Clinical Manifestations and Pathology

The prodromal phase of postnatally acquired rubella usually occurs from 1 to 5 days prior to rash onset, but may be completely lacking, especially in children. Prodromal symptoms may include headache, low-grade fever, malaise, conjunctivitis, mild rhinitis, and lymphadenopathy (most commonly tender swelling of the lymph nodes behind the ears and at the base of the skull). The rash phase of illness begins with a reddish, discrete rash, sometimes itchy, usually appearing first on the face and then spreading to the hands and feet. Although the progression, duration, and extent of the rash vary greatly, it typically covers the whole body within 24 hours and has disappeared completely by the end of the third day - hence the name 3-day measles. It is important to note that the variability and sometimes the absence of prodromal symptoms as well as rash make a clinical diagnosis uncertain, and laboratory serologic tests are necessary for confirmation of the diagnosis.

Complications in postnatally acquired illness may include arthritis and arthralgia, which are more common in adults and women than in prepubertal children and men. Neurological involvement, including encephalitis, is a rare complication of rubella.

In congenitally acquired rubella, the fetal infection may result in abortion, stillbirth, congenital malformations, or growth retardation. The congenital rubella syndrome is the result of inhibition of cell multiplication in the developing fetus and a chronic infective state that may persist for many months after birth. Some consequences of fetal infection may not become apparent until years after birth. Common congenital abnormalities and active infective processes at birth include cataracts, deafness, central nervous system defects leading to mental retardation, structural defects of the heart and myocarditis, bone lesions, pneumonitis, and hepatitis.

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