What are the symptoms of Rubella?

Rubella Symptoms

Rubella is characterized by nonspecific signs and symptoms including transient erythematous and sometimes pruritic rash, postauricular or suboccipital lymphadenopathy, arthralgia, and low-grade fever. 1

Primary Clinical Manifestations

• Rash: Erythematous, maculopapular rash that classically begins on the face, spreads cephalocaudally, becomes generalized within 24 hours, and disappears within 3 days 2
• Lymphadenopathy: Primarily affects postauricular and suboccipital lymph nodes 1
• Fever: Low-grade fever is common 1
• Joint symptoms: Transient polyarthralgia or polyarthritis, particularly common among adult women (up to 70% of cases) 1

Important Clinical Considerations

• Subclinical infection: 25-50% of rubella infections are subclinical with no apparent symptoms 1
• Incubation period: Ranges from 12 to 23 days 1
• Contagious period: Patients are most contagious when the rash first appears, but the period of maximal communicability extends from a few days before to 7 days after rash onset 1
• Differential diagnosis: Clinically similar exanthematous illnesses are caused by parvovirus, adenoviruses, and enteroviruses 1

Complications

• Arthritis: More common in adults, especially women 1
• Central nervous system complications: Encephalitis occurs at a rate of 1 per 6,000 cases, more likely to affect adults 1
• Thrombocytopenia: Occurs at a rate of 1 per 3,000 cases, more likely to affect children 1

Congenital Rubella Syndrome (CRS)

The most serious consequence of rubella is infection during pregnancy, which can lead to:

• Pregnancy complications: Miscarriages, stillbirths, and fetal anomalies, especially during the first trimester 1
• Classic triad of congenital defects:
  • Cataracts and other eye defects
  • Congenital heart defects (patent ductus arteriosus, peripheral pulmonary artery stenosis)
  • Sensorineural deafness 1, 2
• Other CRS manifestations:
  • Neurological: Microcephaly, meningoencephalitis, mental retardation 1
  • Growth: Intrauterine and postnatal growth retardation 1
  • Additional findings: Radiolucent bone defects, hepatosplenomegaly, thrombocytopenia, and purpuric skin lesions (blueberry-muffin appearance) 1

Clinical Pitfalls and Caveats

• Diagnostic challenges: Clinical diagnosis of rubella is unreliable due to its variable presentation and similarity to other exanthematous illnesses 1
• Laboratory confirmation: The only reliable evidence of previous rubella infection is the presence of serum rubella IgG antibody 1
• Risk assessment in pregnancy: The risk of congenital defects is highest (up to 85%) when infection occurs during the first 8 weeks of gestation 1
• Subclinical maternal infection: Even inapparent (subclinical) maternal rubella infection can cause congenital malformations 1

Laboratory Diagnosis

• Serologic testing: Positive test for rubella-specific IgM antibody or significant rise in rubella IgG antibody between acute and convalescent sera 1
• Viral isolation: Detection of rubella virus RNA by reverse transcriptase-PCR 2