Congenital rubella syndrome overview
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: :Kalsang Dolma, M.B.B.S.[2]; Aditya Govindavarjhulla, M.B.B.S. [3]
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Overview
Congenital rubella syndrome (CRS) can occur in a developing fetus of a pregnant woman who has contracted rubella during her first trimester. Problems rarely occur when rubella is contracted by the mother after 20 weeks of gestation.
Pathophysiology
Congenital rubella syndrome results from the spread of infection to fetus by mother during viremic stage. Rubella virus enters fetus through the placenta and cause damage to all germ layers of fetus. This results in rapid death of some cells.
Historical Perspective
Originally, rubella was referred to as the third disease, because it was thought to branch from measles or Scarlet fever. However, in 1814, it was recognized as a separate entity of disease and became known as German measles.[1][2] In 1941, congenital rubella syndrome was recognized as a complication of rubella infection among pregnant women who became infected with the virus early in their pregnancy.[1][2] An Australian ophthalmologist made the connection and reported 78 cases of congenital cataract among infants born to mothers who had a rubella infection early in their pregnancy.[1][2]
Classifcation
There is no classification scheme for congenital rubella syndrome. However, in 2009, the CDC published the case classification of congenital rubella syndrome and divided into suspected cases, probable cases, confirmed cases and infection only, based on symptoms and/or laboratory findings.[3]
Causes
The cause of congenital rubella syndrome is rubella virus. Rubella virus is a single stranded, positive sense RNA virus (ssRNA). It is the only member of the genus Rubivirus and belongs to the family of Togaviridae.
Differentiating Congenital Rubella Syndrome from other Diseases
Congenital rubella syndrome has to be differentiated from other congenital infections (TORCH infections) as they may have some overlapping features.
Epidemiology and Demographics
The exact incidence of congenital rubella syndrome is hard to estimate, because in many parts of the developing world rubella has been eliminated. However, very few cases are still reported in the U.S and they are believed to be imported cases. In addition, rubella infection and congenital rubella syndrome are still a challenge in the developing world, with most cases occurring in Africa and Southeast Asia.[4][5]
Screening
There is no screening test for congenital rubella syndrome.[6]
Natural History, Complications and Prognosis
Congenital rubella syndrome can cause serious birth defects and the prognosis depends on the severity of the problem. Heart defects can be corrected but neurological damage is permanent.
Diagnosis
Physical Examination
Congenital rubella syndrome is characterized by triad of sensorineural deafness, eye abnormalties (cataracts, retinopathy) and heart defects (PDA).
Laboratory Findings
Diagnostic tests used to confirm congenital rubella syndrome include serologic assays and detection of rubella virus using real time PCR.
Electrocardiogram
Electrocardiogram findings in a child of congenital rubella syndrome depends on the type of heart defect (mostly PDA) and its severity.
Chest X Ray
Chest radiograph may show increased pulmonary vascularity and cardiomegaly due to ventricular enlargement. The heart size might be normal if the shunt is small.
Treatment
Medical Therapy
There is no specific treatment for congenital rubella syndrome. Symptoms are treated as appropriate. Management for ocular congenital rubella syndrome (CRS) is similar to that for age-related macular degeneration, including counseling, regular monitoring, and the provision of low vision devices, if required.[7]
Surgery
Treatment of newly born babies is focused on management of the complications. Congenital heart defects and cataracts can be corrected by direct surgery.[8]
References
- ↑ 1.0 1.1 1.2 De Santis M, Cavaliere AF, Straface G, Caruso A (2006). "Rubella infection in pregnancy". Reprod. Toxicol. 21 (4): 390–8. doi:10.1016/j.reprotox.2005.01.014. PMID 16580940.
- ↑ 2.0 2.1 2.2 Cooper LZ, Krugman S (1967). "Clinical manifestations of postnatal and congenital rubella". Arch. Ophthalmol. 77 (4): 434–9. PMID 4164540.
- ↑ Center for Disease Control and Prevention https://www.cdc.gov/vaccines/pubs/surv-manual/chpt15-crs.html. Accessed on Jan 5, 2017
- ↑ Bouthry E, Picone O, Hamdi G, Grangeot-Keros L, Ayoubi JM, Vauloup-Fellous C (2014). "Rubella and pregnancy: diagnosis, management and outcomes". Prenat. Diagn. 34 (13): 1246–53. doi:10.1002/pd.4467. PMID 25066688.
- ↑ "Three cases of congenital rubella syndrome in the postelimination era--Maryland, Alabama, and Illinois, 2012". MMWR Morb. Mortal. Wkly. Rep. 62 (12): 226–9. 2013. PMID 23535689.
- ↑ U.S. Preventive Services Task Force https://www.uspreventiveservicestaskforce.org/BrowseRec/Search?s=congenital+rubella+syndrome. Accessed on Jan 17, 2017.
- ↑ Weisinger HS, Pesudovs K (2002). "Optical complications in congenital rubella syndrome". Optometry. 73 (7): 418–24. PMID 12365660.
- ↑ Khandekar R, Sudhan A, Jain BK, Shrivastav K, Sachan R (2007). "Pediatric cataract and surgery outcomes in Central India: a hospital based study". Indian J Med Sci. 61 (1): 15–22. doi:10.4103/0019-5359.29593. PMID 17197734.