Rubella presents with a mild prodromal illness of fever, headache, upper respiratory symptoms, and lymphadenopathy.
The prodrome is often subclinical in children, but tends to be more severe in older patients.
One to five days following the prodrome, the exanthem appears as discrete pink to red macules and papules on the face that spreads to the trunk and extremities within 24 hours (cephalocaudal direction; Fig. 7.3).
Lesions may coalesce to form an erythematous rash reminiscent of scarlet fever.
The eruption is characteristically short-lived, fading in 1 to 3 days in the same order it appeared sometimes accompanied by fine, branny desquamation.
Petechiae may also be present on the soft palate and are called Forschheimer spots.
The exanthem is often accompanied by tender lymphadenopathy especially of the postauricular, suboccipital, and posterior cervical lymph nodes.
Constitutional symptoms usually resolve within 24 hours of the onset of the rash but in some cases the lymphadenopathy persists for weeks.
The clinical features of rubella are not distinctive enough to allow one to make the diagnosis with certainty based on the clinical presentation alone.
Although unnecessary in most cases, acute and convalescent antibody titers (IgM and IgG) can confirm the diagnosis. These tests are important in pregnant women who may have been exposed to rubella.
Erythema Infectiosum |