Congenital Rubella (German Measles) and Cytomegalovirus Infection (CMV)

00:01 Let’s switch gears one more time to rubella.

00:05 Rubella is rare in the U.S. because we have a vaccine, the measles-mumps-rubella vaccine, which is a great vaccine.

00:13 Rubella is an RNA virus.

00:15 And primary infection is not such a big deal.

00:20 Patients will get a low-grade fever, they’ll get headache, maybe conjunctivitis, maybe cough and congestion And they will get a classic rash.

00:27 Here’s a classic rash of a patient with rubella.

00:32 But it’s not really the primary infection that we’re worried about in children.

00:37 What we’re worried about is the other getting a primary infection while the infant is inside them.

00:44 So if a mother acquires the disease while she’s pregnant, the infant can be born stillborn.

00:53 Stillborn babies are reasonably common with congenital rubella.

00:58 Or they may have a triad of symptoms.

01:01 So the classic triad of rubella is cataracts, like we can see here, deafness and cardiac defects.

01:10 So eyes, ears, and heart.

01:13 In addition to this triad, infants may be born with blueberry muffin spots.

01:19 This is a commonly tested question.

01:22 These muffin spots are different than the rash I showed you in the previous patient.

01:26 That was just acquired rubella.

01:29 This is congenital rubella and they develop these blue lesions in their skin.

01:35 These blue lesions are because there is actually extramedullar hematopoiesis going on in the skin in these infants.

01:44 Let’s switch gears now to congenital CMV or cytomegalovirus.

01:49 This the most common congenital infection in the United States.

01:54 Fortunately, the majority are asymptomatic.

01:57 But 10% will have symptoms at birth.

02:00 This will present as prematurity, hepatosplenomegaly, being small for gestational age, having a small head, microcephaly, which is similar to toxo, or having seizures.

02:12 They may also have late symptoms, which include hearing, vision loss, developmental delay or a seizure disorder.

02:21 So early symptoms are fairly non-specific except they do have microcephaly and then later symptoms, they can develop hearing and vision loss, developmental delay and seizures.