Ringlet rubella (erythema infectiosum)

The teething troubles Ringlet rubella (erythema infectiosum) are one of several possible manifestations of erythrovirus (parvovirus B19) infection. Not to be confused with the relatively harmless ringlet rubella and rubella.

What is rubella?

Ringlet rubella are a common and highly contagious disease, primarily in childhood, which adults can also develop. The distinctive, butterfly-shaped, crimson facial rash that spreads across the cheeks is characteristic of rubella.

The historical name of rubella as the "fifth disease" is now used mainly in the English-speaking world and comes from the original cataloging of childhood diseases associated with a rash. In most children, rubella disease is mild and requires little treatment, but it can cause serious complications in adulthood.

Typically, children between the ages of 5-15 are particularly affected. By the time they reach adulthood, it can be assumed that half of the adolescents are immunized through contact with rubella.

causes

The causes are Ringlet rubella by the human erythro virus. This human pathogenic virus is so small that it only consists of one strand of DNA. It could only be verified as a cause of rubella in 1981. The erythrovirus multiplies in the bone marrow via so-called precursor cells of red blood cells and is transmitted via secretions from the respiratory tract (saliva or nasal mucus).

An infection with rubella can also be triggered by direct contact with infected people. The time between infection and the appearance of symptoms (incubation time) is usually between 4 and 21 days for rubella. There is a particular risk of infection in the days before the onset of symptoms.

Symptoms, ailments & signs

The disease is very different in its severity, some people remain without symptoms and do not even notice that they are infected. The garland-shaped rash is the most typical sign of rubella, although not all patients experience it. It is also called the children's red run. It forms around four to fourteen days after infection.

It spreads in waves on the cheeks and forehead, it does not affect the region around the mouth. One also speaks of a butterfly-shaped rash because it is symmetrical in the area around the nose in a shape that is reminiscent of a butterfly. In the rest of the body, it is particularly evident on the legs, arms and buttocks.

The rash fades a few days after it started; but can flare up repeatedly over a longer period of time. Sun exposure or heat favor this renewed breakout. As a rule, the red spots do not cause discomfort, in some people they cause itching.

In addition, flu-like symptoms can occur. The patient feels sick, tired and sometimes has a fever. Because the virus also causes anemia, the skin becomes pale. The heart rate may increase as the heart has to work harder to supply enough oxygen to the body despite the anemia.

Diagnosis & course

Most people with Ringlet rubella have no signs or symptoms. When symptoms occur, they vary greatly depending on the age of the sick person. Early signs and symptoms of rubella in children may include a sore throat, mild fever, upset stomach, headache, tiredness, or itching. A pronounced bright red rash may appear on the face, usually on both cheeks, a few days after the first symptoms of rubella appear.

In the further course, the pink-colored and slightly raised rash extends to the arms, torso, thighs or buttocks and already heralds the last phase of rubella. The volatile rash can persist for several weeks. Adults with rubella usually do not develop the characteristic cheek rash. Instead, joint pain occurs primarily in the hands, wrists, knees or ankles, which can last for several weeks.

Complications

In healthy people, complications from rubella disease are rarely to be feared. However, there is sometimes a risk for pregnant women and people who suffer from immunodeficiency.

One possible complication of erythema infectiosum is involvement of the joints. It is noticeable through painful joint inflammation, which occurs particularly in the small joints. Young women and girls are particularly affected by this effect. The duration of the symptoms varies between two weeks and a few months. In the further course they regress again even without therapy.

Some rubella complications arise because the viruses specifically target erythrocytes (red blood cells) and their precursor cells. If a patient suffers from hemolytic anemia (anemia) at the same time, there is a risk of aplastic crises. During this process, the person's bone marrow can temporarily no longer produce red blood cells. The parvovirus B19 is responsible for this. The aplastic crisis is often the first indication of spheroidal cell anemia.

If there are innate or life-long immune system defects, this results in a disruption in the eradication of the rubella virus. The effect of this is often chronic relapsing anemia. A typical indication is that no specific antibodies directed against the parvovirus B19 can be detected in the affected persons.

There is also danger in pregnancy. In a third of all pregnancies, the virus attacks the placenta, so that it is transmitted to the unborn child and there is a risk of severe anemia.

When should you go to the doctor?

Treatment is often not necessary for rubella. The symptoms subside within seven to fourteen days without the fear of further complications. If you have a fever and flu-like symptoms such as joint pain or nausea, a doctor is recommended. If the characteristic rash appears two to five days after these symptoms, a doctor must be consulted on the same day. A rubella infection during pregnancy requires medical evaluation. The doctor will do an ultrasound scan and see if the child has the condition.

People with haemolytic anemia or immune deficiency are also among the risk groups and should consult their doctor if the symptoms described occur. Rubella can only occur once because the body makes long-term antibodies the first time it becomes infected. If similar symptoms occur again, there may be another disease that must be clarified by a doctor. Rubella is treated by a family doctor or pediatrician. If the condition occurs in connection with an existing illness, the responsible specialist is the right contact.

Treatment & Therapy

Since the Ringlet rubella are a relatively harmless disease, a visit to a doctor is usually not necessary if the disease occurs in childhood. In this case, self-treatment for rubella at home is sufficient and primarily serves to relieve symptoms. Since childhood diseases bring with them an important development boost, it should be ensured that the child drinks enough and has plenty of rest. If you have a high fever or pain, lukewarm calf compresses or paracetamol will help.

If the child or someone in the family has a serious underlying disease that can increase the risk of complications from rubella, a doctor should be consulted at short notice. Since the virus that causes rubella mainly affects the precursor cells of the red blood cells, people with anemia are particularly at risk. In the worst case, an aplastic crisis can be triggered. These patients may need to be hospitalized and receive blood transfusions.

Sick people with a weakened immune system (e.g. AIDS or after organ transplants) receive antibodies through immunoglobulin injections to treat rubella. Rubella infection in the first half of pregnancy can be treated with direct blood transfusion to the fetus or drugs that cross the placenta.

prevention

As a result of infection with Ringlet rubella lifelong immunity is acquired. Since there is no preventive vaccination against rubella, the usual hygiene measures such as hand washing or the use of unused tissues are indicated for prevention.

Aftercare

A ringlet infection usually heals completely within a few days and therefore does not require any special follow-up measures. As the rash and other typical symptoms such as fever, muscle, headache and joint pain subside after about seven to ten days, patients can safely resume their usual activities. To prevent overstressing the body, the general condition of the patient should be taken into account.

Sports activities should be gradually increased again. Longer lasting after-effects are usually to be expected at most as a result of the receding rash. If there is increased itching or if those affected suffer from flaky skin, ordinary skin care products can alleviate these symptoms. However, these skin reactions also usually disappear on their own after a short time.

If serious complications arose during the course of the disease that were treated with medication according to the doctor's instructions, special measures may also be required. Patients with a weakened immune system or anemia should follow the individual guidelines of their doctor.

You may have to consider longer regeneration times with physical rest. As high-risk patients, pregnant women should also strictly follow the recommendations of their doctor. Once the ringlet infection has healed, patients can no longer get infected again. You are immune to the disease for life.

You can do that yourself

Ringlet rubella cannot yet be treated specifically, but it usually heals on its own. The most important self-help measure is to take it easy and take the medication prescribed by a doctor.

If the child suffers from ringlet infection, the parents must provide the child with sufficient fluids and light food. A tried and tested home remedy for itching are cooling compresses. Alternatively, you can use fatty creams from the pharmacy. In addition, the sick person should not come into contact with healthy people. It is advisable to observe the child carefully so that the necessary measures can be taken immediately in the event of any complications. A high fever, severe itching and persistent gastrointestinal complaints require medical clarification. If the rubella does not subside within two weeks, a doctor's visit is also necessary.

If the rubella infection occurs during pregnancy, regular follow-ups must be taken. The doctor uses an ultrasound examination to determine whether the pathogen has passed on to the unborn child and, if necessary, can initiate suitable therapy. Patients with a disturbed immune system must be supplied with special antibodies if they are chronically anemic.