What Is Congenital Rubella?

If a pregnant woman develops rubella in early pregnancy, rubella virus can infect the fetus through the placenta, and the newborn baby can be immature, and can suffer from congenital heart malformations, cataracts, deafness, and developmental disorders. It is called congenital rubella or congenital Rubella syndrome.

Causes of congenital rubella

The principle of rubella virus causing special teratogenesis is not fully known. Pregnant women are infected with rubella and have had viremia one week before the rash. Whether the mother's rubella infection can be passed on to the fetus depends on how soon the mother becomes infected.

Clinical manifestations of congenital rubella

Generally speaking, congenital heart malformations, cataracts and glaucoma are often due to viral infection in the first 2 to 3 months of pregnancy, while hearing loss and central nervous system lesions are often infected later in pregnancy. Newborns can also use transient congenital rubella, which is often transmitted by infections in early pregnancy, but occasionally due to infection in late pregnancy, the mother and the fetus are at the same time.

1. Performance at birth

Infants born alive may show some acute lesions, such as neonatal thrombocytopenic purpura, with scattered spots of varying purple-red size at birth, and often accompanied by other temporary lesions and poor calcification of the palate in the long bones, Patients with congenital rubella of the liver and spleen are swollen, hepatitis, hemolytic anemia, and the forehead are full, or there may be increased cerebrospinal fluid cells. These conditions are severe manifestations of congenital infections. Other manifestations at birth include low body weight, congenital heart disease, cataracts, deafness, and microcephaly. The prognosis is poor. Rubella viral hepatitis and interstitial pneumonia can also occur in the neonatal period.

2. Heart malformation

Cardiovascular malformations are most common when the arterial duct is not closed. Some people even isolate rubella virus in the wall tissue of the duct. Pulmonary artery stenosis or stenosis of its branches are also more common. Other atrial septal defects, ventricular septal defects, aortic arch abnormalities, and more complicated deformities are also common. Most infants with mild cardiovascular symptoms at birth are not severe; however, those who have heart failure within the first month of life have a poor prognosis.

Deafness

Hearing loss can be light or heavy, on one or both sides. The lesions are found in the cotyle of the inner ear. But there are also cases of middle ear lesions. Hearing loss can also be classified as the only manifestation of congenital rubella, especially in people infected after 8 weeks of pregnancy.

4. Eye defects

The most characteristic ocular lesions are piriform cataracts, most of which are bilateral or unilateral, often accompanied by small eyeballs. Cataracts may be small or invisible at birth and must be carefully examined with ophthalmoscope. In addition to cataracts, congenital rubella can also cause glaucoma, which is difficult to distinguish from hereditary infantile glaucoma. Glaucoma with congenital rubella appears as enlarged cornea and opacities, anterior chamber deepening, and increased intraocular pressure. Normal newborns can also have transient corneal opacities, which can disappear spontaneously and have nothing to do with rubella. Glaucoma with congenital rubella must be operated on, and transient corneal opacities need not be treated. The most common scattered melanin plaques on the retina vary in size. Most of these pigments are not harmful to vision, but their presence is helpful for the diagnosis of congenital rubella.

5. Developmental disorders and neurological deformities

Infant rubella can also cause disease in the central nervous system. Autopsy of the infant confirmed that rubella virus is very toxic to nerve tissue, causing developmental defects of varying degrees. There are often changes in the cerebrospinal fluid, such as increased cell numbers and increased protein concentrations, and the virus can still be isolated from the cerebrospinal fluid even at the age of 1 year. Developmental disorders in intelligence, behavior and movement are also a major feature of congenital rubella. This early developmental disorder is caused by rubella encephalitis and may cause permanent mental retardation.

Congenital rubella test

Virus isolation

Infants with congenital rubella can have chronic infection for many months after birth, becoming a source of infection for contacts. Rubella virus can be isolated from pharyngeal secretions, urine, cerebrospinal fluid, and other organs of infants. Those with severe lesions are more likely to be isolated. Those who get rubella the day after tomorrow rarely excrete the virus for more than 2 to 3 weeks. The positive rate of congenital rubella virus isolation decreases with the age of the month, and the virus can no longer be isolated when the congenital rubella is 1 year old. Unless the infant has a congenital immune deficiency that cannot produce antibodies, the virus is rarely isolated from the blood.

2. Serological examination

Serum rubella antibodies should be determined when a pregnant woman has a history of rubella exposure or has clinically suspected rubella symptoms. If the specific anti-rubella IgM is positive, it means that there has been a first infection with rubella recently, especially in early pregnancy, and an abortion should be considered. When infants with congenital rubella are born, the titer of serum rubella antibodies is similar to that of their mothers. Most of these antibodies are IgG from the mother's fetus, which have diminished from 2 to 3 months after birth; and the anti-rubella produced by the fetus itself at birth IgM (IgM cannot pass through the placenta) peaks from March to April after birth and disappears around 1 year old. The infant's own anti-rubella IgM begins within 1 month of birth and reaches a peak at 1 year of age, which can last for several years. Therefore, if rubella-specific IgM is detected from the serum of newborn infants, or if rubella is not infected after birth, and a large amount of serum rubella IgM antibodies are still present after 5 to 6 months, this baby can be proved to be congenital rubella. As mentioned earlier, those who are infected with rubella after birth can have lifelong anticoagulant antibodies in their serum. However, some children with congenital rubella can no longer detect the antibody when they are 5 years old. Most susceptible children have antibody-producing effects after rubella vaccine injection, while children with congenital rubella whose antibodies have been negatively converted have little effect after rubella vaccine injection. Therefore, if the rubella vaccine is injected in children over 3 years old, the production of hemagglutination inhibitory antibodies cannot be measured. After excluding immunodeficiency diseases and other reasons, adding the history of rubella infection during pregnancy and other clinical manifestations of children can help confirm the congenital Diagnosis of rubella.

Diagnosis of congenital rubella

1. Epidemiological data. Pregnant women have a history or history of rubella exposure during early pregnancy. And the laboratory has confirmed that the mother has been infected with rubella.

2. Children have one or more birth defects after birth.

3. Specific rubella IgM antibodies were present in serum or cerebrospinal fluid specimens in early infancy.

4. In children with passive maternal antibodies no longer existed 8 to 12 months after birth, continuous levels of rubella antibodies continue to appear in continuous serum samples. After congenital infection with rubella, miscarriages, stillbirths, deformed live births or completely normal newborns can occur, and they can also be recessive infections. Almost all organs of the fetus can develop temporary, progressive, or permanent lesions.

Differential diagnosis of congenital rubella

Rubella needs to be distinguished from measles, scarlet fever, infant rash drug rash, infectious mononucleosis, enterovirus infection, intrauterine infection, toxoplasmosis, cytomegalovirus infection, and herpes simplex virus infection.

Congenital rubella complications

The general symptoms of rubella are mild and few complications. Only a few children can be complicated by otitis media, pharyngitis, bronchitis, pneumonia or myocarditis, pancreatitis, hepatitis, gastrointestinal bleeding, thrombocytopenic purpura, hemolytic anemia, nephrotic syndrome, acute Chronic nephritis, etc. The heavier ones are the following:

Encephalitis

Rare, mainly seen in children, generally occurs one day after the rash, headache, drowsiness, vomiting, diplopia, neck stiffness, coma convulsions, ataxia, limb paralysis and other changes in cerebrospinal fluid, similar to other viral encephalitis, The course of disease is relatively short. Most patients heal themselves after one day, and a few can have sequelae or chronic progressive panencephalitis.

Myocarditis

The patient complained of chest tightness, palpitations, dizziness, softness, changes in electrocardiogram and cardiac enzymes, and recovered more or within weeks. May coexist with other complications such as encephalitis.

3. Arthritis

It is mainly found in adults, especially women. There have been reports of rubella arthritis in children in China, and the mechanism of its occurrence has not been fully defined. It is caused by multiple viruses directly invading the joint cavity or immune response. During the rash, the joints, wrists, and knees were red and swollen. The joint cavity effusion contains monocytes, and sometimes several joints are swollen and painful, similar to rheumatic multiple arthritis, but most of them disappear on their own within a day.

4. bleeding tendency

Rarely, due to thrombocytopenia and increased capillary permeability. He usually bleeds suddenly after the rash, and the skin and mucous membrane petechiae, ecchymosis, vomiting blood, blood in the stool, and hematuria appear. Most of them resolve on their own within one week. A few patients have intracranial hemorrhage, which can cause death. Others may have liver and kidney dysfunction.

Congenital rubella treatment

The treatment of congenital rubella syndrome is only symptomatic therapy, and people with rubella antibodies hold nursing positions. After discharge, contact with pregnant women must be contraindicated.

General rehabilitation therapy

Intensive care, keep indoor air fresh and strengthen nutrition. Isolate until 5 days after the rash.

2. Western medicine and western medicine treatment methods

Mainly supportive therapy, symptomatic treatment. Antipyretics, cough suppressants and analgesics may be given as appropriate.

Congenital rubella prevention

Testing for pregnant women Prenatal testing for rubella virus is performed during pregnancy. Early pregnant women diagnosed with rubella virus infection should generally terminate their pregnancy to prevent the birth of such babies.