Rubella in adults
definition
Ringlet rubella (also: Erythema infectiosum, 5th disease, Fifth Disease) describes an infectious disease that particularly affects children and occurs only in rare cases in adults. That is why rubella is one of the childhood diseases. The disease is transmitted by droplets (e.g. by sneezing).
Rubella is a viral disease and is caused by the rubella virus (human parvovirus B19) triggered. Often the disease proceeds without symptoms and without being noticed (clinically inapparent).
When symptoms occur, the cheeks are often reddened (Slapping rash), a rash on the arms and legs, as well as a slight fever and a slight exhaustion.
Normally no therapy is necessary as the disease passes by itself (self-limiting). Complications such as joint inflammation (arthritis), or a more severe course of the disease.
Rubella infection is also dangerous for pregnant women, as the unborn child can be infected and serious consequences and even death of the child can result.
Read more on the topic: Ringlet rubella
causes
Rubella is caused by a virus called parvovirus B19. The human parvovirus B19 has a single genetic strand (DNA strand) in a capsule.
After infection, it enters the bone marrow via the bloodstream, where it affects cells that are responsible for the formation of blood cells (erythropoid progenitor cells). There it leads to the death of the infected cells, which leads to anemia (anemia) and other released substances trigger a general, non-directional inflammatory response of the body.
This manifests itself in the form of a rash and fever. In particular the typical rash (Rash) is probably mainly caused by the defense reaction (Immune reaction) of the body triggered. Why the disease generally takes more severe courses in adults than in children has not yet been conclusively researched.
How long is the incubation period in adults?
The incubation period, i.e. the time between infection and the onset of the first symptoms, is a few days to about two weeks for rubella. The highest risk of infection is between the fifth and tenth day of the incubation period, i.e. at a time when the infected person is not yet aware of the infection.
diagnosis
The diagnosis is usually based on the typical, garland-shaped rash (Rash) that can occur in both children and adults.
In addition, the suspicion can be confirmed by examining the blood in the laboratory. Anemia (anemia) because the virus attacks the blood-forming cells. Specific antibodies can also be detected. In addition, the genetic material (DNA) of the virus can be detected in the blood, bone marrow or, in pregnant women, in the amniotic fluid. This is only necessary in rare cases.
Read more on the topic: Rash with rubella
How contagious is rubella?
A past infection with rubella can be detected in 60-70% of adults in Germany. This already indicates that the rubella virus is very contagious (high contagiousness).
The virus is mainly transmitted by droplet infection, for example by sneezing. Since small children are particularly affected, who are usually less aware of hygiene in this area, the virus is quickly transmitted from person to person.
The greatest risk of infection comes from infected people even before the symptoms of rubella have appeared, which is why precautions (such as staying at home or not shaking hands) are often taken.
Theoretically, infection can also occur through blood contact, but this is very unlikely. Infection of unborn children can occur if the mother is sick. The virus is able to cross the border of the placenta (Plaster cake) to cross between maternal and child blood (diaplacental transmission). This happens to about a third of pregnant and infected women.
Animals (e.g. mosquitoes) cannot be infected with the rubella virus and thus play no role in the transmission of the disease. The virus can only survive in humans.
Concomitant symptoms in adults
The symptoms of rubella in adults, as in children, are quite variable. The typical symptoms of rubella infection usually start 4 days to two weeks after the actual infection. While many adults do not even notice that they have contracted the virus, others complain of flu-like symptoms. These include, above all, a feeling of weakness, tiredness and fatigue, but also fever, headache, nausea and diarrhea. In addition to these symptoms, joint pain sometimes occurs. These are particularly common in the small joints of the hands and feet and particularly affect younger women. The joint problems usually only last for about one to two weeks. More rarely, longer lasting pain of over two months can occur.
In almost all infected people, in addition to the symptoms described above, so-called anemia (anemia of the red blood cells) occurs. However, this usually goes unnoticed as it is only temporary. However, immunocompromised people, such as the chronically ill or the elderly, can also develop persistent anemia. Then typical symptoms appear, such as fatigue, paleness, hair loss. In addition to anemia, a drop in other blood cells can rarely occur. These include the blood platelets, which are responsible for blood clotting, and the so-called granulocytes, a type of immune cell.
Find out more about the topic here: These symptoms can be recognized by rubella
What are the symptoms in the early stages?
The initial stage of rubella in adults, as in children, is usually characterized by the same symptoms. These include typical flu-like symptoms such as fever, fatigue, tiredness and headache. Adults also often report severe joint pain in the early stages of rubella infection. While children usually develop a rash afterwards, this is less common in adults.
skin rash
Classically, there is also a rash (Rash). Usually the rash begins with a reddening of the face, whereby the nose and mouth, as well as the area directly around the mouth, are not reddened (Cheek erythema, slapping rash).
The rash then spreads to the arms, legs, and trunk. At first it appears as a general reddening with small pimples and then fades over time, whereby a typical curled (also garland-like or net-like) structure becomes visible.
In many cases, the rash is accompanied by mild itching. All of these symptoms can or do not have to occur as the disease is often symptom-free. In adults in particular, the same symptoms can be more pronounced. In addition, joint inflammation occurs significantly more frequently in adults, especially women, than in children, which is particularly concentrated on the fingers, knees and ankles.
Also read: Rash with rubella
Joint pain
Joint pain (Arthralgia) can occur in the case of rubella infection especially in adult women, and in rarer cases also in men and children.
Overall, this phenomenon is common with 20-50% of those infected. The pain is caused by inflammation of the joints caused by the rubella virus (parvovirus B19 arthritis).
The virus attacks the synovial fluid here. When the body's own immune cells attack the virus there, this leads to an inflammatory reaction. Arthritis in rubella usually affects several joints (polyarthritis) and occurs on the same side (i.e. symmetrically), for example on the finger joints of both the right and the left hand.
It mainly affects the small joints of the fingers and hand, as well as the knee joints and the ankle joints. A specific therapy is usually not necessary, as the joint complaints usually go away on their own after 3-4 weeks.
The pain can seldom remain permanent because viruses remain in the synovial fluid for reasons that are not yet clear.
itching
Itching usually does not occur in the context of rubella. Occasionally, children report a slight itchiness in the area of the rash. This is rarely reported in adults as the rash is less common. If itching occurs, cooling the skin or using moisturizing creams can help. This measure also prevents the skin from drying out later and often has a positive effect on the duration of the rash.
therapy
Specific therapy for rubella is only necessary in exceptional cases, in people with a weakened immune system and in pregnant women. Usually the body can deal with the infection on its own.
Symptomatic therapy can always be carried out, so antipyretic agents such as ibuprofen or paracetamol can be taken; the package insert should always be observed and possible side effects, etc. be considered. If you have a sore throat, throat lozenges can be sucked.
Otherwise, it is important to ensure that you drink enough fluids and, especially if you are very exhausted, infected people should take care of themselves.
If pregnant women are infected, more drastic therapy is often indicated. An infusion of antibodies can prevent the infection from spreading to the unborn child. If the unborn child is already infected, blood exchange for the child can be considered, whereby the child remains in the womb (intrauterine blood transfusion).
In people with a severely weakened immune system or diseases of the red blood cells (erythrocytes; such as thalassemia, spherocytosis, sickle cell anemia), severe anemia may occur (aplastic crisis). A blood transfusion and the administration of antibodies should also be considered here.
Rubella during pregnancy
Rubella infection during pregnancy is considered dangerous. If the mother is infected, the virus crosses the placenta barrier (placenta) in a third of the cases and infects the fetus (diaplacental transmission).
Since the mother's infection is usually symptom-free, timely detection is not always possible. If you suspect rubella or if you come into contact with sick people, you should consult a doctor.
In the unborn child, the virus attacks the blood-forming cells, which leads to severe anemia in the fetus. This in turn can lead to so-called hydrops fetalis, a massive accumulation of fluids in various body cavities of the fetus (including the pericardium, lungs and peritoneum) which in turn can cause the fetus to die and miscarriage comes.
The risk of this is particularly high in the 1st trimester. The further the pregnancy has progressed, the lower the risk of serious consequences. In the third trimester, the child usually suffers from temporary anemia without permanent damage. Nevertheless, a doctor should be consulted.
You might also be interested in: Skin diseases in pregnancy
Duration
After infection, the first symptoms usually appear after 4-14 days. These, especially the rash, will begin to fade and go away after 5-8 days.
Most of the time, the disease is over with this, but in rare cases the symptoms can reappear months later. If joint pain occurs, it usually lasts 3-4 weeks. After this time they go away on their own without therapy. In very rare cases they can persist (persist).
In people with severe immune deficiencies, the disease can last longer or have longer consequences.
Duration of sick leave for rubella
Most often, the disease is not diagnosed until the rash appears. At this point, the sick person is no longer contagious, which is why a sick note is no longer absolutely necessary. The length of the sick leave depends on the stage of the disease. In the early stages, before the onset of a rash, there is still a risk of infection. Then you should definitely be on sick leave for a few days in order to reduce the risk of infection for others. Once the rash has set in, there is usually no longer any risk of infection. Then, depending on the symptoms, you can be on sick leave for a few days up to a week. If the symptoms persist, this may need to be extended. Since there is often no skin rash in adulthood, if you are unsure about the risk of infection and there is no rash, you should be on sick leave for a few days as a precaution.
Especially in physically demanding jobs, a sick leave for 3-5 days is still often indicated to give the illness time to be completely cured. In addition, regardless of the job, the personal health of the sick person should be included. This can vary greatly from case to case. If you feel sick or weak, you should also be on sick leave. Since the symptoms can vary widely, it is best to seek specific advice from your family doctor for your own situation.
Rubella anemia
Anemia describes anemia, i.e. the lack of red blood cells (Erythrocytes), which are responsible for the transport of oxygen to organs and muscles.
Anemia can develop in rubella because the blood-forming cells are infected by the virus and not enough red blood cells are produced.Normally it is only a slight anemia, which the body can cope with well and which can be compensated for after a short time.
Symptoms can include increased tiredness and fatigue. Only people with severe immunodeficiency or red blood cell disease (such as thalassemia, spherocytosis, sickle cell anemia) may develop severe anemia that requires treatment and is known as aplastic anemia.
Read more on the topic: aplastic anemia
Course of rubella infection
After the actual infection, there is initially a phase without symptoms, as there is not enough virus in the body. This time is called the incubation period. Infected people can already be contagious at this time.
After 4-14 days the symptoms begin. The typical rash usually starts on the face and then spreads to the arms, legs, and trunk. Usually it is initially red all the way through and then fades over time to show the typical striped pattern.
The rash usually disappears after 5-8 days. The remaining symptoms also begin to regress. If joint pain has occurred, it usually takes 3-4 weeks to subside.
They can rarely persist. In rare cases, all symptoms can reappear months later.
How dangerous can rubella be?
In most cases, rubella is mild in adults too. The danger is almost only present in the elderly and sick people. Then, in extreme cases, acute anemia can even endanger life. The very rare secondary diseases, such as liver inflammation and myocarditis, are also potentially life-threatening. In addition, pregnant women pose a risk to the unborn child. Children whose mothers became infected with the virus during pregnancy can become disabled or even born dead.
You may also be interested in this topic: Rubella during pregnancy
Long-term effects of rubella infection
Rubella infection usually heals without any consequences, but symptoms can reappear months later, and once the disease has been overcome, the infection cannot be re-infected. Rubella is usually milder in children than in adults. Nonetheless, long-term effects are only very rarely to be expected in adulthood. Persistent joint pain is one of the most common complications of rubella infection. Adult women in particular develop joint pain in the small joints of the hands and feet as part of the disease. While these disappear again after a few weeks in most cases, persistent courses over two months and longer have also been described. Then there is often a persistent infection, which can be detected by virus particles in the synovial fluid.
In addition to joint problems, anemia can also become chronic during rubella infection. The patients then show the typical symptoms of anemia, such as paleness, tiredness, shortness of breath and hair loss. Particularly in the chronically ill and the elderly, severe and even life-threatening conditions have been described. In the meantime, persistent rubella infection has also been blamed for numerous other secondary diseases. These include inflammation of the liver (hepatitis), autoimmune diseases especially of the blood vessels, kidney infections (glomerulonephritis) and heart muscle inflammation (myocarditis).
Is there a vaccination?
Unfortunately there is no vaccination against rubella.
However, once the disease is over, antibodies remain in the blood for a lifetime, which reliably protect against the disease. Pregnant women and women planning a pregnancy should be tested for these antibodies.
If no antibodies are present in a pregnant woman, great caution is required. Contact with infected people should be strictly avoided. Outbreaks of illness in kindergarten are a particular danger here.
