Congenital rubella infection

Clinical features

Intrauterine rubella infection: miscarriage, preterm birth, fetal growth restriction (especially likely if infection occurs during the first trimester)
Congenital rubella syndrome
- Triad of congenital rubella syndrome
  - Cardiac defect: most common defect (e.g., patent ductus arteriosus, pulmonary artery stenosis)
  - Cataracts: Other eye manifestations may also occur later in life, including glaucoma and salt and pepper retinopathy (abnormal retinal pigmentation)
  - Cochlear defect: bilateral sensorineural hearing loss
- Early features
  - Hepatosplenomegaly, jaundice
  - Hemolytic anemia, thrombocytopenia
  - Petechiae and purpura, i.e., blueberry muffin rash (due to extramedullary hematopoiesis in the skin)
- Late features
  - CNS defects: microcephaly, intellectual disability, panencephalitis
  - Skeletal abnormalities

Mnemonic

CCC-Triad of congenital rubella syndrome: Cataracts, Cochlear defects, Cardiac abnormality

Prevention
- Maternal preconception immunization with live attenuated rubella vaccine

Treponema pallidum

Perinatal
- Intrauterine fetal demise
- Prematurity, low birth weight
- Focal necrosis of the umbilical cord
Mucocutaneous
- Snuffles: copious rhinorrhea, often purulent or serosanguineous
- Desquamating, maculopapular rash involving palms/soles
- Fissures near orifices (eg, anal, oral)
- Jaundice
Musculoskeletal
- Long bone abnormalities (eg, periosteal thickening, metaphyseal erosion)
  - Bilateral and symmetric metaphyseal erosions and periosteal inflammation of long bones
  - Pathologic fractures
  - Swelling, pain, and limited movement of affected extremities
Reticuloendothelial
- Hepatomegaly ± splenomegaly
- Lymphadenopathy
- Anemia, thrombocytopenia, leukopenia/leukocytosis