The rubella represents the sharp viral infection which is shown characteristic rashes against the background of moderate intoxication, is followed by a regionarny limfoadenopatiya and hematologic reaction. The virus of a rubella takes root into an organism through mucous airways where it gets with the inhaled air. The incubatory period lasts from 10 to 25 days. Signs, typical for a rubella, is emergence of rash on a face, its bystry distribution on all body and absence on skin of palms and soles in the beginning. The diagnosis of a rubella is established clinically.
The rubella represents the sharp viral infection which is shown characteristic rashes against the background of moderate intoxication, is followed by a regionarny limfoadenopatiya and hematologic reaction.
Characteristic of the activator
The rubella is caused by the RNA-containing sort Rubivirus virus. The virus is a little steady against factors of the external environment, is easily inactivated under the influence of ultra-violet radiation, heating, chemical disinfectants. The virus can keep the viability within several hours at the room temperature, easily transfers freezing.
The tank and source of the causative agent of a rubella is the sick person. At the same time the disease can proceed both with clinical symptomatology, and in the latent, erased form. Allocation of a virus begins one week prior to manifestation of an ekzantema and 5-7 days proceed later. At a congenital rubella at children the activator is allocated with a secret of a mucous nasopharynx, urine (sometimes with excrements).
The rubella extends by means of the aerosol mechanism of transfer in mainly airborne way. Infection with a contact and household way at general use is possible with toys, ware. Infection through hands and household items epidemiologically is not significant. At infection with a rubella of pregnant women transplacentary transmission of infection to a fruit is carried out. In view of weak firmness of a virus infection with a rubella demands closer communication, than transfer of causative agents of chicken pox, measles.
Natural susceptibility of the person – high. In particular – at women of childbearing age, mainly 20-29 years. Entrance gate of an infection are mucous membranes of the top airways, sometimes – the damaged integuments. Reproduction and accumulation of a virus happens in regionarny lymph nodes. The bred virus extends with blood current, affecting other lymph nodes and settling in integuments, at the same time provoking the immune answer. The created antibodies attack a virus and clear an organism. Post-infectious immunity resistant, lifelong.
The incubatory period of a rubella makes 10-25 days. The disease at adults usually begins with prodromalny signs: temperature increase (sometimes can reach enough high values), indispositions, weaknesses, a headache. Moderate cold, dry cough, irritation in a throat, dacryagogue, a photophobia are quite often noted. Survey can reveal slight hyperaemia of a pharynx and a back wall of a throat, irritation of a conjunctiva. These symptoms remain usually from one to three days. At children catarrhal signs most often are absent.
In an initial stage of a disease both at adults, and at children lymphadenitis of mainly occipital and srednesheyny lymph nodes is noted. Lymph nodes are increased in a size, are to the touch painful. Lymphadenitis can remain up to 2-3 weeks. After the catarrhal period rashes develop. Emergence of rash is usually preceded by a skin itch.
In 75-90% of cases rash develops in the first day of a disease, at first on a face and a neck, behind ears, under hair. In certain cases rash can extend from other localization. Per day rash covers various sites of skin except for palms and soles. In particular rashes on buttocks, a back, the razgibatelny surfaces of extremities are characteristic, the small single enantema of a mucous membrane of a mouth (Forkheym's spot) in rare instances comes to light. Rash is the small, spotty, not towering over a surface skin. Spots red or pink, roundish, with smooth edges, integuments around elements of rash are not changed. At adults rash elements quite often merge, the drain ekzantema is not characteristic of children.
In the period of a rash body temperature remains within norm, or increases to subfebrilny figures, polylymphadenitis is noted. Sometimes take place of a mialgiya and artralgiya, dyspepsia symptoms, a moderate gepatosplenomegaliya can be shown. Women often note polyarthritis symptomatology. Rash usually remains about 4 days then quickly disappears, without leaving consequences. In general the rubella at adults proceeds practically as well as at children, but weight and duration of a current is usually more considerable, brighter catarrhal symptomatology, plentiful drain rash, signs of a limfoadenopatiya are less expressed, can not be noted by patients at all.
Complications at a rubella are not frequent, as a rule, result from accession of a bacterial infection. Mainly secondary pneumonia, quinsies, otitises occur among those. Sometimes the rubella is complicated by arthritis, trombotsitopenichesky purple. At adults development of complications from nervous system is in rare instances possible: encephalitis, encephalomeningitis, encephalomyelitis.
Big danger is constituted by a rubella in case of its development in pregnant women. The infection does not exert noticeable impact on mother's organism, but has extremely adverse effects for a fruit: beginning from congenital malformations to pre-natal death. The probability of formation of malformations directly depends on the pregnancy term on which there was infection with a rubella. The same dependence is traced concerning developing of a congenital rubella: at mothers who got sick on 3-4 week of pregnancy, the risk of pathology of the baby makes 60%, at defeat of the woman after 13-14 weeks – is reduced to 7%.
Diagnosis of a rubella
To methods of specific serological diagnosis of a rubella have retrospective diagnostic value as the research of pair serums at an interval of 10 days is made. Define increase of credits of immunoglobulins M and G by RSK, IFA, RTGA or RIA.
Besides, the serological analysis and statement of reaction of a blasttransformation of lymphocytes is made at the pregnant women who had contact with the persons sick with a rubella for detection of contamination and probability of defeat of a fruit. The analysis of serum of blood of the pregnant woman is made in the earliest terms and no later than the 12th day after contact with the patient. Identification of immunoglobulins G in these terms usually demonstrates transferring before an infection and the available immunity to it that allows to keep pregnancy fearlessly. Emergence of antibodies only in the second serum (mainly immunoglobulins M) speaks about the active infectious process taking place able negatively to affect development of a fruit.
It is possible to refer the general blood test to nonspecific methods of laboratory diagnosis of a rubella. The blood picture, as a rule, shows at the general leykopeniya, increase in SOE. Plazmotsita can be found in adults in blood. Additional methods of diagnostics at a rubella are necessary generally at suspicion on development of complications. Diagnosis of pneumonia is carried out by means of a X-ray analysis of lungs. At neurologic violations carry out brain EEG, a rheoencephalography, Ekho-EG. Developing of otitis demands consultation of the otolaryngologist.
Treatment of a rubella
As a rule, the rubella to be treated on an outpatient basis, hospitalization is performed only in case of development of dangerous complications. Etiotropny treatment of a rubella it is not developed, in most cases recovery is caused independently owing to elimination of a virus by the created immune answer.
Therapy in cases of a heavy current consists in purpose of symptomatic and pathogenetic medicines (dezintoksikatsionny therapy, febrifuges sedative, antihistaminic medicines). At development of krasnushny arthritis it is appointed to 5-7 days. Development of neurologic complications serves as the indication to purpose of Prednisolonum, dehydrational therapy. The congenital rubella will not respond to treatment today.
Forecast and prevention of a rubella
In most cases the forecast favorable, the disease comes to an end with an absolute recovery without any consequences. The forecast in case of development of krasnushny encephalitis worsens. The rubella in obstetric practice has special value. Transferring of an infection by mother can have extremely adverse effects for a fruit. A variety of probable malformations of a fruit (a congenital cataract, deafness, heart diseases, a mikrotsefaliya, etc.) at a rubella of pregnant subjects is wider, than infection took place earlier.
Specific prevention of a rubella in the developed countries is made by means of planned vaccination by the live associated vaccine against measles, parotitis and a rubella. Besides there are monovaccines. Vaccination against a rubella is made twice, the first time at the age of 12-16 months, then a revaccination in 6 years. Besides, further quite often revaccinations are exposed girls of teenage age and young women.
The emergency prevention is performed to contact children and pregnant women by means of introduction of protivokrasnushny immunoglobulin. Patients with a rubella are in isolation up to the 5th day after developing of a rash. Special quarantine events concerning ill and contact persons it is not made.