OVERVIEW
Rubella encephalitis, which is also known as TORCH (an acronym for a group of pathogenic microorganisms), is one of the complications caused by human infection with the rubella virus. Rubella encephalitis is a complication of rubella virus infection in humans. 1 in 5,000 to 10,000 children with rubella may develop rubella encephalitis, and it has been found that rubella encephalitis is not uncommon in children. The disease develops with lethargy and spasms one to three days after the rash appears. 75% of cases resolve in less than two weeks. Chronic progressive encephalitis may also be present.
Causes
Rubella encephalitis is caused by a viral infection, and the pathogen is mainly transmitted through the respiratory tract. It is usually seen in children, but can also occur in adults and the elderly. In the case of newborns, intrauterine infection with rubella virus should be considered. Intrauterine infection can cause miscarriage, stillbirth, preterm labor, and many other manifestations.
Symptoms
1. Rubella encephalitis
Rubella encephalitis may be characterized by deafness, small eyeballs, cataracts, glaucoma, retinal abnormalities, mental retardation and small head. Neurologic symptoms such as epilepsy, mental retardation and neurologic symptoms may also appear gradually in the first few years of life. They usually occur 1 to 7 days after the onset of the rash and include headache, lethargy, vomiting, diplopia, neck tonus, coma, convulsions, ataxia, and limb paralysis. Cerebrospinal fluid changes are similar to other viral encephalitis. The course of the disease is short, and most patients recover spontaneously after 3-7 days, while a few may have sequelae.
2. Progressive rubella encephalitis
Progressive rubella encephalitis is a progressive neuropathy that occurs in children with congenital rubella and may be caused by reactivation of rubella virus infection. The disease usually develops in the 20s, with behavioral changes, cognitive deficits, and dementia often being the first symptoms, presenting with cerebellar ataxia, myoclonus that is less pronounced than in subacute sclerosing total encephalitis (SSPE), and seizures that may be present. There is no headache, fever, or cervical rigidity, and the course of the disease is similar to that of SSPE, with the development of coma and brainstem involvement often leading to death within a few years. The course of the disease may be prolonged for 8 to 10 years.
Examination
1. Virus isolation
Infants with congenital rubella may continue to carry the disease for several months, and rubella virus can be isolated from their pharyngeal secretions, urine, cerebrospinal fluid and other organs. However, the positive rate of virus isolation decreases with age.
2. Serologic examination
Measurement of rubella antibody, if rubella specific IgM antibody is positive, it indicates recent rubella infection, which is helpful for diagnosis. In secondary rubella virus infection, serum hemagglutination inhibiting antibodies may persist for life.
3. Other
Pathologic changes are predominantly chronic meningitis with foci of necrosis in the periventricular basal ganglia and brainstem. Delayed myelination is not uncommon, and can be seen as enlarged ventricles on CT and mild diffuse brain atrophy on MRI. CT is preferred for evaluation of delayed cerebral myelination.
Diagnosis
Diagnosis of rubella virus infection is confirmed by the combination of clinical manifestations and laboratory tests.
Differential diagnosis
Rubella encephalitis should be differentiated from poliomyelitis, encephalitis caused by coxsackievirus, and subacute sclerosing encephalitis caused by measles virus.
Treatment
Clinical treatment is mainly symptomatic and supportive. Immunoglobulin, leuprolide, etc. can be tried or can relieve symptoms, reduce the condition and shorten the course of the disease. Vaccination can prevent the onset of the disease.
Prognosis
Rubella encephalitis has a poor prognosis, and children should be well cared for, taught and helped to learn about life and develop independent living and labor abilities.