What are the symptoms of rubella?

Symptoms of Rubella

Rubella infection presents with low-grade fever, lymphadenopathy (particularly postauricular and suboccipital), malaise, and a characteristic erythematous maculopapular rash that begins on the face and spreads throughout the body within 24 hours. 1

Primary Symptoms

• Rash characteristics:

  • Erythematous and maculopapular
  • Sometimes pruritic
  • Begins on the face
  • Spreads cephalocaudally (head to toe)
  • Becomes generalized within 24 hours
  • Typically disappears within 3 days 1, 2

• Lymphadenopathy:

  • Primarily affects postauricular and suboccipital lymph nodes
  • Enlargement may precede the rash 1

• Fever:

  • Low-grade (>37.2°C or >99°F) 1

• Malaise 1

Important Clinical Considerations

• Subclinical infection: 25-50% of rubella infections are asymptomatic, though these individuals can still transmit the virus 1, 3

• Joint manifestations: Particularly common in adults, especially women

  • Transient polyarthralgia or polyarthritis
  • Occurs in up to 70% of infected adult women 1

• Period of contagiousness:

  • Incubation period: 12-23 days
  • Most contagious when rash first appears
  • Maximal communicability extends from a few days before to 7 days after rash onset 1

Complications

• Central nervous system complications:

  • Encephalitis (approximately 1 per 6,000 cases)
  • More common in adults 1

• Hematologic complications:

  • Thrombocytopenia (approximately 1 per 3,000 cases)
  • More common in children 1

• Pregnancy-related complications:

  • Congenital Rubella Syndrome (CRS) when infection occurs during pregnancy, especially first trimester
  • Can lead to miscarriages, stillbirths, and therapeutic abortions 4, 2

Diagnostic Challenges

Clinical diagnosis of rubella is unreliable and should not be confirmed without laboratory testing 4, 1. Many rash illnesses can mimic rubella, including:

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

Laboratory confirmation is essential through:

• Rubella-specific IgM antibody testing
• Significant rise in rubella IgG antibody between acute and convalescent sera
• Isolation of rubella virus from clinical specimens 1

Transmission

Rubella is transmitted through:

• Direct or droplet contact from nasopharyngeal secretions
• Inhalation of virus-laden airborne droplets 1, 2

Clinical Pitfalls

• Do not rely solely on clinical presentation for diagnosis as many rubella infections are unrecognized or confused with other exanthems
• Remember that asymptomatic individuals can still transmit the virus
• Always consider rubella in pregnant women with rash illness due to the serious consequences of congenital infection

Vaccination remains the cornerstone of prevention for both rubella and the more serious congenital rubella syndrome 2, 3.