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Congenital rubella syndrome due to rubella infection in early pregnancy, rubella virus infection of the fetus through the placenta, causing fetal congenital malformations. For premature infants born children, congenital heart disease, cataracts, deafness, developmental disorders, known as congenital rubella, or congenital rubella syndrome. The damage caused by congenital rubella syndrome as a temporary exception of a few, but mostly progressive or permanent lesions, and no effective therapy. Rubella virus is a weak resistance to external respiratory viruses, primarily spthrough air droplets directly. Rubella disease all year round, spring, a higher prevalence. Congenital rubella syndrome is caused by what the?
(A) etiology
Rubella virus is mainly spthrough air droplets. Virus present in children with respiratory secretions and infected persons, through coughing, sneezing, talking, etc., to produce droplets, is transmitted by inhalation susceptible. Also susceptible children through with rubella feces, urine contamination with the virus utensils, clothing and other supplies, while the occurrence of .
Rubella virus can be passed to the fetus through the fetus, which is an important way to cause CRS. RV placenta and fetus in the long-term survival and reproduction, resulting in multi-system chronic, progressive infection.
(B) of the pathogenesis
Rubella virus into the upper respiratory tract, the first in the local mucosa and cervical lymph nodes copy propaga


tion, and then invade the blood circulation caused by the 1st viremia. Virus through the system of white blood cells to reach single-copy circulation after the re-entry into the 2nd cause viremia. Rash is mainly caused by the rubella virus, inflammation of the upper dermis of the capillaries, showed capillary congestion and slight inflammatory exudate.
Rubella virus can infect the fetus through the placenta, which was mainly due to improved placental barrier has not yet developed, the virus through the placenta chorionic have persistent infection. First, the initial formation of the placenta during early pregnancy, the defensive barrier function is not perfect, the virus can be passed to the fetus through the placenta; Second, pregnant women infected with rubella in pregnant within 3 months, a time when the three germ layers of fetal differentiation, the formation of the important organs period, cell differentiation was inhibited, the formation of organs are affected, resulting in a variety of congenital malformations. 3 months pregnant before the embryo, fetus, neither the ability to resist the virus, the organ and is in its infancy and therefore vulnerable to rubella virus attacks and hazards. Fetal infection in early pregnancy, the three germ layers are subject to virus attacks, outside, mesoderm, is particularly significant. Affected tissue due to rubella virus infection, resulting in growth retardation of the asexual reproduction cell lines, can be transmitted to progeny cells. Cell differentiation was inhibited, rubella virus is most dangerous teratogenic factors, can cause congenital cataracts, retinitis, deafness, congenital heart disease, microcephaly and mental retardation. These diseases can be obvious at birth, but after birth a few weeks, months or even years can be clearly demonstrated. Gradual emergence of ventilation, deafness, retinopathy; increases with age, but also of learning difficulties, behavioral disorders, muscle strength is weak, activity imbalance and other symptoms, and sensory disturbances occur. Even if the deformed children born full term, weight less, with 10% -20% 1 year after birth, about death. Experts study shows that the incidence of fetal malformations, and rubella virus infection in pregnant women sooner or later, generally in early pregnancy, the risk of large primary infection, with the growth of gradually decreasing gestational age. What are the performance of congenital rubella syndrome and how to diagnose?
Rubella infection in pregnant women may be asymptomatic, or only upper respiratory tract infection symptoms such as fever, swollen lymph nodes (especially the occipital lymph nodes and lymph nodes behind the ear), and rash and a series of symptoms. Women infected with rubella during early pregnancy, the fetal loss, stillbirth more than the normal pregnancy. Labor troubles are more infant deaths with congenital rubella. Some of the normal newborn at birth. Also have developmental disabilities; there were obvious clinical manifestations have occult infection, but fetal infection in early pregnancy, almost all organs are possible temporary or permanent, progressive damage. After birth showed severe liver, splenomegaly, jaundice, purpura, full anterior fontanel, or cerebrospinal fluid cells increased and so on. Found at birth, congenital heart disease, cataracts, deafness, microcephaly, with its poor prognosis. If rubella viral hepatitis, blood alkaline phosphatase and bilirubin transfer combined with increasing urethane increased; as interstitial pneumonia, respiratory distress can occur.
1. By the time classification of congenital rubella syndrome, according to the time divided into 3 categories:
(1), congenital rubella syndrome: significant damage, including the neonatal period.
(2) delayed onset of congenital rubella syndrome: including the neonatal period is not obvious and significant damage later.
(3) Late congenital rubella performance: including emerging damage. Between these types can overlap.
2. Clinical manifestations of congenital rubella syndrome complex, multi-body system involved.
(1) the performance of birth: live birth infants can suffer from the performance of some acute diseases such as neonatal thrombocytopenic purpura, at birth of various sizes scattered with purple spots, and often accompanied by lesions and other temporary Ministry of long bone epiphyseal calcification bad, hepatosplenomegaly, hepatitis, hemolytic anemia and full anterior fontanel, or may have increased cerebrospinal fluid cells. These serious manifestations of congenital infection. Born with low birth weight, congenital rubella often cause intrauterine growth retardation, often as small for gestational age children born, there were reports of congenital infection in children less than 60% of birth weight 10th percentile, 90% less than the first 15 percentile. About half of children with birth weight less than 2500g. Other manifestations of congenital heart disease, cataracts, deafness and head malformations, the prognosis is poor. Based on 58 cases of purpura in infants suffering from the results of follow-up 1 year, mortality as high as 35%. Rubella can also occur in the neonatal period of viral hepatitis and interstitial pneumonia.
(2) hearing loss: 66%, mostly bilateral sensorineural hearing loss or associated with conduction disorders, the extent of damage on both sides of the basic - To, the incidence of congenital rubella deafness, with the increased age of the detection test rate of increase in the degree of hearing loss can be light weight, subsequent language development disorders lead. Deafness is caused by degeneration of cochlear and development of Corti caused by poor control. Hearing the first 1 year after birth can be of deterioration, but also develop hearing loss suddenly.
(3) eye damage: 78%, mostly bilateral, with the highest incidence of cataract, cataract may be small at birth or can not be found, must be carefully examined with the ophthalmoscope. Followed by congenital glaucoma, corneal showed increased turbidity. Increased anterior chamber depth, intraocular pressure high. Congenital rubella glaucoma surgery must be carried out. Neonates may have a transient corneal opacity, but it can go away, nothing to do with rubella. Often associated with small eye cataracts exist. Retinal melanin spots common in congenital rubella, it may be the only form of eye damage. Unilateral common retinal melanin spots, the spot size and shape are quite different vision without prejudice to such change will help the diagnosis of congenital rubella.
(4) cardiovascular malformations: the first 2 months of pregnancy rubella virus infection in congenital rubella syndrome occurs in about 58% of children with cardiac damage, the most common for the patent ductus arteriosus, was isolated from the duct wall of rubella virus-positive, pulmonary artery and its branches also narrow room, ventricular septal defect, pulmonary stenosis, TOF psychosis. The general performance of children with heart damage at birth is not serious, but also in life occur within 1 month after heart failure.
(5) central nervous system lesions: 62%, mainly as mental retardation, microcephaly, severe motor impairment and typical bilateral spastic paralysis can be seen. A few weeks after birth, the presence of soft meningitis, encephalitis, anterior fontanel fullness. Irritability, lethargy, muscle tone disorders, paroxysmal spasms. Increased cerebrospinal fluid cell count and protein increased. There are reports of light, chronic encephalitis, 50% of the cerebrospinal fluid, or other parts of the detachable the rubella virus, severe virus isolation positive rate as high as 70% or more, few can be expressed as chronic progressive panencephalitis. Sick child intellectual, behavioral and movement disorders are the result of congenital rubella encephalitis. And may be permanent damage.
(6) Other: such as thrombocytopenia, neonatal thrombocytopenic purpura, the occurrence rate of 15% ~ 58%. More than 1 month after birth disappeared. Hemolytic anemia, systemic lymph node tumor, hepatosplenomegaly, hepatitis, jaundice, bone damage, cartilage does not grow capillaries, X line see the distal femur and proximal tibial epiphyseal end of the density reduction, similar to congenital syphilis changed costal side is also true. Skin rash, abnormal dermatoglyphics, inguinal hernia, pneumonia, rubella, and so other gross deformities.
1. Epidemiological data of pregnant women with rubella early in pregnancy, a history of exposure or disease history. And has been confirmed in the laboratory have been affected by maternal rubella infection.
2. Born with abnormalities in children with congenital defects in one or more of the performance.
3. Identify specific IgM antibodies in serum or cerebrospinal fluid of early infant samples, the presence of specific rubella IgM antibodies, can be diagnosed as congenital rubella.
4. Persistent IgG antibodies in children at the age 8 to 12 months have been passively acquired maternal antibodies do not exist, consecutive serum samples, there is still a considerable level of ongoing rubella IgG antibodies, all contribute to the diagnosis of congenital rubella.
The diagnosis of congenital rubella depends on virological and serological examination. For children suspected of having congenital rubella, pharyngeal secretions, urine, cerebrospinal fluid, or other pathological tissue can be isolated from the diagnosis of rubella virus. [3] Next


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