pediatrics
Rubella
Symptoms and Signs of Rubella
Many cases are mild. After a 14- to 21-day incubation period, a 1- to 5-day prodrome, usually consisting of low-grade fever, malaise, conjunctivitis, and lymphadenopathy, occurs in adults but may be minimal or absent in children. Tender swelling of the suboccipital, postauricular, and posterior cervical nodes is characteristic. There is pharyngeal injection at the onset. The rash that develops subsequently is similar to that of measles but is less extensive and more evanescent; it is often the first sign in children. It begins on the face and neck and quickly spreads to the trunk and extremities. At onset, a blanching, macular erythema may appear, particularly on the face. On the 2nd day, the rash often becomes more scarlatiniform (pinpoint) with a reddish flush. Petechiae form on the soft palate (Forchheimer spots), later coalescing into a red blush. The rash lasts 3 to 5 days. Constitutional symptoms in children are absent or mild and may include malaise and occasional arthralgias. Adults usually have few or no constitutional symptoms but occasionally have fever, malaise, headache, stiff joints, transient arthritis, and mild rhinitis. Fever typically resolves by the 2nd day of the rash. Encephalitis has occurred rarely during large military outbreaks. Complete resolution is typical, but encephalitis is occasionally fatal. Thrombocytopenic purpura and otitis media occur rarely. 