rubella in children
Introduction
Introduction to Pediatric Rubella Pediatric rubella is an acute respiratory infection caused by rubella virus. Its clinical features are mild inflammation of the upper respiratory tract, fever, systemic red maculopapular rash, posterior auricular, posterior occipital and cervical lymph nodes, mild condition and good prognosis. The rubella virus is weak in vitro and is as infectious as measles. It is usually spread by coughing, talking or sneezing. During the fever, you should rest in bed, strengthen the care, keep the indoor air fresh, give vitamins and nutritious and digestible food. Those who have high fever and headache can use antipyretic analgesics. Patients with sore throat can use the compound boric acid solution to gargle, cough can use peony and cough medicine. Patients with severe illness can be treated with anti-viral drugs such as ribavirin and interferon. basic knowledge The proportion of illness: 0.3% Susceptible people: children Mode of infection: respiratory transmission Complications: myocarditis, arthritis, hematuria
Cause
Pediatric rubella cause
Virus infection (30%):
Rubella virus is an envelope virus with a diameter of about 60-70 nm. It is a rough spherical shape. It consists of a single-stranded RNA genome and a lipid shell. It contains an electron dense core covering two layers of loose coat. The virus is not heat-resistant, it is quickly inactivated at 37 ° C and room temperature, -20 ° C can be stored for a short period of time, -60 ° C can be relatively stable for several months, 7 days before rash and 7 or 8 days after rash retreat, nasopharynx Viruses can be found in secretions, and subclinical patients are also infectious. Human beings are the only natural host of rubella virus. They spread through droplets and are most contagious in the days before, during and after the rash. In addition to nasopharyngeal secretions, there are also viruses in blood, feces and urine. It is more common in winter and spring, and is more common in children aged 1 to 5 years. The incidence rate of men and women is equal.
Maternal factor (30%):
Mother's antibodies protect the baby from morbidity 6 months ago. After the widespread use of vaccines, the incidence rate is reduced and the age of onset is increased. The mother's primary infection during pregnancy can cause intrauterine infection through the placenta. The incidence and teratogenic rate are closely related to the gestational age at the time of infection, which is the highest in early pregnancy. Children with congenital rubella still have virus excretion within a few months after birth, so they have infectious diseases.
Prevention
Pediatric rubella prevention
Control the source of infection
Isolation of the child, the isolation period from the onset to 5 days after the rash.
Cut off the route of transmission
During the epidemic of rubella, try not to bring susceptible children to public places and avoid contact with children with rubella. Strengthen medical observations for close contacts, pay attention to rash and fever, in order to facilitate early detection of patients. The contact classes of the child care institutions should be separated from other classes during the incubation period, and no new students should be accepted to prevent the spread.
Immunization
(1) Active immunization: Live attenuated rubella vaccine has proven to be safe and effective. After vaccination, the antibody positive rate can reach more than 95%, and the antibody can be maintained for more than 7 years. Inoculation of active immunization with a live attenuated rubella vaccine is the main measure to prevent rubella. The immunization target is children aged 1 to 12 years old and susceptible women of childbearing age. Or use measles, rubella, mumps triple vaccine to reduce the number of vaccinations in children.
(2) Passive immunization: Because childhood rubella is mild, no passive immunization is needed. The passive immunization effect of applying immunoglobulin is still unclear.
Complication
Pediatric rubella complications Complications Myocarditis Arthritis Hematuria
encephalitis
Rarely, the incidence rate is 1:6000, mainly seen in children. It usually occurs 1 to 7 days after the rash, mild headache, lethargy, severe vomiting, double vision, neck stiffness, coma, convulsions, ataxia, limb paralysis and so on. Cerebrospinal fluid changes are similar to other viral encephalitis. The course of the disease is relatively short, and most patients self-heal after 3 to 7 days, and a small number can leave sequelae. Chronic progressive whole encephalitis can also be present.
Myocarditis
The patient complained of chest tightness, palpitations, dizziness, weakness, electrocardiogram and cardiac zymogram. Recover more than 1 or 2 weeks. It can coexist with other complications such as encephalitis.
arthritis
Mainly found in adults, especially women patients, China has reported children with rubella arthritis, the principle of occurrence has not been completely clear, multi-line virus directly invaded the joint cavity or immune response. During the rash, the knuckles, wrist joints, knee joints, etc. are red, swollen, and painful, and the joint fluid contains monocytes. Sometimes several joints are swollen and painful, similar to rheumatoid polyarthritis, but most can disappear by themselves within 2 to 30 days.
Bleeding tendency
Rare. Due to thrombocytopenia and increased capillary permeability. Often after the rash, sudden bleeding, skin and mucous membrane defects, ecchymosis, hematemesis, blood in the stool, hematuria, most of them relieve within 1 to 2 weeks, a small number of patients with intracranial hemorrhage can cause death.
other
Abnormal liver and kidney function may occur.
Symptom
Pediatric rubella symptoms Common symptoms Sore throat skin macules pediatric coughing ear lymph nodes size facial rash fever with cold war fever accompanied by rash neck lymphadenopathy
Incubation period
During this period, the child did not feel discomfort, and the length of time was different, usually 2 to 3 weeks.
Precursor period
One to two days before the rash, the symptoms were mild or had no obvious prodromal symptoms. May have low or moderate fever, accompanied by headache, loss of appetite, fatigue, cough, sneezing, salivation, sore throat and combined membrane congestion and other mild upper respiratory tract inflammation; occasional vomiting, diarrhea, nasal discharge, gum swelling. Some patients have rosy or hemorrhagic rash in the pharynx and soft palate.
Rash period
Fever After the first 1-2 days, the rash appears first in the face and neck. It is covered with trunk and limbs within 24 hours, but there is no rash on the palm and sole: the rash is pale red fine spotted macule, maculopapular rash, or papule The diameter is 2~3mm, and the skin between the rashes is normal. The rash on the face and distal extremities is sparse, and some of them are similar to measles. The trunk and back rash are dense and fused into a piece, similar to a scarlet hot rash. The rash usually lasts for 1 to 4 days, and the rash is often accompanied by low fever and mild upper respiratory tract inflammation. At the same time, the superficial lymph nodes of the whole body were swollen, and the lymph nodes were most obvious after the ear, the posterior occipital and the posterior neck. The swollen lymph nodes were mildly tender, not fused, and not purulent. The spleen is slightly enlarged. When the rash retreats, the body temperature returns to normal, and the systemic symptoms disappear. The spleen and superficial lymph nodes disappear slowly, often lasting for 3 to 4 weeks. After the rash subsides, there is generally no pigmentation and no scaling. No rash rubella refers to only some patients with rubella, fever, upper respiratory tract inflammation, swollen lymph nodes without rash. After infection with rubella virus, there are no symptoms and signs. Serological examination of rubella antibody is positive, so-called recessive or subclinical patients.
Examine
Pediatric rubella examination
(1) blood routine: peripheral blood like white blood cell count decreased, lymphocytes increased relatively, and atypical lymphocytes and plasma cells appeared.
(2) Determination of serum-specific antibodies: methods include hemagglutination inhibition test, complement fixation test, immunofluorescence test and enzyme-linked immunosorbent assay, among which hemagglutination inhibition test is most commonly used because of its advantages of fast, simple and reliable. . Specific antibody This antibody IgM appears first, but the maintenance time is short. The IgG antibody can be elevated in 2~3 days after rash, reaching a peak in about 2~4 weeks, and then gradually decreasing, still maintaining a certain level for life. Therefore, an increase in specific IgM or an increase in the serum IgG antibody titer of more than 4 times can diagnose the acute phase of rubella. Rubella-specific secretory IgA antibodies can be found in the nasopharynx and are helpful for diagnosis. The rubella virus RNA is also detected by dot blot hybridization to diagnose a rubella infection. And lasts longer. Neonatal serum-specific antibody IgM is positive for the diagnosis of congenital rubella.
(3) Virus isolation: The nasopharynx secretion is taken for tissue culture from 1 to 2 days before the rash to 2 days after the rash, and the rubella virus can be isolated.
Clinical diagnosis is easier based on epidemiological history and clinical manifestations. However, there are more patients with atypical symptoms during the epidemic, so a specific diagnosis of specific IgM antibodies must be performed. Infants born with suspected intrauterine infections and women suspected of having rubella during pregnancy should be tested for rubella IgM antibodies to determine whether they are congenital rubella syndrome.
Diagnosis
Pediatric rubella diagnosis and identification
Epidemiological data
Susceptible people have a history of rubella exposure, or local rubella epidemic.
Clinical manifestation
According to the short prodromal period, mild inflammation of the upper respiratory tract, low fever, rapid and rapid rash, and post-occipital, posterior, and posterior cervical lymphadenopathy, clinical diagnosis can be made.
Differential diagnosis
Need to identify measles, scarlet fever, children with acute rash, EB virus infection, enterovirus infection, drug rash and other rash diseases.
Childhood acute rash
6 months to 1 year and a half children are more common, sudden high fever, upper respiratory tract catarrhal symptoms, high fever 3 to 4 days, rash after heat retreat, rash is pale red maculopapular rash, leaving no trace after the rash.
Scarlet fever
High fever, sore throat, tonsil redness and purulent discharge, rash on the first day of 1-2 days, diffuse red maculopapular rash, miliary rash, strawberry tongue, white blood cells are obviously elevated, throat swab is cultured as streptococcus mutans .
measles
Acute onset, high fever lasted for 3 days to start rash, upper respiratory tract catarrh (hemorrhoids, tears, photophobia, sneezing, etc.) heavier, measles mucosal plaques (Corne plaques).
Drug eruption
Caused by the use or exposure of a certain drug in the near future, the shape is different, itching, accompanied by fever or no heat, eosinophils increase, and the drug is gradually relieved.
