645 Acute Encephalitis Complicating Rubella: Four Case Reports

Background Rubella encephalitis is a rare complication of rubella with an incidence that has been reported to range from 1/4300 to 1/24000. Methods We report four pediatric cases of acute encephalitis complicating rubella during an epidemic of rubella between March 2011 and November 2011 to the Fattouma Bourguiba Hospital. Results Three males and one female were included. The mean age was 9 years (7–12 years), rubella vaccine have been given only for two patients. Macular rash was reported in three cases. The most clinical symptoms were: headache, fever, loss of consciousness and seizures. Serum immunoglobulin (Ig) M antibodies against rubella virus were present in all cases. In all cases cerebrospinal fluid (CSF) analysis reveals lymphocytic pleocytosis, elevated protein levels and normal glucose levels and the presence of immunoglobulin M antibodies against rubella virus. Electroencephalogram (EEG) showed slow wave activity without focal or paroxysmal features in all cases and computed tomographies of the brain (CT) were normal. Mechanical ventilation was needed in 3. Acyclovir was administered intravenously for all patients given the initial concern of herpes simplex encephalitis. Favourable outcomes in all cases were reported. Conclusion In Tunisia a revision of our vaccination program against rubella is needed. Benefits and the costs of a non-selective vaccination strategy including all children and all women of childbearing age must be weighted to prevent such a severe complication.