Understanding Ruby Virus and Rubella

Hi guys! This one is going to be a little bit different than most of my videos because there's not going to be any drawing. My Surface Pen isn't working properly right now, so while I get that figured out I'm just going to talk directly to you. So in this video we're going to talk about Ruby Virus. Ruby Virus is the causative agent of rubella, which was previously called German measles. thankfully we don't really see it all that much anymore because there's an awesome vaccine that actually takes care of it so ruby virus is technically a toga virus the last time we talked about toga viruses when we were it was when we were thinking about either encephalitis or mosquitoes because all of the other toga viruses are arboviruses they are spread by an arthropod and they therefore can infect invertebrates and vertebrates alike Rubella is actually kind of an exception to that rule then because rubella we are the only host. So we are the only host that the virus actually has a reservoir in and it is not an arbovirus. It is not spread by any sort of vector. It's actually spread by aerosols. All of the toga viruses including ruby virus are enveloped. They are positive sense single-stranded RNA genomes. And with the exception of Ruby virus, the rest of them are all Arboviruses. So let's talk some more about what rubella is. So rubella, I've already mentioned the title here. It's an aerosol virus. So basically coughing, sneezing, talking, spitting, things like that. That's how we're going to spread it person to person. And actually, prior to the vaccine, this one ran rampant through communities, as you would expect. with any good aerosolized virus. Humans, because we're the only reservoir, at one point the last pandemic of this was like 1964 and 1965. These days, very rare, greater than 90% of adults are seropositive. If you are, you know, fairly young on the younger side, then that's probably because you were vaccinated. If you were around in 1964 to 65, it's probably because you were exposed. The vaccine for this one is the MMRV or MMR vaccine. So this is the R in those vaccines. So it's measles, mumps, rubella, and if you're dealing with the V, it's varicella. It's important really to note that vaccination rates, particularly for the MMR and MMRV, have decreased in recent years, as is evidenced by recent outbreaks of measles and mumps. So we need to be concerned again about rubella. For most patients, rubella isn't actually that big a deal, but who it's really a big deal for are pregnant women and their babies. It can spread transplacentally from mother to fetus, and while the mother is viremic, the incidence of congenital infection is actually dependent on the month of gestation, and it decreases significantly after the fifth month. Okay, so in the first month, within the first trimester, we're not that worried about it but by the time you get to the fourth month you're at about six percent so months one two and three that accounts for 18 percent of congenital infections month four six percent month five less than two percent and after about the fifth month we don't really see transplacental infection um but that said if an infant is infected so let's say mom gets ruby virus in like month four okay six per or eighteen percent of children will then or sorry six percent of children will then contract it from their mother during that month the infection will actually persist in the infant in utero for months and if it's not you know appropriately dealt with for years after birth so um this can be a really rough one um to maintain immunity we obviously want vaccination and we also want to make sure that people are getting their boosters at about 10 to 15 years old just to make sure we have a nice protected pool of people. Okay, I'm forgetting how this works. There we go. All right, so what is measles? In general, sorry, German measles, which is different than measles, which is actually the whole point of this slide. So German measles, measles virus, and roseola, which has actually caused by a human herpes virus, which we'll talk about in another video, all kind of form this rash, okay? There are slight differences in the way they present. So like roseola tends to start on the it tends to be more pink, it shows up after the fever subsides, measles tends to start around the hairline and then move down, rubella tends to start on the face and then move down, and there's differences in whether or not it's pruritic or non-pruritic. So you know these are kind of the things that we use to describe the different rashes okay. A typical rubella disease is a two to three week incubation period following exposure. In children it's typically pretty mild. The symptoms, and I'm talking like kids kids, like post utero, so they weren't infected in utero they were infected you know at school. So the symptoms are typically like a low-grade fever, headache, lymphadenopathy, cough, rhinitis, and then the telltale maculopapular rash. Measles and roseola will have their own syndromes. Like I said with roseola, you're still gonna see those fevers and that cough, but less lymphadenopathy. It's kind of an acute onset and then the fever subsides and the rash shows up. With measles, we've already talked about the three C's and P's, so the cough, choriza, and these things are associated with measles and have their own protroom. For rubella, adult infection actually can be more severe and it can include kind of larger body problems, so arthralgia and arthritis. Occasionally you'll see thrombocytopenia or post-infectious encephalopathy, but the real person that we're actually concerned about with rubella or German measles is the fetus because that is the patient that is most at risk. So like I said earlier, the defects are kind of dependent on the month of gestation, and it decreases significantly after the fifth month, okay? There's a whole host of different symptoms that are associated with congenital rubella infection. So, you know, I've got them listed here. So in the first two months, you're thinking neonatal pura pura, cataracts, glaucoma. Any time in the first trimester, so one through three months, we're thinking congenital heart disease. Within the first four months, we see cognitive deficits and deafness. And then five months, retinopathy, cataracts, salt and pepper. So I'll show an image of that in a minute. This neonatal pura pura is sometimes referred to in literature, but never, ever, ever in front of patients as blueberry muffin baby syndrome, because you can see The baby is kind of jaundiced here. See how the skin is kind of sallow? And then you have these big purplish pink splotches, so it almost looks like a blueberry muffin. You might also see hepatitis and pad of Megali observed. There's also this thing called celery stalking which occurs, which is basically where the bones don't fuse correctly. These symptoms probably sound really similar to a lot of the other congenital infection symptoms, particularly CMV. And that's true, you know, because of the way our bodies develop in utero, viruses kind of lead to these similar symptoms over and over and over again. So just looking at this baby, you couldn't necessarily tell if the baby has rubella or CMV. However, the one thing I will point out, congenital cataracts. That is typically associated with rubella, less so with CMV. So just something to kind of keep in mind here. So this is a picture of that right here. You can see kind of right here the cataract in this poor little baby's eye. And then if you were to actually take a look at the visual field here, you can see this salt and pepper retinopathy. This is kind of at the back of the eye. and this is associated with rubella unfortunately it is not particularly treatable to my knowledge so this is glaucoma congenital glaucoma this baby has a severe congenital glaucoma and in this case it's actually more likely to be due to a high intraocular pressure which is causing this corneal edema so if you reduce the IOP the corneas will clear up right away So this has to be treated really aggressively right away. You can perform surgery. There are also some medicines that can help to reduce the blood pressure. Both are typically used really, really quickly. If you were to examine the baby's eyes with a little pressure above and below, it would feel like a marble. Like that's how high the pressure is. and how expanded the eyeball is there. Okay, so let's talk diagnosis and treatment. So for this one, the thing that you want to keep in mind is basically that it's a virus. So we're gonna look toward PCR. PCR becomes even more important when we're thinking about vaccine-eligible diseases because think about it. the whole point of a vaccine is to lead to positive serology. So if you have an unvaccinated individual and you suddenly have a positive IgG or IgM for rubella, well then that's very telling. But if they were vaccinated, that serology really doesn't mean anything unless you can follow it over time. And we don't really want to follow it over time. So PCR is your better bet here. You do want to check titers in pregnant women just to make sure that they are well protected and if not, potentially get those titers up where we want them, preferably before the patient becomes pregnant. Because remember, MMRV is one of those live vaccines. Treatment, there isn't one. It's one of those viruses where we don't really have a good antiviral, but do have a highly effective vaccine. That's all I'm gonna tell you about rubella. We will talk about varicella and some of the other torches infections in separate videos. So the torches infections are like toxoplasma. The O technically stands for other and it includes things like Zika and parvovirus and varicella. This is rubella. The C is for CMV. The H is for herpes, and then the S is for syphilis. So I've made videos for all of those organisms. So if you just want to refresh yourself on the TORCHES infections, that acronym is kind of used to discuss the infections that tend to lead to significant congenital morbidity or mortality. So those are the things that I'd review.

So in this video we're going to talk about Ruby Virus. Ruby Virus is the causative agent of rubella, which was previously called German measles. thankfully we don't really see it all that much anymore because there's an awesome vaccine that actually takes care of it so ruby virus is technically a toga virus the last time we talked about toga viruses when we were it was when we were thinking about either encephalitis or mosquitoes because all of the other toga viruses are arboviruses they are spread by an arthropod and they therefore can infect invertebrates and vertebrates alike Rubella is actually kind of an exception to that rule then because rubella we are the only host.

So we are the only host that the virus actually has a reservoir in and it is not an arbovirus. It is not spread by any sort of vector. It's actually spread by aerosols. All of the toga viruses including ruby virus are enveloped.

They are positive sense single-stranded RNA genomes. And with the exception of Ruby virus, the rest of them are all Arboviruses. So let's talk some more about what rubella is. So rubella, I've already mentioned the title here.

It's an aerosol virus. So basically coughing, sneezing, talking, spitting, things like that. That's how we're going to spread it person to person.

And actually, prior to the vaccine, this one ran rampant through communities, as you would expect. with any good aerosolized virus. Humans, because we're the only reservoir, at one point the last pandemic of this was like 1964 and 1965. These days, very rare, greater than 90% of adults are seropositive.

If you are, you know, fairly young on the younger side, then that's probably because you were vaccinated. If you were around in 1964 to 65, it's probably because you were exposed. The vaccine for this one is the MMRV or MMR vaccine. So this is the R in those vaccines.

So it's measles, mumps, rubella, and if you're dealing with the V, it's varicella. It's important really to note that vaccination rates, particularly for the MMR and MMRV, have decreased in recent years, as is evidenced by recent outbreaks of measles and mumps. So we need to be concerned again about rubella. For most patients, rubella isn't actually that big a deal, but who it's really a big deal for are pregnant women and their babies.

It can spread transplacentally from mother to fetus, and while the mother is viremic, the incidence of congenital infection is actually dependent on the month of gestation, and it decreases significantly after the fifth month. Okay, so in the first month, within the first trimester, we're not that worried about it but by the time you get to the fourth month you're at about six percent so months one two and three that accounts for 18 percent of congenital infections month four six percent month five less than two percent and after about the fifth month we don't really see transplacental infection um but that said if an infant is infected so let's say mom gets ruby virus in like month four okay six per or eighteen percent of children will then or sorry six percent of children will then contract it from their mother during that month the infection will actually persist in the infant in utero for months and if it's not you know appropriately dealt with for years after birth so um this can be a really rough one um to maintain immunity we obviously want vaccination and we also want to make sure that people are getting their boosters at about 10 to 15 years old just to make sure we have a nice protected pool of people. Okay, I'm forgetting how this works. There we go. All right, so what is measles?

In general, sorry, German measles, which is different than measles, which is actually the whole point of this slide. So German measles, measles virus, and roseola, which has actually caused by a human herpes virus, which we'll talk about in another video, all kind of form this rash, okay? There are slight differences in the way they present.

So like roseola tends to start on the it tends to be more pink, it shows up after the fever subsides, measles tends to start around the hairline and then move down, rubella tends to start on the face and then move down, and there's differences in whether or not it's pruritic or non-pruritic. So you know these are kind of the things that we use to describe the different rashes okay. A typical rubella disease is a two to three week incubation period following exposure.

In children it's typically pretty mild. The symptoms, and I'm talking like kids kids, like post utero, so they weren't infected in utero they were infected you know at school. So the symptoms are typically like a low-grade fever, headache, lymphadenopathy, cough, rhinitis, and then the telltale maculopapular rash. Measles and roseola will have their own syndromes. Like I said with roseola, you're still gonna see those fevers and that cough, but less lymphadenopathy.

It's kind of an acute onset and then the fever subsides and the rash shows up. With measles, we've already talked about the three C's and P's, so the cough, choriza, and these things are associated with measles and have their own protroom. For rubella, adult infection actually can be more severe and it can include kind of larger body problems, so arthralgia and arthritis.

Occasionally you'll see thrombocytopenia or post-infectious encephalopathy, but the real person that we're actually concerned about with rubella or German measles is the fetus because that is the patient that is most at risk. So like I said earlier, the defects are kind of dependent on the month of gestation, and it decreases significantly after the fifth month, okay? There's a whole host of different symptoms that are associated with congenital rubella infection. So, you know, I've got them listed here.

So in the first two months, you're thinking neonatal pura pura, cataracts, glaucoma. Any time in the first trimester, so one through three months, we're thinking congenital heart disease. Within the first four months, we see cognitive deficits and deafness. And then five months, retinopathy, cataracts, salt and pepper.

So I'll show an image of that in a minute. This neonatal pura pura is sometimes referred to in literature, but never, ever, ever in front of patients as blueberry muffin baby syndrome, because you can see The baby is kind of jaundiced here. See how the skin is kind of sallow?

And then you have these big purplish pink splotches, so it almost looks like a blueberry muffin. You might also see hepatitis and pad of Megali observed. There's also this thing called celery stalking which occurs, which is basically where the bones don't fuse correctly.

These symptoms probably sound really similar to a lot of the other congenital infection symptoms, particularly CMV. And that's true, you know, because of the way our bodies develop in utero, viruses kind of lead to these similar symptoms over and over and over again. So just looking at this baby, you couldn't necessarily tell if the baby has rubella or CMV. However, the one thing I will point out, congenital cataracts.

That is typically associated with rubella, less so with CMV. So just something to kind of keep in mind here. So this is a picture of that right here.

You can see kind of right here the cataract in this poor little baby's eye. And then if you were to actually take a look at the visual field here, you can see this salt and pepper retinopathy. This is kind of at the back of the eye.

and this is associated with rubella unfortunately it is not particularly treatable to my knowledge so this is glaucoma congenital glaucoma this baby has a severe congenital glaucoma and in this case it's actually more likely to be due to a high intraocular pressure which is causing this corneal edema so if you reduce the IOP the corneas will clear up right away So this has to be treated really aggressively right away. You can perform surgery. There are also some medicines that can help to reduce the blood pressure.

Both are typically used really, really quickly. If you were to examine the baby's eyes with a little pressure above and below, it would feel like a marble. Like that's how high the pressure is. and how expanded the eyeball is there.

Okay, so let's talk diagnosis and treatment. So for this one, the thing that you want to keep in mind is basically that it's a virus. So we're gonna look toward PCR.

PCR becomes even more important when we're thinking about vaccine-eligible diseases because think about it. the whole point of a vaccine is to lead to positive serology. So if you have an unvaccinated individual and you suddenly have a positive IgG or IgM for rubella, well then that's very telling. But if they were vaccinated, that serology really doesn't mean anything unless you can follow it over time. And we don't really want to follow it over time.

So PCR is your better bet here. You do want to check titers in pregnant women just to make sure that they are well protected and if not, potentially get those titers up where we want them, preferably before the patient becomes pregnant. Because remember, MMRV is one of those live vaccines.

Treatment, there isn't one. It's one of those viruses where we don't really have a good antiviral, but do have a highly effective vaccine. That's all I'm gonna tell you about rubella.

We will talk about varicella and some of the other torches infections in separate videos. So the torches infections are like toxoplasma. The O technically stands for other and it includes things like Zika and parvovirus and varicella. This is rubella. The C is for CMV.

The H is for herpes, and then the S is for syphilis. So I've made videos for all of those organisms. So if you just want to refresh yourself on the TORCHES infections, that acronym is kind of used to discuss the infections that tend to lead to significant congenital morbidity or mortality. So those are the things that I'd review.

Transcript for:Understanding Ruby Virus and Rubella

Transcript for:
Understanding Ruby Virus and Rubella