Question

Cindy is a thirty-five-year-old volunteer in an inner-city church-sponsored preschool program. The mothers of the neighborhood are encouraged to bring their children to the program for a “time out.” Most of the children are present on an irregular basis one or two times a week.

            One day, Zach, a 2½ year-old became ill during his stay. A rash of small red spots that were not raised above the skin surface was observed during his changing, and he had a slight fever. His mother was located and encouraged to take him to the local clinic.

            Shortly after this, Cindy confirmed what she had suspected for about a month—a home pregnancy test was positive. At her visit to the obstetrician, Cindy relayed the story of Zach’s illness to the nurse when asked if she had recently been exposed to any illnesses. Cindy had not been overly-concerned about Zach’s rash but had seemed to be mildly ill herself about three weeks after that incident. The obstetrics nurse seemed to be very interested in this exposure and said that they would contact the clinic and see if Zach had visited and been diagnosed. Blood tests were also ordered for Cindy.

Laboratory Results

            The initial hemagglutination inhibition test indicated an antibody titer of 1:16. Subsequent sera collected 10 and 21 days later showed no significant change. There was no significant level of IgM-specific antibody detected.

Which of these is most characteristic of Zach’s symptoms

		Rubeola
		Scarlet Fever
		Rubella
		Chicken pox 2)How could Zach’s illness have been prevented? Be specific 3)A rise in titer over 10 to 21 days and the presence of the specific IgM type antibiodies is diagnostic of a current infection in this illness. Based on the laboratory results given in this case study, Cindy’s baby is at risk for congenital rubella syndrome?true/false 4)

Answer 1

1. Answer: Rubella.

• Rubella is a viral infection with clinical manifestations of mild fever and spot like rashes.
• Zach’s symptoms suggest that his illness is due to Rubella infection.

2.

• There is no specific treatment for the disease, except isolation, keeping hydrated and rest.
• Prevention includes vaccination.
• MMR or Measles-Mumps-Rubeola vaccine is given to prevent the disease.
• Two doses of the vaccine is administered by injection, at 12 months and 18 months of age.
• It may also be given at older age and to pregnant women for prevention of the disease.
• Thus, the disease could be prevented in Zach, if he had been vaccinated.

3.

• Rubella virus may spread from mother to fetus, if the mother contracts the disease during pregnancy.
• This is referred to as congenital Rubella infection (CRI), which may lead to abortion, still birth, teratogenic condition, and other complications in the fetus.
• Hemagglutination test is thus required to be conducted in pregnant women to prevent CRI conditions.
• Rubella antigen induces the production of antibodies IgM and IgG.
• If IgM is present in test, it indicates a recent infection or exposure to Rubella.
• IgG antibody may be present if there was a previous infection or due to immunization.
• The HAI test value less than 1:8 indicates that no immunity has been established against the infection and CRI may result.
• HAI value greater than 1:20 indicates established immunity against Rubella.
• HAI value 1:10 to 1:20 indicate immunity development against Rubella.
• Thus, HAI value of 1:16 in this case suggest that Cindy has developed a immune response against the disease and has lesser chance of CRI condition.
• False