Progressive rubella panencephalitis

Progressive rubella panencephalitis
Specialty	Infectious disease

Progressive rubella panencephalitis (PRP) is a neurological disorder which may occur in a child with congenital rubella.[1] It is a slow viral infection of the brain characterized by chronic encephalitis, usually manifesting between 8–19 years of age. It is believed to be due to a persistence or reactivation of rubella virus infection.

Cause

It develops 6 months to 4 years after the primary rubella infection, which in most cases is a congenital rubella. In children with congenital rubella infection the deficits remain stable; neurological deterioration after the first few years of life is not believed to occur.

Progression of the disease can be divided into two stages:

1st stage: Behavioural Changes
- insidious onset
- subtle changes in behaviour and declining school work
2nd stage: Neurological Changes
- seizures – sometimes myoclonic
- cerebellar ataxia
- spastic weakness
- retinopathy, optic atrophy
- frank dementia leading to coma
- spasticity and brainstem involvement with death in 2–5 years

Diagnosis

The diagnosis is considered when a child with congenital rubella develops progressive spasticity, ataxia, mental deterioration, and seizures. Testing involves at least CSF examination and serology. Elevated CSF total protein and globulin and elevated rubella antibody titers in CSF and serum occur. CT may show ventricular enlargement due to cerebellar atrophy and white matter disease. Brain biopsy may be necessary to exclude other causes of encephalitis or encephalopathy. Rubella virus cannot usually be recovered by viral culture or immunohistologic testing.

Treatment

Although no specific treatment exists, the disease can be managed with anticonvulsants, physiotherapy, etc.

Incidence

PRP is very rare and similar to SSPE but without intracellular inclusion bodies. Only 20 patients have been identified since first recognized in 1974.

gollark: Also, you could use GPT-J and stuff if you have a lot of compute.

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gollark: Did you look into that thing for bodging long-term memory capability atop GPT-2?

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References

Moore, David P. (2008). Textbook of clinical neuropsychiatry (2nd ed.). London: Hodder Arnold. p. 507. ISBN 9780340939536. Retrieved 6 August 2017.

Townsend JJ, Baringer JR, Wolinsky JS, Malamud N, Mednick JP, Panitch HS, Scott RA, Oshiro L, Cremer NE (1975). "Progressive rubella panencephalitis. Late onset after congenital rubella". N. Engl. J. Med. 292 (19): 990–3. doi:10.1056/NEJM197505082921902. PMID 1117960.
"Rubella". Merck Manual.
Haukenes, G. (2002). "40. Slow viruses: Conventional Slow Virus Infections – Subacute Sclerosing Panencephalitis (SSPE)". In Haaheim, L. R.; Pattison, J. R.; Whitley, R. J. (eds.). A Practical Guide to Clinical Virology (2nd ed.). Wiley. ISBN 9780470844298. Archived from the original on 2011-02-08.

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[1] Moore, David P. (2008). Textbook of clinical neuropsychiatry (2nd ed.). London: Hodder Arnold. p. 507. ISBN 9780340939536. Retrieved 6 August 2017.