Driver Dalin picked me up in his vehicle to visit his home for a consultation. On the way, he explained that his wife Shumin had given birth to a full-term baby boy ten days earlier, weighing less than 4 jin (approximately 2 kg). The infant didn't cry, slept constantly, and showed no response to external stimuli. Shumin, a kindergarten teacher, became distraught upon realizing her child was different from others, crying until her eyes were red. She still hadn't produced any milk. He asked me to examine the child to determine what was wrong.
Upon arriving at their home, I carefully examined the child. He was indeed very small, with overall underdevelopment—a tiny head, small eyes whose pupils I couldn't discern, no hearing, and no response to sound, clearly indicating deafness. When I inquired about Shumin's pregnancy, she stated she had never been ill and hadn't taken any medication.Later, I suddenly recalled that during her early pregnancy, several children in the kindergarten class had contracted an epidemic—fever and rash, milder than measles, resolving within days. This provided a crucial clue.
To confirm the diagnosis, I advised them to have an ophthalmologist examine the child's eyes and send urine and blood samples for laboratory testing. The ophthalmologist later informed me the child had congenital cataracts.Laboratory results confirmed the presence of specific IgM antibodies in the child's blood, and rubella virus was isolated from the urine. This confirmed the child was born with congenital rubella syndrome, a devastating condition caused by the rubella virus that left the child both deaf and blind.
The first to discover rubella's teratogenic effects was an ophthalmologist named Glich. In the early 1940s, the year following a major rubella epidemic in Australia, he observed that nearly all children born to mothers infected with rubella during pregnancy developed congenital cataracts, with some also exhibiting congenital heart defects. Similar findings emerged after a major rubella outbreak in the United States.
Recent research has identified the following characteristics of rubella virus teratogenicity:
1. Rubella is more common in young children, presenting with fever, rash, and swollen lymph nodes. Adult infections often show no obvious symptoms, meaning pregnant women may be infected without realizing it;
2. The earlier in pregnancy, the greater the risk of fetal infection. The infection rate is 50% before 8 weeks gestation and 30% thereafter;
3. The rubella virus can affect most fetal organs, inhibiting cell proliferation and causing growth disorders. Common complications include cataracts, sensorineural hearing loss, encephalitis, seizures, and congenital heart disease;
4. Infants may remain infected for several years post-birth, with the virus detectable in urine, blood, and cerebrospinal fluid—aiding diagnosis;
5. Vaccinating women before pregnancy may prevent rubella infection and subsequent fetal malformations caused by the virus.