when there is a possibility of contact with a measles patient. The disease leaves immunity to it for life. The causative agent of rubella is still unknown. Infection occurs from the patient by direct contact, transmission of the disease through a third person is unknown, nor is the infection transmitted through objects. The disease occurs more often in the form of sporadic cases. Outbreaks of this disease are noted in schools, children's homes and other institutions for children, when infection enters there. In summer, rubella is rare. The accumulation of children in winter in closed, poorly ventilated rooms contributes to the spread of the disease. In closed institutions, the spread of rubella is observed for a short time. The duration of epidemics is usually from 2 to 3 months. Susceptibility to the disease is most pronounced in the age group from two to ten years. Infants rarely get sick. Diseases of rubella are also possible in adults. In terms of transmission of infection, the period of rash is most dangerous, but as the rash fades, the danger of infection to others completely disappears. The incubation period ranges from 9 to 22 days. During this period, no painful symptoms are noted, but blood examination reveals an increase in the number of leukocytes. The prodromal period is either absent or may be noted for several hours before the appearance of the rash in the form of general malaise, slight elevation of temperature, mild runny nose and conjunctivitis. Often these symptoms coincide with the appearance of the rash and characterize the very beginning of the disease. The disease in most cases is detected from the moment of rash on the skin. The rubella rash resembles measles, which is why this disease received the name measles rubella (rubeola morbillosa). The rash begins on the head, on the face and very quickly - within a few hours and rarely a day or more - spreads throughout the body; the rash is most noticeable on the back of the limbs, on the back and less noticeable on the chest and abdomen. On the hairy part of the head, the rash is also noticeable. The speed of spread of the rash and its nature make it possible to distinguish it from measles. The rash appears as pale pink, slightly raised spots, the size of a pinhead to a pea, and these efflorescences do not show central papules and do not merge with each other anywhere. The rash can be very abundant, but always remains pale. Sometimes the appearance of the rash is accompanied by itching. As quickly as the rash appears in rubella, it just as quickly fades, and after it there is no peeling; pigmentation is sometimes observed, but it is less pronounced than in measles. When examining the oral cavity, the tongue is not coated, on the mucous membranes of the cheeks on the day of rash, and sometimes a day before this, in some cases, the appearance of small reddish dotted efflorescences can be noticed, but Filatov-Koplik spots never occur. The phenomena from the mucous membranes are limited to mild conjunctivitis, runny nose and cough; but in many cases these symptoms are absent. There may be no increase in temperature, but where it is present, the temperature does not exceed 39° and lasts from one to two to three days. The highest fever coincides with the complete appearance of the rash. During the disease and often before the appearance of the rash, swelling of the cervical, posterior auricular and occipital glands can be detected - sometimes the glands also swell in other areas. The swollen glands are slightly painful on palpation. This symptom is one of the most characteristic of rubella. No changes are noted from the internal organs. Blood examination during the period of rash reveals leukopenia, a fall in the neutrophil curve and the appearance of Plasmazellen. When examining the autonomic nervous system in the initial periods of rubella, symptoms are obtained indicating an increase in vagotonus - enhancement of the Lshner phenomenon (see), positive reactions to pilocarpine (Bubnova).- The course of rubella is usually mild, without complications. All phenomena last from 2 to 4 days, then the rash fades, the temperature drops, and only for some time the swelling of the glands remains. Usually there are no complications. As an exception, however, some authors point to the possibility of nasal bleeding, pneumonia, nephritis, inflammation of the joints.- For the prevention of rubella diseases, isolation for at least two weeks is required. After the disease has passed, disinfection of the room is not required. Separation of children who have not had the disease - up to 3 weeks. Rubella is a safe disease and does not require treatment. In diagnostic terms, difficulties may only be encountered at the beginning of an epidemic, when rubella is most easily mistaken for measles, but the exceptional mildness of the course, the absence of typical prodromal phenomena of measles, the pale pink color of the rash, almost febrile course with abundant non-merging rash make it possible to establish the correct diagnosis. When diagnosing rubella (measles), it is necessary to keep in mind the so-called scarlet fever rubella. Scarlet fever rubella. Filatov, or the fourth disease of Dukes (Dukes) - an acute, contagious infectious disease, very similar in its manifestations to mild scarlet fever, but differing from the latter by the exceptional mildness of the course. This disease was first described by Filatov in 1885 and 15 years later by Dukes in England. At present, scarlet fever rubella - by some authors is recognized as independent, while others consider it a variety of measles rubella. Its causative agent is unknown, just as the routes of spread are unknown. After having scarlet fever rubella, a stable immunity remains.- The incubation period lasts from 15 to 20 days; no precursors are observed. The symptoms of scarlet fever rubella are identical to the symptoms of the mildest scarlet fever. The disease begins with a slight increase in temperature (not higher than 38-38.5°) and the appearance of a small scarlet fever-like pale pink rash, occupying mainly the trunk and lateral parts of the face and sparing the lips, nose and chin. In the pharynx there is insignificant redness, the tongue is clean, there is no sequential strawberry tongue, there is no swelling of the glands and catarrhal phenomena. In many cases - neither fever nor rash occurs, and the rash lasts only a few hours. The duration of the disease is two to three days. Peeling usually does not occur, but its possibility is admissible (Filatov, Dukes). No complications are observed with this disease. The blood picture in scarlet fever rubella is little studied. The absence of swelling of the posterior cervical and occipital glands, characteristic of measles rubella, makes differential diagnosis possible. The exact diagnosis of scarlet fever rubella has great importance in terms of scarlet fever prevention, since an erroneous diagnosis in the case of recognizing this disease as mild scarlet fever and placing the patient in a scarlet fever ward threatens him with the possibility of contracting severe scarlet fever. In view of the above, the utmost caution is required when assessing the symptoms of the disease and possibly strict isolation for up to 3 weeks, when the absence of peeling gives the right to greater confidence in the diagnosis of the disease. It is hardly possible to confuse rubella with the so-called infectious erythema (fifth disease), which also appears without any precursors after an incubation period of 7 to 14 days and is expressed in the appearance on the face and limbs of a polymorphous spotty-papular rash, in appearance resembling polymorphic erythema or rash in serum sickness. The appearance of a rash on the cheeks in the form of separate spots creates the impression that the cheeks are as if burning, the lips, chin and cartilaginous parts of the nose remain free from the rash, which gives the facial rash the outlines of a butterfly. Simultaneously or somewhat later, the rash appears on the extensor surfaces of the limbs. The spots gradually increase and merge, forming irregularly shaped fields with intervals of normal skin. Particularly characteristic is the reverse development of the rash, proceeding from the center. Gradually the spots turn from red to purple, blue and yellow-brown, while their periphery still retains a bright red color. The duration of the disease is 8-10 days, in mild cases the rash disappears in 3-4 days. The general condition with this disease is good, the temperature is either normal or rises moderately and for a short time. From the blood, at the beginning of the disease there is a normal number of leukocytes, then it is replaced by a slight leukocytosis. In small children under 3 years of age, the rash with this disease often has a measles or rubella-like character, but the absence of Filatov-Koplik prodromal spots and catarrhs of the respiratory tract exclude the possibility of measles, and from rubella, besides localization, larger size and brightness of the rash, this disease is distinguished by the absence of swelling of the occipital glands.

K. s v i n e y-see Swine erysipelas.