Epidemiology
Etiology
Pathophysiology
Clinical features
See Congenital rubella infection
| Characteristic | Rubella | Measles |
|---|---|---|
| Severity of Illness | Generally milder disease | More severe with higher complication rates |
| Rash Characteristics | Fine, pink maculopapular rash starting on face; lasts ~3 days | Erythematous maculopapular rash starting at hairline; more confluent; lasts 5-7 days |
| Prodromal Symptoms | Minimal; mild fever, malaise, lymphadenopathy | Prominent with high fever, cough, coryza, conjunctivitis (“3 Cs”) |
| Pathognomonic Signs | Posterior auricular and suboccipital lymphadenopathy | Koplik’s spots (white spots on buccal mucosa) |
| Congenital Effects | Significant risk of congenital rubella syndrome | No specific congenital syndrome; may cause pregnancy complications |
| Infectivity | Moderately contagious | Highly contagious (one of the most contagious diseases) |
| Complications | Rare in children; arthritis in adults; congenital defects | Pneumonia, encephalitis, SSPE, high mortality in malnourished children |
Diagnostics
Childhood exanthems
Feature Rubella (German Measles) Measles (Rubeola) Scarlet Fever Erythema Infectiosum (Fifth Dis.) Roseola Infantum (Sixth Dis.) Varicella (Chickenpox) Agent Togavirus (RNA) Paramyxovirus (RNA) S. pyogenes (GAS) exotoxin Parvovirus B19 (DNA) HHV-6, HHV-7 (DNA) VZV (HHV-3) (DNA) Prodrome Low-grade fever, postauricular/occipital LAD, arthralgias. 3 C’s: Cough, Coryza, Conjunctivitis. High fever. Fever, pharyngitis, headache, vomiting. Mild flu-like sx. High fever (>40°C) for 3-5 days, child appears well. Fever, malaise. Enanthem Forchheimer spots (petechiae on soft palate) Koplik spots (blue-white spots on buccal mucosa). Pathognomonic. Strawberry tongue, palatal petechiae. N/A Nagayama spots (papules on soft palate). Ulcers in mouth/pharynx. Exanthem Maculopapular rash starts on face, spreads caudally in <24h. Lighter than measles. Maculopapular rash starts at hairline, spreads caudally. Confluent. ”Sandpaper” texture, diffuse erythema. Starts on trunk, spreads out. Spares palms/soles. Circumoral pallor. ”Slapped cheeks” (malar rash), followed by lacy, reticular rash on trunk/extremities. Maculopapular rash appears as fever breaks. Starts on trunk, spreads to face/extremities. Vesicular rash on erythematous base (“dew drop on a rose petal”). Lesions in different stages. Starts on trunk, spreads to face/limbs. Key Buzzwords ”3-day measles”, postauricular LAD. Congenital: PDA, cataracts, deafness. Koplik spots, 3 C’s, SSPE (late complication). Sandpaper rash, strawberry tongue, Pastia’s lines (linear petechiae in flexures). Slapped cheeks, aplastic crisis (in SCD), hydrops fetalis. Fever first, then rash. Febrile seizures common. Pruritic vesicles in crops, Tzanck smear shows multinucleated giant cells. Reactivates as shingles. Tx Supportive. MMR vaccine for prevention. Supportive, Vit A. MMR vaccine for prevention. Penicillin or Amoxicillin (to prevent rheumatic fever). Supportive. Supportive. Supportive. Acyclovir in teens/adults/immunocompromised. Live-attenuated vaccine. Link to original
