Congenital rubella – the viral disease which is transferred from the infected mother to the child in the pre-natal period. Infection of the woman occurs during pregnancy or to it. The disease is shown by multiple internal defects and defects of development of a fruit, mainly damage of organs of vision and hearing, and also cardiovascular and nervous system. It is in most cases shown from the first days of life, but also later detection of symptoms is possible. It is diagnosed from the moment of the birth by special laboratory tests and clinically (on the above-stated symptomatology). Specific treatment is absent, interferon and symptomatic therapy is applied.
Congenital rubella – a contagious disease. It means that the child to whom the pediatrician made such diagnosis can transmit a virus to people around. The disease received the name in 1740 on one of common symptoms – trombotsitopenichesky purple. F. Hoffman was the first doctor who described a disease. However there passed more than two hundred years before the congenital rubella began to cause serious fears as in the second half of the XX century the causative agent of an infection was revealed. Together with it communication between a disease of the woman was found during pregnancy and pathologies of the newborn.
From other features it should be noted high spread of an infection in the countries with a temperate climate and seasonality. The peak of incidence is the share of spring and fall. Large epidemics happen time in 6-9 years, and among not imparted population the frequency of incidence is higher. For this reason pediatrics – the first and most important clinical discipline in questions of prevention of a congenital rubella. In the first years of life children receive a vaccine against a rubella, as allows to avoid infection at adult age, in particular, during pregnancy at women.
The statistics shows that the congenital rubella makes up to 10% among all congenital pathologies. At infection of the woman and a fruit in the first weeks of pregnancy spontaneous abortion happens in 40% of cases. In 75% of cases multiple defeats of bodies (two and more defects) are noted. The latest statistical data demonstrate that incidence steadily increases.
Reasons of a congenital rubella
The rubella virus allocated with the American scientists in 1961 is the only reason of an infection. It is a RNA virus, treats family of togavirus. Infection occurs in the pre-natal period when the activator from the infected mother passes through placenta vessels, getting to fruit blood. The risk of infection depends on when future mother got sick. If the woman has an infection in the first trimester of pregnancy, then in 60-90% of cases the congenital rubella will be diagnosed for the child. In the second trimester the risk decreases to 10-20% of cases. By the end of pregnancy the risk of infection of a fruit increases because of weakening of a placentary barrier again. The women who are not vaccinated earlier are subject to bigger danger.
Passing through placenta vessels, the causative agent of a congenital rubella gets to fruit blood where has teratogenny effect. It influences directly the genetic device of a cage (chromosome), slowing down growth and development of bodies what multiple malformations are connected with. In passing the virus destroys small vessels of a placenta that leads to deterioration in a placentary blood-groove. Lack of due food and a chronic hypoxia of a fruit also promote delay of development of the child. In a crystalline lens of an eye and a snail of an inner ear the virus has direct tsitodekstruktivny effect, that is destroys cages. Than earlier there was infection, especially symptoms of a congenital rubella as on the first weeks of pregnancy there is laying of the main systems will be serious: at first organs of vision, then – organs of hearing, cardiovascular and nervous system etc.
Symptoms of a congenital rubella
In 1942 N. Gregg allocated three main symptoms of a congenital rubella: damage of organs of vision (most often congenital cataract), deafness and heart diseases. The symptomatology is usually observed right after the child's birth, less often the congenital rubella proves in several years. It is about lag in intellectual development. Expressiveness of clinical manifestations depends on the pregnancy term on which there was infection. Therefore in practice the classical triad of symptoms of N. Gregg not always takes place and if they also are presented in total, then violations can be not so rough.
Defeat of the valve of an aorta, aorta stenosis, defects of a mezhpredserdny and interventricular partition often occurs among congenital heart diseases. It causes serious insufficiency of blood circulation because of what all internals are underdeveloped in a varying degree. Defeat of nervous system can be shown by a mikrotsefaliya, hydrocephaly, cases of an encephalomeningitis, paralyzes and spasms, consciousness violations meet. The cataract, glaucoma, a mikrooftalmiya are most probable when infection occurs on the first weeks of pregnancy. Also often skeleton malformations, such as osteoporosis, a dysplasia of coxofemoral joints, a sindaktiliya come to light. Less often malformations of urinogenital and digestive systems meet.
Treats the main symptoms of a congenital rubella also trombotsitopenichesky purple which reason – vascular disorders and changes in blood of the sick child. Visually purple looks as bright red rash on all body of the kid. As a rule, rash passes without treatment through few weeks after the birth. A nonspecific symptom is the long jaundice of the newborn connected with insufficient development of internals and inability to utilize excess bilirubin in blood as it occurs normal. Externally the newborn usually looks slightly slowed down. First of all it is caused by defeat of the visual and hearing aid, but also neurologic violations play a role here.
The disease outcome directly depends on its weight. In hard cases life expectancy of sick children makes several years. Lead to death, as a rule, heart diseases and vessels (a stenosis of an aorta and pulmonary artery, an open arterial channel), a mikrotsefaliya, hydrocephaly, meningoenfefalita, hepatitis, diseases of bones, heavy thrombocytopenia, accession of various infections owing to low immunity, etc. The congenital rubella is considered completely cured when the virus ceases to be found in blood. After a disease resistant immunity is formed.
Diagnosis of a congenital rubella
The first stage – early prenatal diagnosis, that is detection of a disease at the pregnant woman. The infectiologist and the obstetrician-gynecologist observing the woman throughout pregnancy are engaged in it. When the diagnosis is confirmed, it is possible to estimate probability of development of a congenital rubella in the child. Future mother has an opportunity to make the conscious decision on incubation of the child or abortion taking into account all medical indications. The risk of development of a disease in the child depends on the term of pregnancy and reaches 60-90% in the first trimester.
After the delivery the congenital rubella is diagnosed previously clinically, that is on the main symptoms. Doctors pay attention to simultaneous damage of organs of vision and hearing. First, in the course of fizikalny survey will find out that the child does not react to bright light in the patrimonial hall and does not turn the head towards a sound source. At once it is possible to suspect also heart diseases. Sometimes neurologic signs are externally noted: violations of a muscular tone, mikrotsefaliya, hydrocephaly, meningizm symptoms, etc. Bright red rash is noticeable from the first days of life.
The congenital rubella is confirmed by laboratory tests. The diagnosis is considered reliable after detection of specific IgM-antibodies in organism liquids: to urine, blood, cerebrospinal fluid. Most often carry out the analysis of urine and dab from a nasopharynx. IFA-diagnostics allows to reveal antibodies. Laboratory researches help to distinguish a congenital rubella from many diseases with similar symptomatology, such as Cytomegaloviral infection, toxoplasmosis, Epstein-Barre's virus and some other.
For diagnosis of heart diseases carry out the ECG and EhoKG, a hearing disorder and sight narrow experts – the ophthalmologist and specify and confirm. Observation at the children's neurologist since the birth is obligatory. Even if from the first days of life neurologic violations are not revealed, they are very often shown later, even in several years. Then the psychiatrist as lag in intellectual development is inevitable - from easy cognitive frustration to mental retardation of various degrees of severity can be connected to therapy.
Treatment of a congenital rubella
Therapy is carried out only in the conditions of a hospital. As the congenital rubella has the virus nature, the medicines increasing antiviral immunity namely – interferon are involved in treatment. All the rest – fight against disease symptoms.
Rehabilitation measures are directed to compensation or elimination of associated diseases of internals. Heart diseases are most often operable and are corrected. A hearing disorder and sight are eliminated so as far as it is possible. Pre-natal damage of a brain will not respond to treatment, the doctor can only correct the intra cranial pressure, spasms if they are available, but full treatment is impossible. The listed measures can increase quality of life of the sick child considerably. Also social adaptation as the postponed congenital rubella does the child by the disabled person is at the same time carried out, and also influences his intellectual development.
Forecast and prevention of a congenital rubella
The forecast completely depends on severity of a disease which is defined by the term of infection of a fruit and the available symptomatology. In hard cases life expectancy makes several years. If organs of vision and hearing suffered a little, further the congenital rubella will be shown only by lag in development and neurologic violations.
Prevention is closely connected with early diagnosis of a rubella at the pregnant woman. In the first trimester it is recommended to interrupt pregnancy in connection with high risk of infection of a fruit and the heaviest clinical manifestations in case of infection. Mortality among such children remains high. One more effective way of prevention of a congenital rubella is vaccination. At children it is carried out in the first years of life. Vaccination against a rubella is obligatory in the National calendar of inoculations. To adults, especially women of reproductive age, repeated immunization is recommended each 10 years.