Principles of Clinical Diagnosis
Susan Bayliss Mallory, Alanna Bree, Peggy Chern in Illustrated Manual of Pediatric Dermatology, 2005
PathogenesisRubella virus member of Rubivirus genus, RNA virus, TogaviridaeVirus spreads through direct or droplet contact from nasopharyngeal secretionsRash may be result of viral dissemination to skinMechanism of embryopathy unknownMorphology of rash with enlarged lymph nodes suggestive of diagnosisSerology with four-fold increase in antibody titers in acute and convalescent serumSpecific IgM antibody in previous infectionViral isolation from peripheral blood leukocytes, stool or urine for months to years after birth in patients with rubella embryopathy or from nasal mucosa in acute disease
Rubella
Avindra Nath, Joseph R. Berger in Clinical Neurovirology, 2020
Rubella virus infects only humans. There is no known animal reservoirs. This virus is a single-stranded, plus-sense RNA virus belonging to the Togaviridae family. It replicates in the cytoplasm. Surface projections of the envelope are distinct glycoprotein spikes composed of two virus proteins forming heterodimers. Its nucleocapsid has icosahedral symmetry. Three structural virion proteins found, the capsid protein, envelope glycoprotein E1 and envelope glycoprotein E2 [1]. Rubella virus is relatively unstable and is inactivated by lipid solvents, trypsin, formalin, ultraviolet light, extremes of pH and heat and amantadine. Based on the sequence of the E1 protein, the virus has two clades and 13 genotypes (Clade 1A, 1B, 1C, 1D, 1E, 1F, 1G, 1H, 1J, 1I and Clade 2A, 2B, and 2C). Importantly, the vaccines do not cover all genotypes but it is assumed that the sequence diversity is small such that immunization with a few will protect against the others.
Parvovirus
Peter M. Lydyard, Michael F. Cole, John Holton, William L. Irving, Nino Porakishvili, Pradhib Venkatesan, Katherine N. Ward in Case Studies in Infectious Disease, 2010
The vast majority of acute parvovirus B19 infections are self-limiting and require no specific therapy. Indeed, there are no effective antiviral agents with activity against parvovirus B19. In pregnancy, it is important to make the diagnosis (and particularly to prove that the infection is not due to rubella virus), as this will allow appropriate counseling of the patient. Parvovirus arthritis may require administration of analgesics and anti-inflammatory agents. Patients with a parvovirus-induced aplastic crisis may require blood transfusion to get them through the acute phase. A similar rationale exists for giving intra-uterine transfusion to babies of infected mothers who present with hydrops fetalis. Some success in the treatment of chronic parvovirus anemia in immunosuppressed subjects has been reported through the use of normal human immunoglobulin, which is a source of potent neutralizing antibodies.
Immunopathology of Virus-Induced Anterior Uveitis
Published in Ocular Immunology and Inflammation, 2018
Jolanda D. F. De Groot-Mijnes, Anita S. Y. Chan, Soon-Phaik Chee, Georges M. G. M. Verjans
Rubella virus is a positive-stranded RNA virus and the only member of the Rubivirus genus within the Togavirus family. It is the causative agent of rubella and congential rubella syndrome.54 Only in 2004, rubella virus was identified as an etiological agent of Fuchs uveitis syndrome (FUS).55 Hence, few reports are available on the immunology and pathology in Fuchs uveitis (FU) patients with a confirmed intraocular rubella virus infection. Therefore, this part will focus mostly on the immunopathology of FU in general. Do note, however, that HCMV and more recently chickungunya virus have also been reported to be associated with FUS-like clinical entities and that in most reports on FUS, it is not clear which virus is involved in the population described.2,37,56
Comparison of Intraocular Antibody Measurement, Quantitative Pathogen PCR, and Metagenomic Deep Sequencing of Aqueous Humor in Secondary Glaucoma Associated with Anterior Segment Uveitis
Published in Ocular Immunology and Inflammation, 2022
Li Wang, Zhujian Wang, Jinmin Ma, Qiongfang Li, Xueli Chen, Yuhong Chen, Xinghuai Sun
Metagenomic DNA sequencing is a key technology to explore DNA/RNA-based etiology from not-yet-cultivated microbes by bioinformatic analysis and can theoretically detect all pathogens in a clinical sample. MDS can identify bacterium, fungi, parasites, and DNA and RNA viruses in minute volume of intraocular fluid samples for ocular diseases. In 2015, Lee et al.16 identified torque teno viruses in seven culture-negative endophthalmitis cases by deep-DNA sequencing and five of whom were confirmed by qPCR. Thus, they provided a testable hypothesis for a pathogenic mechanism in culture-negative endophthalmitis. Moreover, Doan T et al.39 identified rubella virus by MDS in aqueous fluid specimen from one eye and in vitreous sample from the other eye of a 40-year-old man with bilateral, idiopathic chronic anterior and intermediate uveitis, which was subsequently confirmed with RT-PCR. Afterward, the same study group detected six pathogens including CMV, HHV-6, HSV-2, HTLV-1, Klebsiella pneumoniae, and Candida dubliniensis by MDS in 8 of 36 (22%) vitreous samples with infectious uveitis which were tested negative by pathogen-directed PCRs (CMV, VZV, HSV, and T. gondii).40 In 2018, MDS was reported to find fungal, bacterial, amoebal, and cytomegalovirus pathogens in 18 of 20 formalin-fixed corneal specimens with infectious keratitis, which showed potential applications in clinical diagnostics and research.17
Changing Trends in Uveitis in the United Kingdom: 5000 Consecutive Referrals to a Tertiary Referral Centre
Published in Ocular Immunology and Inflammation, 2023
N. P. Jones, S. Pockar, L. R. Steeples
The relevance of Rubella virus in a substantial proportion of patients with FHU is now well established,11,12 and there is supportive evidence in that in the USA, the incidence of FHU has been found to decrease following the introduction of rubella vaccination.13 It is therefore interesting to witness the profound reduction in the incidence of this disease over a period in this clinic, where 30 years ago it was once four times more common than it is now. In the UK nearly 95% of children are rubella-vaccinated by 5 years of age, infection levels are so low that the World Health Organisation has described the disease as “eliminated” in the UK and 5 years ago routine Rubella screening in pregnancy was discontinued owing to low risk. It is likely that the incidence of FHU will reduce further. However, it will not disappear as there is evidence of other potential triggers including cytomegalovirus14 (UK incidence possibly to be increased by immigration from the Far East), and toxoplasmosis.15