1 / 18

Morning Report

5th Annual Advocacy Project: Immune Wise Section on Medical Students, Residents, and Fellowship Trainees 2009-2010. Morning Report. Case Presentation. A 24 year old G1P0 woman and her husband arrive for a prenatal visit

madge
Download Presentation

Morning Report

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. 5th Annual Advocacy Project: ImmuneWiseSection on Medical Students, Residents, and Fellowship Trainees2009-2010

  2. Morning Report

  3. Case Presentation • A 24 year old G1P0 woman and her husband arrive for a prenatal visit • The woman is a day care provider, and lets you know that there was a case of rubella reported at the day care center where she works • She was in her first trimester

  4. Case Presentation • In order to work at the day care center, her immunization record was reviewed • She was up-to-date (had two MMRs) • She also had blood work done following her exposure (because she told her OB about it) • She was tested for rubella antibody • Her rubella IgG was positive

  5. Case presentation • The positive rubella IgG indicates immunity! • The woman still has a lot of questions about rubella, especially about what it could have meant for the baby and what to watch for in the children at the day care center…

  6. Rubella - Epidemiology • Droplet or Direct Transmission • Humans are the only source • Pre-vaccine • Epidemic disease in 6-9 year cycles • Post-vaccine (1969) • < 25 cases/year in the U.S. since 2001 • Vaccine is immunogenic in 98% of recipients • Lifeline immunity in 90%

  7. Rubella - epidemiology • In the last decade, the rate of congenital rubella is down to less than 10 cases each year • Occurrence of congenital defects is 85% if the maternal infection is during the 1st trimester --- this drops to 25% by end of 2nd trimester • One-half of maternal infections are subclinical

  8. Rubella – ClinicalCongenital • The ‘R’ of TORCH infections • Clinical findings may include: • Ophthalmologic: Cataracts, pigmented retinopathy, microphthalmos, congenital glaucoma • Dermatologic: Dermal erythropoiesis (“blueberry muffin rash”) • Cardiac: PDA, pulmonary artery stenosis • Auditory: Sensorineural hearing impairment • This is the most common manifestation • Neurologic: Mental retardation • A majority of infants with proven congenital rubella are asymptomatic in the neonatal period

  9. Congenital Rubella

  10. Rubella – ClinicalChildren/Adolescents • Incubation period 14-23 days • 25% of patients are asymptomatic but still transmit disease • Prodrome: Malaise, low-grade fever, eye pain, sore throat, lymphadenopathy (occipital, post-auricular, cervical) • Exanthum • Discrete, pinkish red, fine, maculopapular; rarely puritic • Begins on face – spread is cephalocaudal • Generalized by 24 hours, usually resolved within 72 hours

  11. Fine, maculopapular rashon face and chest

  12. Rash (close-up)

  13. Rubella – ClinicalChildren/Adolescents • Arthralgias/Arthritis • Especially Fingers, wrists, and knees • More common in adolescents • Develops day 2-3 and lasts for up to 10 days • Encephalitis – rare! • Thrombocytopenia and purpura – rare!

  14. Rubella Diagnosis • Rubella-specific IgM antibody usually indicates a recent infection • False positives from rheumatoid factor, parvovirus IgM, heterophile antibody • Virus is best isolated by cell culture of throat or nasal specimens (special test) • Blood, urine, CSF can be particularly helpful in congenital infections

  15. Rubella - Treatment • Supportive care • Isolation with droplet precautions for 7 days after the onset of rash • Infants with congenital rubella are considered contagious until 1 year of age!

  16. From Prep 2005 A 3100 gram term male infant is being evaluated in the nursery shortly after birth. Findings on physical examination include a cataract in the left eye and a heart murmur. There is no evidence of intrauterine growth retardation, microcephaly, or hepatosplenomegaly. Of the following, the MOST likely cause of these findings in this infant is • Cytomegalovirus • Herpes simplex virus • Rubella • Syphilis • Toxoplasmosis

  17. From Prep 2005 A 3100 gram term male infant is being evaluated in the nursery shortly after birth. Findings on physical examination include a cataract in the left eye and a heart murmur. There is no evidence of intrauterine growth retardation, microcephaly, or hepatosplenomegaly. Of the following, the MOST likely cause of these findings in this infant is • Cytomegalovirus • Herpes simplex virus • Rubella • Syphilis • Toxoplasmosis

  18. References • Centers for Disease Control • Red Book 2009 – paper and online • www.sciencemuseum.org.uk/broughttolife

More Related