Congenital rubella - symptoms and signs, treatment, prevention
Symptoms and signs, treatment, prevention of congenital rubella.
Congenital rubella is a viral infection, the infection of which occurred from the mother during pregnancy. Manifestations include multiple congenital malformations that can lead to the death of a child. The diagnosis is made on the basis of serological and virological studies. There is no specific treatment. Prevention is carried out by routine vaccination.
Congenital rubella usually develops during the initial infection of the mother. Despite the widespread use of vaccination, 10–20% of people after puberty have an insufficient amount of antibodies.
Primary virus replication is believed to occur in the upper respiratory tract, followed by viremia and dissemination of the virus, including in the placenta.The fetus is at maximum risk of developing malformations during infection during the first 16 weeks of gestation, especially the first 8-10 weeks. It is believed that the virus in the early stages of gestation leads to the occurrence of chronic intrauterine infection. The effect of the virus includes damage to the endothelium of the blood vessels, a direct cytolytic effect on the cells and interruption of cell mitosis.
Symptoms and signs of congenital rubella
Rubella in a pregnant woman may not manifest clinically or be characterized by symptoms of lesions of the upper respiratory tract, fever, lymphadenopathy and maculopapular rash. After these manifestations, symptoms may arise from the joints.
In the fetus, the mother’s disease may not cause any effects, lead to multiple malformations or fetal death. The most common malformations include intrauterine growth retardation, meningoencephalitis, cataracts, retinopathy, deafness, heart defects, hepatosplenomegaly, and bone lesions with rarefaction of the bone tissue. Also found are thrombocytopenic purpura, foci of erythropoetin in the skin, which look like bluish-red skin lesions, adenopathy and interstitial pneumonia.Frequent examinations are necessary to detect subsequent hearing impairment, mental retardation, behavioral abnormalities, endocrinopathies, or rarely progressive encephalitis.
In pregnant women, the titer of antibodies against rubella is routinely determined in early pregnancy. This study is repeated in seronegative women who develop symptoms or signs of rubella; The diagnosis is made during seroconversion or a titer increase of 4 or more times in the study in the acute period and the recovery period. The virus can be isolated from nasopharyngeal swabs.
In children suspected of having congenital rubella, serological and virological research should be performed. Persistence of rubella-type IgG antibodies in a child of 6-12 months suggests congenital infection. An increase in IgM rubella antibodies also indicates rubella. A sample of biological fluids can be used to isolate a virus; the laboratory should be warned that rubella virus is suspected. In some centers, the diagnosis can be made prenatally by isolating the virus from the amniotic fluid,determination of IgM rubella antibodies from fetal blood; or reverse transcriptase PCR with fetal blood or chorionic biopsy preparations.
Other methods include complete blood count with leukocyte count, spinal fluid analysis and X-ray examination of the bones to identify characteristic areas of rarefaction and compaction of bone tissue. It is also useful to conduct a thorough ophthalmological and cardiological examination.
Treatment of congenital rubella
Specific treatment is not developed for the treatment of the mother, or for congenital rubella. If contact or rubella occurs in early pregnancy, women should be informed of the potential risk to the fetus. Some experts recommend that gamma globulin be administered during infection in early pregnancy, but this does not guarantee the prevention of the disease in the fetus, and its routine use is not recommended by the American Pediatric Association.
Prevention of congenital rubella
Rubella disease can easily be prevented by vaccination. In the US, children are vaccinated against rubella, along with measles and epidemicparotitis at the age of 12-15 months of life, and again when enrolling in elementary school or high school. Women after puberty in the absence of information about the presence of immunity against rubella should be vaccinated. . After vaccination, women should be recommended to protect themselves for 28 days. Efforts should be made to screen and vaccinate high-risk groups, such as hospital and children's institutions, recruits and students.
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