congenital rubella
Introduction
Introduction to congenital rubella Congenital rubella or congenital rubella syndrome (congenitalrubellasyndrome) refers to pregnant women with rubella in the early pregnancy, rubella virus can pass through the placenta to infect the fetus, the newborn can be immature, can suffer from congenital heart malformation, cataract, Deafness, developmental disorders, etc. Once infected with rubella in the first month of pregnancy, the incidence of congenital rubella syndrome in the fetus can be as high as 50%, 30% in the second month, 20% in the third month, and 5% in the fourth month. He also believes that the infection of rubella after 4 months of pregnancy is not completely harmless to the fetus. basic knowledge The proportion of sickness: 0.00652% Susceptible people: infants and young children Mode of transmission: vertical transmission Complications: Myocarditis Pancreatitis Hepatitis Digestive tract hemorrhage Thrombocytopenic purpura Anemia Nephrotic syndrome
Cause
Congenital rubella cause
Genetics (20%):
The principle of special teratogenicity caused by rubella virus is still not fully known. Pregnant women are infected with rubella. They have viremia 1 week before the rash, and the mother's rubella infection can be transmitted to the fetus. This is related to the time when the mother is infected. In the second to sixth weeks of the embryo, the infection has the greatest impact on the heart and eyes; in the second trimester, the fetus gradually develops immunity (such as the appearance of plasma cells and the production of IgM), and the fetus's rubella infection is not as easy to construct as early pregnancy. Chronic infection, according to Kibrick et al (1974), the incidence of congenital rubella syndrome in the first month of pregnancy can be as high as 50%, 30% in the second month, 20% in the third month, the first month of pregnancy 5% of 4 months, and believe that the infection of rubella 4 months after pregnancy is not completely harmless to the fetus.
Prevention
Congenital rubella prevention
According to the US literature, about 20% of women of childbearing age in cities have a susceptibility to rubella. In the 1964 pandemic, about 3.6% of pregnant women were infected with rubella, but in non-popular years, the infection rate was only about 0.1%. 0.2%; the earlier the pregnant woman is infected with rubella, the more the fetus is infected, the infection rate is very low in the second trimester, and the fetus is not susceptible to infection in the later stage; in the pandemic, Siegal et al observed 333 pregnant women with rubella in the early pregnancy. Among them, 213 (64%) underwent induced abortion, 38 (11.4%) had spontaneous abortion. After the fetus was infected, 10-20% of the children died within 1 year after birth, which can be separated from the tissues and body fluids of the deceased. The rubella virus can also excrete viruses from the pharynx and urine several months after birth. This long-term virus-laden disease and continuous virus excretion are obviously serious threats to the surrounding health-susceptible people, especially pregnant women.
For the prevention of congenital rubella syndrome, see the prevention of rubella above. It is worth noting that rubella re-infection can also affect the fetus during pregnancy. In pregnant women who have been vaccinated against rubella, the chance of re-infection is higher than that of pregnant women who have naturally suffered from rubella. Much more, the increase of adrenal cortex hormones in the body during pregnancy, the cellular immune function is reduced, so the virus easily spread in the body, which affects the fetus.
For non-pregnant people, rubella reinfection is almost asymptomatic, no viremia, just like the vaccine booster, resulting in increased antibody in the body, but pregnant women may have congenital rubella syndrome after reinfection, so Even if pregnant women have been vaccinated against rubella, they should also attach importance to strict isolation from patients with rubella.
Complication
Congenital rubella complications Complications Myocarditis Pancreatitis Hepatitis Digestive tract Hemorrhage Thrombocytopenic purpura Anemia Nephrotic syndrome
Rubella is generally mild and has fewer complications. Only a few children may have otitis media, pharyngitis, bronchitis, pneumonia or myocarditis, pancreatitis, hepatitis, gastrointestinal bleeding, thrombocytopenic purpura, hemolytic anemia, nephrotic syndrome, and urgency. Chronic nephritis and so on. The heavier ones are as follows:
Encephalitis
Rarely, mainly seen in children, usually occurs one day after the rash, headache, drowsiness, vomiting, double vision, neck stiffness, coma, coma, ataxia, limb paralysis and other cerebrospinal fluid changes, similar to other viral encephalitis, The course of the disease is relatively short. Most patients self-heal after a day, a small number of sequelae can be left, but also chronic progressive encephalitis.
2. Myocarditis
The patient complained of chest tightness, palpitations, dizziness, weakness, electrocardiogram and cardiac zymogram, which were more or more recovered within weeks. It can coexist with other complications such as encephalitis.
3. Arthritis
Mainly found in adults, especially women patients. There are reports of children with rubella arthritis in China, and the principle of occurrence is not completely clear. Multi-line viruses directly invade the joint cavity or immune response. During the rash, the knuckles, wrist joints, knee joints and other redness and pain. The joint effusion contains monocytes, sometimes several joints are swollen and painful, similar to rheumatoid polyarthritis, but most of them can disappear in one day.
4. bleeding tendency
Rarely due to thrombocytopenia and increased capillary permeability. Often after the rash, sudden bleeding, skin mucous membrane spots, ecchymosis, hematemesis, blood in the stool, hematuria, most of them relieve within a week, a small number of patients with intracranial hemorrhage, can cause death. Others may have abnormal liver and kidney function.
Symptom
Symptoms of congenital rubella Common symptoms Pigmented plaque thrombocytopenic opacity Liver splenomegaly Deafness ventricular septal defect Cardiac malformation Small eyeball ductus arteriosus pulmonary stenosis
1. Epidemiological data Pregnant women have a history of rubella exposure or history in the early stages of pregnancy, and have been confirmed in the laboratory that the mother has been infected with rubella.
2. Children have one or several manifestations of birth defects after birth.
3. Specific rubella IgM antibodies are present in serum or cerebrospinal fluid specimens in early infants.
4. When the passive parental antibody is absent from 8 to 12 months after birth, a considerable level of rubella antibody continues to appear in the serial serum samples.
Congenital infections can occur after abortion, stillbirth, malformed live births or completely normal newborns, can also be recessive infections, almost all organs of the fetus may have temporary, progressive or permanent lesions.
1. Infants with live birth at birth may show some acute lesions, such as neonatal thrombocytopenic purpura, which have scattered spots of different sizes of purple and red at birth, often accompanied by other temporary lesions and long bones. Bad calcification of the ankle, hepatosplenomegaly, hepatitis, hemolytic anemia and fullness of the anterior humerus, or increased cells of the cerebrospinal fluid. These conditions are severe manifestations of congenital infection, other manifestations at birth and low body weight, congenital Heart disease, cataract, deafness and microcephaly, the prognosis is poor, according to the results of 58 cases of purpura with the imitation of 1 year, the mortality rate is as high as 35%, can also occur in the neonatal period, rubella viral hepatitis and interstitial pneumonia.
2, cardiac malformation cardiovascular abnormalities are most common for patent ductus arteriosus, some people even isolated rubella virus in the wall tissue of the catheter, pulmonary stenosis or its branch stenosis is more common, others can still have a room Septal defect, ventricular septal defect, aortic arch abnormality and more complicated malformation, most of the infants have no cardiovascular symptoms at birth; but there are also heart failure in the first month after birth, the prognosis bad.
3, deafness can be light and heavy, one or both sides, the lesions exist in the inner ear of the Corti cochlea, but there are also lesions in the middle ear, the hearing can be divided into the only manifestation of congenital rubella, You are more likely to be infected after 8 weeks of pregnancy.
4, the most characteristic eye lesions of the eye defects are piriform nucleus cataracts, most of which are bilateral, or unilateral, often accompanied by small eyeballs, cataracts may be small or invisible at birth, must be Ophthalmoscope carefully scrutinize, in addition to cataract, congenital rubella can also produce glaucoma, and hereditary infant glaucoma is difficult to identify, glaucoma of congenital rubella manifested as corneal enlargement and opacity, anterior chamber deepening, intraocular pressure increased, normal Newborns can also have a transient corneal opacity, can disappear spontaneously, has nothing to do with rubella, glaucoma of congenital rubella must be performed; and transient corneal opacity does not need to be treated, the most common scattered melanin plaque on the retina The size of the pigment is mostly unaffected by vision, but its presence is helpful in the diagnosis of congenital rubella.
5, developmental disorders and neurological malformations intra-fetal infection rubella can also cause disease to the central nervous system, the infant autopsy confirmed that the rubella virus is very toxic to nerve tissue, causing different degrees of developmental defects, cerebrospinal fluid often changes, such as increased cell number The protein concentration is increased, and the virus can be isolated from the cerebrospinal fluid even at the age of one.
Developmental disorders in intelligence, behavior, and exercise are also a hallmark of congenital rubella, which is caused by rubella encephalitis and can cause permanent mental retardation.
In general, congenital heart malformations, cataracts and glaucoma are often due to viral infections during 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 innate The performance of sexual rubella is often transmitted by early pregnancy infection, but even due to infection in the third trimester of pregnancy, the mother and the fetus are at the same time.
Examine
Congenital rubella examination
1. Virus isolation Congenital rubella may cause chronic infections to persist with the virus for many months after birth. It becomes a source of infection for the contacts. The pharyngeal secretions, urine, cerebrospinal fluid and other organs of the infant can be isolated from the rubella virus. Severe cases are easier to separate; and those who are infected with rubella in the day after tomorrow, the virus is rarely discharged for more than 2 to 3 weeks. The positive rate of congenital rubella virus isolation decreases with the age of the month. When the age is 1 year old, the virus can no longer be separated unless the baby is infected. Innate immune defects do not produce antibodies, and few viruses can be isolated from the blood.
2, serological examination When pregnant women have a history of rubella exposure or clinical symptoms of suspected rubella, serum rubella antibodies should be measured, if specific anti-Rubella IgM positive (use the ELA determination IgM kit supplied by Beijing Biopharmaceuticals), It indicates that there has been a primary infection of rubella in the near future, especially in the early pregnancy, and should be considered for abortion. When the infant with congenital rubella is born, the titer of serum rubella antibody is similar to that of the mother. This antibody is mostly transmitted by the mother. IgG, reduced from February to March after birth; while the fetus produces its own anti-Rubella IgM (IgM can not pass the placenta) to reach the peak of 3 to 4 months after birth, disappears around 1 year old; Rubella IgM begins within 1 month of birth and reaches a peak of 1 year and can last for several years. Therefore, if rubella-specific IgM is detected from newborn infant serum, or if it is not infected with rubella after birth, after 5-6 months Serum rubella IgM antibody is also abundantly present, and it can be proved that the baby is a congenital rubella disease. As mentioned above, the blood coagulation inhibitory antibody of the serum can be sustained for a lifetime after birth, but the congenital rubella disease child is about 20 % At the age of 5, the antibody can no longer be detected. Generally, 95% of the susceptible children have the effect of antibody production after the injection of rubella vaccine, and the children with congenital rubella whose antibodies have turned negative rarely have an effect after the injection of rubella vaccine. Therefore, if a child with children over 3 years old is injected with rubella vaccine, the production of hemagglutination inhibitory antibodies cannot be measured. After the exclusion of immunodeficiency disease and other causes, the history of infection with rubella during pregnancy and other clinical manifestations of the child can help Diagnosis of congenital rubella.
Diagnosis
Congenital rubella diagnosis and identification
The rash form of rubella patients is between measles and scarlet fever. Therefore, we should focus on the differential diagnosis of common fever and rash disease. In addition, rubella needs to be associated with children with acute rash, drug rash, and infectious mononuclear cells. Syndrome, enterovirus infection, such as Coxsackie virus group A, type and group B, type Echovirus, type infection identification (see measles chapter), congenital rubella syndrome also needs to be arched with intrauterine infection Body disease, cytomegalovirus infection, and herpes simplex virus infection are identified. This intra-fetal infection has similar symptoms to congenital rubella.
