Editing Rubella (section)

==Signs and symptoms==
[[File:10145 lores.jpg|thumb|upright=1.3|Young boy displaying the characteristic maculopapular rash of rubella<ref>{{cite web|title=Public Health Image Library (PHIL)|url=http://phil.cdc.gov/phil/details.asp|website= cdc.gov| publisher= Center for Disease Control and Prevention|access-date=24 May 2015|date=1966|url-status=live|archive-url=https://web.archive.org/web/20150315065100/http://phil.cdc.gov/phil/details.asp|archive-date=15 March 2015}}</ref>]]
[[File:Rubella.jpg|thumb|upright=1.3|Generalized rash on the abdomen due to rubella]]

Rubella has symptoms similar to those of flu. However, the primary symptom of rubella virus infection is the appearance of a rash (exanthem) on the face which spreads to the trunk and limbs and usually fades after three days, which is why it is often referred to as three-day measles. The facial rash usually clears as it spreads to other parts of the body. Other symptoms include low-grade fever, swollen glands (sub-occipital and posterior cervical [[lymphadenopathy]]), [[arthralgia|joint pains]], [[headache]], and [[conjunctivitis]].<ref name="pmid16022642">{{cite journal|vauthors=Edlich RF, Winters KL, Long WB, Gubler KD |title=Rubella and congenital rubella (German measles)|journal=J Long Term Eff Med Implants|volume=15|issue=3|pages=319–28|year=2005|pmid=16022642|doi= 10.1615/JLongTermEffMedImplants.v15.i3.80}}</ref>

The swollen [[gland]]s or [[lymph nodes]] can persist for up to a week and the [[fever]] rarely rises above 38&nbsp;°C (100.4&nbsp;°F). The rash of rubella is typically pink or light red. The rash causes itching and often lasts for about three days. The rash disappears after a few days with no staining or peeling of the skin. When the rash clears up, the skin might shed in very small flakes where the rash covered it. [[Forchheimer spots]] occur in 20% of cases and are characterized by small, red [[papule]]s on the area of the [[soft palate]].<ref>{{cite book| first1= Robert | last1= Kliegman| first2=  Waldo E. | last2= Nelson| first3=  Hal B. | last3= Jenson| first4= Karen J.| last4= Marcdante| first5= Richard E. | last5= Behrman| title= Nelson Essentials of Pediatrics| page= 467| publisher= Elsevier Health Sciences| year= 2006 |isbn= 978-1-4160-0159-1}}</ref>

Rubella can affect anyone of any age. Adult females are particularly prone to arthritis and joint pains.<ref name=":1">{{Cite book|title=Harrison's principles of internal medicine|isbn=978-1-259-64404-7|edition= 20th |location=New York|chapter=Rubella (German Measles)|oclc=990065894|last1 = Kasper|first1 = Dennis L.|last2=Fauci|first2=Anthony S.|last3=Hauser|first3=Stephen L.|last4=Longo|first4=Dan L.|last5=Larry Jameson| first5=J.| last6= Loscalzo |first6= Joseph| date=2018-02-06 | authorlink2= Anthony Fauci}}</ref>

In children, rubella normally causes symptoms that last two days and include:
* Rash begins on the face which spreads to the rest of the body.
* Low fever of less than {{cvt|38.3|C}}.
* Posterior cervical lymphadenopathy.<ref>{{cite web |url= http://kidshealth.org/parent/infections/skin/german_measles.html|title=Rubella (German Measles) | website= kidshealth.org |url-status=live|archive-url= https://web.archive.org/web/20131006091930/http://kidshealth.org/parent/infections/skin/german_measles.html|archive-date=2013-10-06}}</ref>

In older children and adults, additional symptoms may be present, including{{citation needed|date=July 2023}}
* Swollen glands
* [[Coryza]] (cold-like symptoms)
* Aching joints (especially in young females)

Severe complications of rubella include:
* [[Encephalitis|Brain inflammation]] (encephalitis)<ref name=":1" />
* [[Thrombocytopenia|Low platelet count]]<ref name=":1" />
* Ear infection<ref>{{cite web |title=Diseases and Conditions: Rubella: Complications |date=13 May 2015 |website= mayoclinic.org |publisher=Mayo Foundation for Medical Education and Research |url= http://www.mayoclinic.org/diseases-conditions/rubella/basics/complications/con-20020067 |url-status=live |archive-url=https://web.archive.org/web/20150518082651/http://www.mayoclinic.org/diseases-conditions/rubella/basics/complications/con-20020067 |archive-date=18 May 2015 }}</ref>

Coryza in rubella may convert to [[pneumonia]], either direct [[viral pneumonia]] or secondary [[bacterial pneumonia]], and [[bronchitis]] (either viral bronchitis or secondary bacterial bronchitis).<ref>{{cite book |first=M. |last=Michael |chapter=Rubella: Report of Epidemic of Eighty Cases |title=Archives of Pediatrics |page=604 |editor-first=E.B. |editor-last=Treat |year=1908 |chapter-url=https://books.google.com/books?id=1uFFAAAAYAAJ&pg=PA604 |url-status=live |archive-url=https://web.archive.org/web/20151125000500/https://books.google.com/books?id=1uFFAAAAYAAJ&pg=PA604 |archive-date=2015-11-25 }}</ref>

===Congenital rubella syndrome===
{{main|Congenital rubella syndrome}}
[[File: Cataracts due to Congenital Rubella Syndrome (CRS) PHIL 4284 lores.jpg|thumb|upright=1.3|Child with cataracts in both eyes due to congenital rubella syndrome]]
Rubella can cause [[congenital rubella syndrome]] in the newborn, this being the most severe sequela of rubella. The syndrome (CRS) follows intrauterine infection by the rubella virus and comprises cardiac, cerebral, ophthalmic, and auditory defects.<ref name="pmid15259032">{{cite journal|vauthors=Atreya CD, Mohan KV, Kulkarni S|title=Rubella virus and birth defects: molecular insights into the viral teratogenesis at the cellular level|journal=Birth Defects Res. A|volume=70|issue=7|pages=431–7|year=2004|pmid=15259032|doi=10.1002/bdra.20045|url=https://zenodo.org/record/1229123|access-date=2019-07-05|archive-date=2020-08-06|archive-url=https://web.archive.org/web/20200806213719/https://zenodo.org/record/1229123|url-status=live}}</ref> It may also cause prematurity, low birth weight, neonatal thrombocytopenia, anemia, and hepatitis. The risk of major defects in [[organogenesis]] is highest for infection in the [[Pregnancy#First trimester|first trimester]]. CRS is the main reason a vaccine for rubella was developed.<ref name="pmid16580940">{{cite journal|vauthors=De Santis M, Cavaliere AF, Straface G, Caruso A |title=Rubella infection in pregnancy|journal=Reprod. Toxicol.|volume=21|issue=4|pages=390–8|year=2006|pmid=16580940|doi=10.1016/j.reprotox.2005.01.014}}</ref>

80–90% of mothers who contract rubella within the critical first trimester have either a miscarriage or a stillborn baby.<ref name="pmid16022642" /> If the fetus survives the infection, it can be born with severe heart disorders ([[patent ductus arteriosus]] being the most common), blindness, deafness, or other life-threatening organ disorders. The skin manifestations are called "blueberry muffin lesions".<ref name="pmid16580940"/> For these reasons, rubella is included in the [[TORCH complex]] of perinatal infections.<ref>{{Cite web |title=TORCH Syndrome |url=https://rarediseases.org/rare-diseases/torch-syndrome/ |access-date=2022-05-18 |website=NORD (National Organization for Rare Disorders) |language=en-US |archive-date=2017-06-27 |archive-url=https://web.archive.org/web/20170627074729/https://rarediseases.org/rare-diseases/torch-syndrome/ |url-status=live }}</ref><ref>{{Cite journal |last1=Epps |first1=R E |last2=Pittelkow |first2=M R |last3=Su |first3=W P |date=1995-06-01 |title=TORCH syndrome |url=https://doi.org/10.1016/s1085-5629(05)80016-1 |journal=Seminars in Dermatology |volume=14 |issue=2 |pages=179–186 |doi=10.1016/s1085-5629(05)80016-1 |issn=0278-145X |pmid=7640200 |access-date=2022-05-18 |archive-date=2023-01-13 |archive-url=https://web.archive.org/web/20230113143047/https://linkinghub.elsevier.com/retrieve/pii/S1085562905800161 |url-status=live }}</ref>

About 100,000 cases of this condition occur each year.<ref name=Lambert15/>