Many patients with rubella have few or no symptoms.
Symptoms can be cold-like including a runny nose, a cough, or sneezing.
The primary symptom though is a rash and this is gonna start on the face
and spread to the trunk and then the limbs.
It's usually going to fade after 3 days and it's gonna be pink or light red, and maybe itchy.
There are other signs and symptoms including a low-grade fever,
swollen lymph nodes in the neck, joint pains, headache, conjunctivitis, and Forchheimer's sign
which are red papules that we see on the soft palate.
These are gonna occur in 20% of cases.
We can also see these in other conditions including strep throat.
Here's the rubella rash.
Now, use caution when diagnosing a patient's rash because this looks a lot like roseola
and it can also resemble the measles. So first, you wanna get your patient's medical history.
Then, you're gonna evaluate their immunization status
and this is to exclude other causes of their fever and rash.
One dose of the MMR is 97% effective against rubella.
Next, you'll move on to your physical exam.
This includes the vital signs, a thorough head, eyes, ears,
nose, throat exam, cardiac, respiratory, and a full skin exam.
Now, this part's important because rubella is so teratogenic,
you want to do a pregnancy test in women of child-bearing age.
Rubella needs to be reported to the Health Department in all suspected cases.
How do you diagnose rubella?
You can do this via lab testing and you need to consult your local
and state Health Department for guidance. Testing is strongly recommended.
A positive rubella IgM antibody will show up a short time after this characteristic rash.
These IgM antibodies can remain positive for up to one year.
There are gonna be some risk factors for a heightened clinical suspicion
and this is maybe your patient is unvaccinated or they've had a recent international travel.