Rubella

Background

• Also known as "German measles"
• Incubation 2-3wk
• Nearly eradicated in the United States with the use of the MMR (measles, mumps, rubella) vaccination

Clinical Features

Rubella

• Incubation period 12-25d, peak at 16 to 18 days
• Prodrome 1-5d
  • Fever, malaise, headache, sore throat
• Rash
  • May be short-lived or protracted (2-3d)
  • Pink macules/papules on face, spreads to neck, trunk, arms
    • Coalesces on face as it reaches the lower extremities
  • Lesions remain discrete (in contrast to measles) and pink in contrast to raised deeply erythematous macular papules seen in rubeola
• Forschheimer spots: petechiae on hard/soft palate
• Lymphadenopathy
  • Suboccipital and posterior auricular nodes
• Arthralgias, arthritis

• Rare complications
  • Thrombocytopenia, thrombocytopenic purpura
  • Encephalitis

• Risk of severe congenital illness if fetus exposed to virus, especially in 1st trimester

Differential Diagnosis

Pediatric Rash

• Atopic dermatitis
• Bed bugs
• Contact dermatitis
• Drug rash
• Erythema infectiosum (Fifth disease)
• Hand-foot-and-mouth disease
• Henoch-schonlein purpura (HSP)
• Herpangina
• Herpes simplex virus (HSV)
• Infectious mononucleosis
• Meningitis
• Measles
• Molluscum contagiosum
• Roseola infantum
• Rubella (German measles)
• Scabies
• Scarlet fever
• Smallpox
• Varicella (Chickenpox)

Evaluation

• Clinical history and lack of immunization usually sufficient for diagnosis
• CDC also recommends sending throat/nasal swabs for PCR

Management

• Supportive care
• Isolation for 7 days after onset of rash
• Contact health department

See Also

• Pediatric Rashes