Congenital rubella syndrome: symptoms, pathogenesis

Syndrome of congenital rubella in the form of a triad of the most common developmental anomalies - cataracts, heart defects and deafness, was first described by the Australian ophthalmologist Gregg (triad Greg). Later, CNS lesions with mental retardation, microphthalmia, low birth weight, dermatitis, etc. Were described. Some developmental defects caused by the rubella virus do not always appear at an early age, they may occur later. The defeat of some organs in the first days of life is not always easy to diagnose. It is especially difficult to recognize defects in the development of the hearing organ, retinopathy, myopia of high degree, congenital glaucoma. Defects in the development of the cardiovascular system can not always be recognized in the first days of a child's life. The defeat of the fetal brain with the rubella virus often leads to the development of chronic meningoencephalitis, but the clinical manifestations of the newborn can be expressed very weakly in the form of drowsiness, lethargy or, conversely, increased excitability. Sometimes there are cramps. In these cases, microcephaly is gradually detected.

From early neonatal manifestations of congenital rubella characterized by multiple hemorrhages, accompanying thrombocytopenia. Eruptions last 1-2 weeks, sometimes longer. There are hepatitises with jaundice, an increase in the spleen, hemolytic anemia, interstitial pneumonia, damage to the tubular bones (X-ray examination reveals areas of rarefaction and compaction of bones).

Rarely observed malformations of the skeleton and skull, organs of the genitourinary, digestive system, etc. The developmental anomalies depend on the time of exposure of the virus to the fetus.

All children whose mothers had rubella in the first 8 weeks of pregnancy have some defects. With the disease in subsequent terms, the frequency of anomalies is significantly reduced. However, the teratogenic effect of the virus manifests itself on the 4th and even the 5th month of pregnancy. In addition, with rubella pregnancy often results in miscarriage or stillbirth.

With congenital rubella there is a chronic infection with persistence of the virus from several months to 1 year and longer. Such children represent an epidemiological danger to others.

Pathogenesis of congenital rubella

The virus enters the fetus through the bloodstream of the mother during the viremia, which lasts 7-10 days before the rash appears and for a while during the rash. It is suggested that the rubella virus affects the epithelium of the chorionic villi and the endothelium of the placenta capillaries and from there in the form of minute emboli is introduced into the fetal bloodstream and disseminated into tissues. There is a chronic infection, which is the cause of the formation of congenital malformations.

Cytodestructive effect is not characteristic of the rubella virus, it is manifested only in the lens of the eye and in the cochlea of the inner ear. The rubella virus depresses the local mitotic activity of the cells, which leads to a slow growth of cellular populations that are unable to participate in differentiation and interfere with the proper development of the organ.

By attacking the embryo at different gestation times, the rubella virus causes different developmental defects, depending on which organ is developing in the given period. It is important to determine the indications for interrupting pregnancy with rubella in the first 3 months of pregnancy. When a pregnant woman contacts a patient with rubella, a repeated serological examination should be performed at intervals of 10-20 days to detect an asymptomatic infection.

The use of immunoglobulin for the prevention of rubella in pregnant women is ineffective.

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