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Patient Case: Rubella (German Measles)

Patient Case: Rubella (German Measles)

Discussion

A 22-year-old university student presents to the clinic with a mild fever, sore throat, and a pinkish rash that started on her face and has spread downward over the past 24 hours. She reports feeling generally unwell for the past two days, with headache, muscle aches, and swollen glands behind her ears. She is otherwise healthy and has no history of chronic illness.

On examination, she has a low-grade fever (37.8°C/100°F) and a fine, maculopapular rash covering her face, neck, and trunk. Notably, there is bilateral postauricular and occipital lymphadenopathy. The rash is non-itchy and fading in areas where it first appeared. No conjunctivitis or Koplik spots are present.

A clinical diagnosis of rubella (German measles) is made, and the patient is advised to rest, stay hydrated, and take symptomatic treatment for fever and discomfort. Since rubella is a self-limiting viral illness, no specific antiviral treatment is required. However, the physician counsels her about avoiding contact with pregnant women due to the risk of congenital rubella syndrome (CRS). She is also advised to check her vaccination status, as rubella is preventable with the MMR vaccine.

Questions
  1. What is the most characteristic clinical sign of rubella?
    A) High fever with a widespread vesicular rash
    B) Fine maculopapular rash with postauricular and occipital lymphadenopathy
    C) Target-like lesions with central necrosis
    D) Blistering rash following a dermatomal distribution
  2. Why should this patient avoid contact with pregnant women?
    A) Rubella can cause congenital rubella syndrome (CRS) in the fetus
    B) Pregnant women are more likely to develop severe rubella symptoms
    C) Rubella in pregnancy leads to rapid disease progression in the mother
    D) Rubella has no effect on pregnancy, so no precautions are necessary
  3. How is rubella primarily prevented?
    A) Early antibiotic treatment
    B) Rubella vaccination as part of the MMR vaccine
    C) Isolation and quarantine measures only
    D) Lifelong antiviral prophylaxis
  4. Which of the following is a common complication of rubella in adults?
    A) Postherpetic neuralgia
    B) Encephalitis and arthritis
    C) Rheumatic heart disease
    D) Chronic liver failure
Reveal answers

Answers

  1. Answer: B) Fine maculopapular rash with postauricular and occipital lymphadenopathy
    • Rubella presents with a characteristic pinkish maculopapular rash that starts on the face and spreads downward, often accompanied by postauricular and occipital lymphadenopathy. High fever with a vesicular rash (A) is seen in varicella (chickenpox), target-like lesions (C) suggest erythema multiforme, and a blistering dermatomal rash (D) is typical of herpes zoster (shingles).
  2. Answer: A) Rubella can cause congenital rubella syndrome (CRS) in the fetus
    • Rubella is dangerous in pregnancy because it can cause congenital rubella syndrome (CRS), leading to birth defects such as hearing loss, cataracts, and congenital heart disease. Pregnant women typically do not develop severe symptoms (B), nor does rubella progress rapidly in them (C). The statement that rubella has no effect on pregnancy (D) is incorrect.
  3. Answer: B) Rubella vaccination as part of the MMR vaccine
    • The MMR (measles, mumps, and rubella) vaccine is the most effective way to prevent rubella infection and congenital rubella syndrome. Antibiotics (A) do not work against viruses, isolation alone (C) cannot fully prevent outbreaks, and lifelong antiviral prophylaxis (D) is unnecessary, as rubella is self-limiting.
  4. Answer: B) Encephalitis and arthritis
    • In adults, rubella can lead to complications such as encephalitis (inflammation of the brain) and arthritis (joint inflammation), especially in women. Postherpetic neuralgia (A) is a complication of herpes zoster, rheumatic heart disease (C) follows streptococcal infections, and chronic liver failure (D) is unrelated to rubella.

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