Diagnosis

The diagnosis is usually made on the basis of the typical garland-shaped rash (exanthema) that can occur in both children and adults. In addition, the suspicion can be confirmed by examination of the blood in the laboratory. Here, anemia can often be diagnosed, since the virus attacks the blood-forming cells.

Specific antibodies can also be detected. In addition, the genetic material (DNA) of the virus can be detected from blood, bone marrow or, in pregnant women, from the amniotic fluid. This is only necessary in rare cases.

How contagious are ringed rubella?

In 60-70% of the adults in Germany a past infection with rubella can be detected. This already indicates that the ringel rubella virus is very contagious (high contact sensitivity). The virus is mainly transmitted by droplet infection, for example by sneezing.

Since small children in particular are affected, who usually pay less attention to hygiene in this area, the virus is quickly transmitted from person to person. The greatest danger of infection comes from infected people even before the symptoms of rubella have appeared, which is why often no precautionary measures (such as staying at home or refraining from shaking hands) are taken. Theoretically, infection can also occur through blood contact, but this is very unlikely.

Infection of unborn children can occur if the mother is ill. The virus is able to cross the border of the placenta (placenta) between maternal and fetal blood (diaplacental transmission). This happens in about one third of pregnant and infected women. Animals (e.g. mosquitoes) cannot be infected with the ringworm virus and therefore play no role in the transmission of the disease. The virus can only survive in humans.

Associated symptoms in adults

The symptoms of rubella in adults are quite variable, as in children. The typical symptoms of rubella infection usually begin 4 days to two weeks after the actual infection.While many adults do not even notice that they are infected with the virus, others complain of flu-like symptoms. These include a feeling of weakness, tiredness and exhaustion, but also fever, headaches, nausea and diarrhoea.

In some cases, joint pain occurs in addition to these symptoms. These are particularly common in the small joints of the hands and feet and affect mainly younger women. The joint pain usually lasts only about one to two weeks.

More rarely, however, pain lasting longer than two months can occur. In almost all infected persons, in addition to the symptoms described above, a so-called anaemia (anemia of the red blood cells) occurs. However, this usually goes unnoticed, as it is only temporary.

Immunocompromised persons, for example chronically ill or elderly people, can also develop persistent anemia. In this case, typical symptoms such as fatigue, paleness and hair loss will appear. In rare cases, other blood cells may also drop in addition to the anaemia.

These include the blood platelets, which are responsible for blood clotting, and the so-called granulocytes, a type of immune cells. The initial stage of rubella is usually characterized by the same symptoms in adults as in children. These include typical flu-like symptoms such as fever, fatigue, tiredness and headaches.

Adults also frequently report severe joint pain in the early stages of rubella infection. While children usually develop a skin rash afterwards, this is less common in adults. Classically, a rash (exanthema) also occurs.

Usually the exanthema begins with a reddening of the face, whereby the nose and mouth, as well as the area directly around the mouth, are not reddened (cheek erythema, slap exanthema). The rash then spreads to the arms, legs and trunk. At first it appears as a general redness with small pimples and then fades with time, revealing a typical curled (also garland-like or net-like) structure.

In many cases the rash is accompanied by mild itching. All these symptoms can occur, but do not have to, as the disease often proceeds without symptoms. In adults in particular, the same symptoms may be more pronounced.

In addition, joint inflammation is much more common in adults, especially in women, than in children, and is particularly concentrated in the fingers, knees and ankle joints. Joint pain (arthralgia) can occur with a rubella infection mainly in adult women, and in rarer cases also in men and children. Overall, this phenomenon is common in 20-50% of infected persons.

The pain is caused by an inflammation of the joints caused by the ringworm virus (parvovirus B19 arthritis). Here, the virus infects the synovial fluid. If the body’s own immune cells attack the virus there, this leads to an inflammatory reaction.

Arthritis in rubella usually affects several joints (polyarthritis) and occurs on the same side (i.e. symmetrically), for example on the finger joints of both the right and left hand. The small joints of the fingers and hand are particularly affected, as are the knee joints and the ankle joints. A specific therapy is usually not necessary here, as the joint complaints usually stop on their own after 3-4 weeks.

Rarely can the pain remain permanent because, for reasons as yet unclear, viruses remain in the synovial fluid. Itching usually does not occur in the context of rubella. Occasionally children report a slight itching in the area of the rash.

This is hardly ever reported in adults, as the rash also occurs less frequently. Should itching occur, cooling the skin or care with moisturizing creams can often help. This measure also prevents the skin from drying out later and often has a positive effect on the duration of the rash.