What are the symptoms of rubella?

Rubella Symptoms

Rubella is characterized by a transient erythematous maculopapular rash, low-grade fever, postauricular or suboccipital lymphadenopathy, and arthralgia, with 25-50% of infections being asymptomatic. 1

Key Clinical Features

Primary Symptoms

• Rash:

  • Erythematous and sometimes pruritic maculopapular rash
  • Begins on the face and spreads cephalocaudally
  • Becomes generalized within 24 hours
  • Typically disappears within 3 days 1, 2

• Lymphadenopathy:

  • Distinctive postauricular and suboccipital lymph node enlargement
  • A characteristic feature that helps distinguish rubella from other exanthematous illnesses 1

• Fever:

  • Low-grade fever (>37.2°C or >99°F) 3, 1

• Other common symptoms:

  • Malaise
  • Arthralgia (particularly common in adults) 1

Important Clinical Considerations

Subclinical Infections

It's crucial to note that 25-50% of rubella infections are subclinical, meaning infected individuals may not display any symptoms but can still transmit the virus 3, 1. This makes identification and control of outbreaks challenging.

Complications

1. Joint manifestations:

   • Transient polyarthralgia or polyarthritis
   • Particularly common among women (up to 70% of infected adult women) 1
   • More frequent in adults than children

2. Neurological complications:

   • Encephalitis occurs at a rate of approximately 1 per 6,000 cases
   • More common in adults 1

3. Hematologic complications:

   • Thrombocytopenia occurs at a rate of approximately 1 per 3,000 cases
   • More common in children 3, 1

Diagnostic Challenges

Rubella can be confused with other exanthematous illnesses caused by:

• Parvovirus
• Adenoviruses
• Enteroviruses
• Other common respiratory viruses 3, 1

Clinical diagnosis alone is often unreliable, and laboratory confirmation is essential for definitive diagnosis. This typically involves:

• Serologic testing for rubella-specific IgM antibody
• Significant rise in rubella IgG antibody between acute and convalescent sera
• Isolation of rubella virus from clinical specimens 3

Congenital Rubella Syndrome (CRS)

The most serious consequence of rubella is infection during pregnancy, especially in the first trimester, which can lead to Congenital Rubella Syndrome. CRS manifestations include:

• Auditory: Sensorineural deafness
• Ophthalmic: Cataracts, microphthalmia, glaucoma, chorioretinitis
• Cardiac: Patent ductus arteriosus, pulmonary artery stenosis, atrial or ventricular septal defects
• Neurologic: Microcephaly, meningoencephalitis, mental retardation
• Other: Growth retardation, radiolucent bone defects, hepatosplenomegaly, thrombocytopenia, and purpuric skin lesions 1

Transmission and Infectivity

• Transmitted through respiratory droplets and direct contact with infected nasopharyngeal secretions
• Incubation period ranges from 12 to 23 days
• Period of maximal communicability extends from a few days before to 7 days after rash onset 1, 2

Recognizing the symptoms of rubella is critical for prompt diagnosis, especially in pregnant women, to prevent the devastating effects of congenital rubella syndrome.