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1/38. Improved dysgammaglobulinaemia in congenital rubella syndrome after immunoglobulin therapy: correlation with CD154 expression.

    A boy with congenital rubella syndrome developed dysgammaglobulinaemia with elevated serum levels of IgM. CD154 was not induced on his peripheral blood mononuclear cells when rubella virus rna was detected in his throat swabs and peripheral blood by reverse transcriptase polymerase chain reaction. Following intravenous immunoglobulin therapy, improvement of immunoglobulin abnormalities, disappearance of rubella virus and normalisation of CD154 expression were demonstrated. CONCLUSION: These findings implicate the efficacy of intravenous immunoglobulin therapy for dysgammaglobulinaemia in congenital rubella syndrome and a role of CD154 for a prolonged virus infection. ( info)

2/38. An epidemic of congenital rubella in barbados.

    Rubella and congenital rubella syndrome (CRS) are preventable, but epidemics of rubella and CRS are not infrequent in the Caribbean and other developing countries. As a result of a surveillance system initiated after an epidemic of rubella in the Barbadian population in 1996, cases of CRS were identified and investigated. A total of seven cases of CRS were proven to be rubella IgM-positive. The infants were found to have a mean birthweight of 2587 g and a mean gestational age of 38 weeks. The clinical course, complications and outcome of those infants were documented and the cost of acute hospital care for each patient was also recorded. Cataracts in four infants, congenital heart disease in three and central nervous system abnormalities in five were the major clinical abnormalities. In four infants, two or more clinical systems were affected. The combined total hospital stay was 105 days (mean 15, range 0-44). A national effort to immunize all those at risk and a strict surveillance programme are essential to prevent future epidemics. This would lead to a significant reduction in the number of cases of rubella and CRS and could effect substantial savings in the national health budget. ( info)

3/38. Multiple aneurysms associated with congenital rubella.

    We describe the case of a woman with congenital rubella who presented with backache. Plain abdominal X-ray revealed calcification of a superior mesenteric artery aneurysm. Intra-arterial digital subtraction angiography demonstrated multiple aneurysms of the arteries to the upper and lower limbs and the viscera. We have not found another report in the literature of the association of congenital rubella with multiple aneurysms. ( info)

4/38. Successful closure of the arterial duct in the setting of rubella syndrome.

    A 9-year-old boy, with significant left-to-right shunting across a large duct in the context of rubella syndrome, was tested during catheterization to establish the feasability of occluding the duct with a device. The testing, including temporary closure of the duct and monitoring of pulmonary vascular reactivity to vasodilative substances, lead to the decision to implant an Amplatzer occluder. Sixteen months later, there was no residual shunting across the duct, and pulmonary arterial pressures had normalised. It remains unclear why the patient had not developed irreversible pulmonary vascular disease. ( info)

5/38. Optical complications in congenital rubella syndrome.

    BACKGROUND: Post-natal rubella (German measles) is a mild illness, occasionally complicated by arthritis or encephalitis. In contrast, in utero infection can have devastating effects. collectively known as congenital rubella syndrome (CRS). methods: Through the introduction of measles, mumps, and rubella (MMR) vaccination programs, the incidence of notifications and deaths from rubella have been reduced by 96%, to 0.4 per 100,000 births. However, CRS persists in patients who predate the commencement of these programs (c. 1969), as well as those not immunized and--rarely--in re-infection of the immune. The stigmata of CRS are widespread, encompassing neural, ocular, and systemic development, and manifest as a spectrum of involvement. RESULTS: In this report, we present a case of CRS, manifesting with both auditory and visual loss, including changes in visual acuity and visual fields. These losses were the result of bilateral pigment retinopathy and cataract, though the patient is also at risk for development of glaucoma. CONCLUSION: Management for ocular CRS is similar to that for age-related macular degeneration, including counseling, regular monitoring, and the provision of low vision devices, if required. ( info)

6/38. prenatal diagnosis of congenital rubella infection in the second trimester of pregnancy.

    OBJECTIVES: This case report describes the clinical presentation, diagnosis and management of a case of acute rubella infection in the second trimester. The complex issues of prenatal diagnosis of a congenital rubella infection are discussed. methods: A 30-year-old woman presented with a fine macular rash at 15 weeks' gestation. Laboratory testing included maternal rubella-specific IgG and IgM detection (booking blood and acute-phase sample) together with measurement of IgG avidity. prenatal diagnosis at 19 weeks (amniocentesis) and 23 weeks (amniocentesis and fetal blood) was done using a reverse-transcriptase polymerase chain reaction to detect rubella-specific rna. The fetal blood sample was also tested for rubella-specific IgM. RESULTS: Maternal serological results confirmed an acute rubella infection at 15 weeks' gestation. Rubella-specific rna and IgM were detected in the fetal blood taken at 23 weeks' gestation. However, no rubella rna was detected in either of the amniotic fluid samples collected at 19 and 23 weeks. CONCLUSION: In second-trimester rubella where risk of fetal damage is low, prenatal diagnosis can identify the rubella-infected fetus, allowing the parents to make a more informed decision about their options. The optimal sample for prenatal diagnosis is fetal blood as no rubella-specific rna was detected in the amniotic fluid. ( info)

7/38. Congenital rubella syndrome due to infection after maternal antibody conversion with vaccine.

    We experienced a case of congenital rubella syndrome (CRS) due to infection after maternal antibody conversion with vaccine. The mother was immunized with rubella vaccine at 14 years of age, and was confirmed as having rubella-specific hemagglutination inhibition (HI) antibody at the 1:16 level both at ages 26 and 30 during preceding pregnancies. At the second week of the third gestation, her second child developed rubella. She did not suffer any symptoms, but was found to have rubella HI antibody at the 1:512 level at 9 weeks of gestation. She delivered a male baby weighing 2,545 g at 38 weeks of gestation. He had congenital pneumonia, patent ductus arteriosus, bilateral cataracts, sensorineural deafness, and periventricular calcification of the brain. The rubella-specific antibody was 1:512 by HI and 10.1 by IgM enzyme-linked immunosorbent assay. According to these observations, he was diagnosed as having CRS. The rubella virus genome was detected in the fluids of the vitreous body using RT-nested PCR. This case emphasizes the importance of double-dose immunization (once in infants and once in young adults) in order to obtain an adequate level of antibody with duration sufficient to ensure the prevention of CRS. ( info)

8/38. A resurgence of congenital rubella in australia?

    Two infants with congenital rubella defects (congenital rubella syndrome) have been reported from queensland in 2003, after an increase in rubella in that State in 2001-2002. The national measles Control Campaign in 1998 aimed to give measles-mumps-rubella (MMR) vaccine to all unvaccinated preschoolers and a second dose to primary schoolchildren. Following the Campaign no children with congenital rubella defects were born to Australian-born mothers during the five years 1998 to 2002, according to reports to the Australian Paediatric Surveillance Unit. However, three imported cases occurred. Broad immunisation coverage and detection and vaccination of susceptible women of child-bearing age before they become pregnant are necessary to prevent further cases. ( info)

9/38. Aortic hypoplasia and right ventricular outflow tract obstruction in a young man with uncontrolled hypertension.

    We report the case of a 35-year-old man who presented to hospital with symptomatic uncontrolled hypertension. He had no other conventional cardiovascular risk factors, but did have previous cataract surgery and patent ductus arteriosus repair. echocardiography revealed normal valves, right ventricular outflow tract obstruction, and heavy calcification of the aortic root compromising luminal diameter. Pulmonary angiography confirmed supravalvular and subvalvular pulmonary stenosis. aortography showed hypoplasia of the entire aortic trunk extending into the iliac arteries, but without involvement of other major branches. A possible unifying diagnosis, with the combination of aortic hypoplasia, pulmonary artery stenosis, patent ductus arteriosus, and cataracts, was believed to have been congenital rubella syndrome. Although associated with numerous cardiovascular abnormalities, aortic hypoplasia is an extremely rare manifestation of congenital rubella that, to our knowledge, has been reported in only two cases in the literature to date. ( info)

10/38. Brief report: Imported case of congenital rubella syndrome--new hampshire, 2005.

    In 2004, an independent panel convened by CDC declared rubella no longer endemic in the united states. Nine cases of rubella were reported in 2004, and four cases of congenital rubella syndrome (CRS) were reported during 2001-2004. However, worldwide, an estimated 100,000 infants are born with CRS annually. This report describes a case of imported CRS diagnosed in an infant girl aged 10 weeks born in new hampshire to Liberian refugee parents. To prevent transmission of rubella, clinicians should consider a diagnosis of CRS in infants with compatible clinical signs, particularly those born to mothers who recently immigrated from countries without rubella control programs, and rubella vaccine should be administered to susceptible persons. ( info)
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