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Archives de pédiatrie
Volume 20, n° 8
pages 858-862 (août 2013)
Doi : 10.1016/j.arcped.2013.05.010
Received : 14 October 2012 ;  accepted : 28 May 2013
Encéphalite rubéolique : observation récente d’une fréquence inhabituelle
Epidemic of rubella encephalitis
 

N. Ben Achour, H. Benrhouma, A. Rouissi, H. Touaiti, I. Kraoua, I. Turki, N. Gouider-Khouja
 UR06/11, service de neurologie de l’enfant et de l’adolescent, institut national Mongi Ben Hmida de neurologie, 1007 Tunis, Tunisie 

Auteur correspondant.
Résumé

L’encéphalite est une complication rare de la rubéole. Nous en rapportons 9 observations colligées durant l’épidémie de rubéole ayant sévi en Tunisie durant la période mai–juin 2011. Il s’agissait de 8 garçons et 1 fille non vaccinés contre la rubéole. L’âge moyen était de 11,6ans. Le délai moyen entre l’exanthème et les manifestations neurologiques était de 3j. Les crises épileptiques avaient été le symptôme inaugural dans les 9 cas. Un ralentissement du rythme de fond à l’électroencéphalogramme (EEG) avait été noté chez 8 enfants. L’imagerie par résonance magnétique (IRM) cérébrale était normale chez 8 enfants. Un séjour en réanimation avait été nécessaire chez 4 enfants. Ces observations d’encéphalite rubéolique illustrent la gravité potentielle de cette affection. La survenue d’une épidémie est expliquée par l’insuffisance de couverture vaccinale et l’émergence virale (phénomène multifactoriel). Au décours de cette épidémie, le programme vaccinal a été révisé et il sera élargi aux garçons en Tunisie.

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Summary

Rubella is a mild viral illness in children. Rubella encephalitis is an extremely uncommon complication of rubella affecting unvaccinated children, aged between 5 and 14 years. From May to June 2011, we observed 9 cases of rubella encephalitis diagnosed during an epidemic of rubella. All were previously healthy (8 boys and 1 girl). None of them had received rubella vaccine. The mean age was 11.6 years. The onset of neurological symptoms occurred within 1–5 days after the typical rush and was associated with seizures and altered consciousness in all cases. The presence of serum immunoglobulin M antibody against rubella virus was demonstrated in all patients. EEGs showed slow wave activity in all patients and brain MRI was normal in the 9 cases. Full recovery was obtained in all patients. However, 4 of them required intensive care unit referral. Acute encephalitis is an extremely rare complication of rubella. The main neurological findings are headache, ataxia, and hemiplegia. Epileptic seizure and altered consciousness are rarely observed. Rubella encephalitis is generally self-limiting with about 80% recovery rate with no sequelae. However, severe courses have been reported. These cases illustrated the potential severity of rubella and they should be prevented by encouraging widespread early childhood vaccination. In Tunisia, rubella encephalitis has been reported once previously and vaccination against rubella virus has only recently been included in the national vaccination program, prescribed only for adolescent females. Following this rubella epidemic, vaccination strategies in Tunisia have been revised.

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