Novel facial characteristics in congenital rubella syndrome: a study of 115 cases in a cardiac hospital of Bangladesh

Abstract

ObjectiveTo establish novel facial characteristics unique to congenital rubella syndrome (CRS) as prediagnostic criteria to supplement disease diagnosis in patients with or without a history of maternal rubella infection.DesignAn analysis of 115 CRS case series (2018–2020) based on the presence of any of the triad features.SettingOutpatient department of a tertiary care referral cardiac hospital in Dhaka, Bangladesh.ParticipantsIn total, 115 participants (53.1% men) were enrolled. Participants underwent echocardiography if they presented with suspected cardiac symptoms along with deafness, cataract or microcephaly.Main outcome measuresAge, sex and socioeconomic status of the participants; history of maternal vaccination and infection; facial characteristics unique to CRS (triangular face, prominent nose, wide forehead and a whorl on either side of the anterior hairline) named ‘rubella facies’ and frequency of systemic involvements in CRS.ResultsThe median patient age was 2 years. The income of 50.4% of the participating families was <US$1500. Further, 32 mothers (27.8%) were infected with rubella during the first trimester of pregnancy, 15 (13.0%) during the second trimester and 3 (2.6%) during the third trimester. The remainder (65.2%) recalled no history of infection during pregnancy. Rubella facies presented as a triangular-shaped face in 95 (82.6%) cases, a broad forehead in 88 (76.5%) and a prominent nose in 75 (65.2%). A rubella whorl was present on the right or left side of the anterior hairline in 80% and 18.2% of cases, respectively. IgG and IgM antibodies were present in 91.3% and 8.6% of children, respectively. Cataract, deafness, microcephaly, and congenital heart disease were detected in 53.0%, 75.6%, 68.6% and 98.2% of cases, respectively.ConclusionsRubella facies, a set of unique facial characteristics, can support early CRS diagnosis and treatment and may supplement the existing CRS triad.

Incidence, Options of Medical Intervention and Post-Intervention Follow-up of Patients with Patent Ductus Arteriosus: An Experience in Combined Military Hospital, Dhaka

“…We used Indomethacin following the dose schedule 13 and very few patients developed minor complications which were managed promptly. This finding consisted with Begum NNF study 9 . In almost 100% cases, we successfully completed the course of Indomethacin therapy which matches with other study 14 , including one who died after completion of Indomethacin while was on early anti-failure therapy.…”

“…Remaining 29(58%) patients received different modalities of medical therapy and most of the patients (21 out of 29) had their PDA closed. Pharmacologic manipulation is given mainly to pre-term newborn, and almost 90% closure can be achieved if given within 7 days of age 9 . Indomethacin is currently the drug of choice for closure of the PDA in premature infants.…”

Microcephaly in Neurometabolic Diseases

“…This triad is considered to be the major criteria for the diagnosis of Congenital Rubella Syndrome in newborns. There are also minor criteria of CRS, such as: microcephaly, splenomegaly, thrombocytopenia, CRS+ prevention developmental delay, and failure to thrive [ 87 ].…”

“…The diagnosis of CRS is possible when the newborn has two major components of the triad, or one of the triads and one symptom of minor criteria. The detection of rubella IgM antibodies in laboratory tests, or the persistent level of rubella IgG antibodies in the 6–12 month of an unvaccinated newborn and one with the test, also allows for the diagnosis of CRS [ 87 ].…”

“…This vaccine should be given at 9 or 12–15 months of age in combination with the measles and mumps vaccine. Vaccines are designed to prevent CRS [ 86 , 87 ].…”