What are the symptoms of rubella?

Symptoms of Rubella

Rubella is characterized by rash, low-grade fever, lymphadenopathy, and malaise, with 25-50% of infections being asymptomatic. 1

Primary Clinical Manifestations

• Rash: Transient erythematous and sometimes pruritic maculopapular rash 1

  • Classically begins on the face
  • Spreads cephalocaudally (head to toe)
  • Becomes generalized within 24 hours
  • Disappears within 3 days 2

• Lymphadenopathy: Postauricular and suboccipital lymph node enlargement 1

• Fever: Low-grade 1

• General symptoms: Malaise 1

Additional Symptoms in Adults

• Joint manifestations: Particularly common in adults, especially women 1
  • Transient polyarthralgia (joint pain) or polyarthritis (joint inflammation)
  • Occurs in up to 70% of infected adult women 1
  • Usually begins 1-3 weeks after infection
  • Typically persists for 1 day to 3 weeks 1

Complications

• Central nervous system complications: Encephalitis occurs at a rate of approximately 1 per 6,000 cases, more common in adults 1

• Hematologic complications: Thrombocytopenia occurs at a rate of approximately 1 per 3,000 cases, more common in children 1

Important Clinical Considerations

• Clinical diagnosis is often unreliable as many rash illnesses can mimic rubella infection 1

• Similar exanthematous illnesses are caused by adenoviruses, enteroviruses, and other common respiratory viruses 1

• Laboratory confirmation is essential for definitive diagnosis through:

  • Positive serological test for rubella-specific IgM antibody
  • Four-fold or greater increase in rubella-specific IgG between acute and convalescent sera
  • Detection of rubella virus RNA by RT-PCR 2

Congenital Rubella Syndrome

The most significant concern with rubella is infection during pregnancy, which can lead to Congenital Rubella Syndrome (CRS) with the following manifestations:

• Auditory: Sensorineural deafness 1, 3
• Ophthalmic: Cataracts, microphthalmia, glaucoma, chorioretinitis 1, 3
• Cardiac: Patent ductus arteriosus, pulmonary artery stenosis, atrial or ventricular septal defects 1, 3
• Neurologic: Microcephaly, meningoencephalitis, mental retardation 1, 3
• Other: Intrauterine and postnatal growth retardation, radiolucent bone defects, hepatosplenomegaly, thrombocytopenia, and purpuric skin lesions (blueberry-muffin appearance) 1

Transmission and Contagiousness

• Transmitted through direct or droplet contact from nasopharyngeal secretions 1
• Incubation period ranges from 12 to 23 days 1
• Most contagious when the rash first appears
• Period of maximal communicability extends from a few days before to 7 days after rash onset 1
• Less contagious than measles 1

Clinical Pitfalls

• Due to widespread vaccination, clinicians may not recognize rubella when it occurs
• Up to 50% of infections are subclinical, making transmission control difficult 1
• The only reliable evidence of previous rubella infection is the presence of specific antibody 1