🤒 Rubella is usually a mild viral illness but has major consequences in pregnancy. If contracted in the first trimester, it can cause severe congenital anomalies including cataracts, heart defects, and sensorineural hearing loss.

📖 About

Also called German measles (distinct from measles/rubeola).
🦠 RNA virus; incubation 14–21 days; epidemics occur every 10 years.
🌬️ Spread via respiratory droplets; peak incidence in teenagers and young adults.
💉 Vaccine-preventable (MMR); widespread immunisation has drastically reduced cases.

🩺 Clinical Presentation

Often subclinical, but still contagious.
🌡️ Mild fever, malaise, conjunctivitis, coryza.
🤧 Lymphadenopathy (posterior cervical, auricular, suboccipital) is typical.
🌸 Maculopapular rash: pink-red, starts on face → spreads to trunk/limbs, fades by day 3–5.
🔴 Forchheimer spots: small petechiae on soft palate.
🕒 Infectious from 7 days before rash → 7 days after.

🌸 Rubella Rash

⚠️ Complications

Pregnancy risk: Congenital Rubella Syndrome (CRS) if infection in 1st trimester.
🧠 Encephalitis (~1 in 5,000, mortality 30–50%).
🤲 Transient arthritis (esp. in adult women).
🩺 Transient hepatitis.

🤰 Rubella in Pregnancy

CRS triad:
- ❤️ Congenital heart disease (PDA, VSD).
- 👁️ Ocular: cataracts, microphthalmia.
- 👂 Sensorineural hearing loss.
Also: microcephaly, developmental delay, hepatosplenomegaly, bone lesions, interstitial pneumonia.
📅 First trimester = greatest risk; later infection is less damaging but still concerning.

🔎 Investigations

Serology: Rubella IgM (acute infection), rising IgG titre (recent infection).
Viral isolation from nasopharynx useful in pregnancy cases.
A fourfold IgG rise between acute and convalescent samples confirms infection/reinfection.

💊 Management

Prevention: MMR vaccination (two doses) = best protection.
Preconception: Check rubella immunity in women planning pregnancy. Vaccinate if non-immune (contraindicated once pregnant).
During pregnancy:
- Serology if exposed.
- Immunoglobulin sometimes considered, but limited efficacy at preventing CRS.
Supportive care: No antiviral; manage with fluids, antipyretics, analgesia.
CRS: Supportive treatment for complications – e.g., cardiac surgery, cochlear implants, cataract surgery.

💡 Exam tip: Think of rubella in a non-immune pregnant woman with rash + lymphadenopathy. CRS = classic triad of congenital heart disease + cataracts + hearing loss.

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Rubella (German Measles) Notifiable