Management of severe rubella encephalitis requiring intensive care unit admission.

Encephalitis is an inflammation of the brain structures: neurons, vessels or glial cells leading to neurological dysfunction. 1 Kneen R. Michael B.D. Menson E. Mehta B. Easton A. Hemingway C. et al. Management of suspected viral encephalitis in children – association of British neurologists and British paediatric allergy, immunology and infection group national guidelines. J Infect. 2012; 64: 449-477 Abstract Full Text Full Text PDF PubMed Scopus (117) Google Scholar Encephalitis has many causes and herpes simplex encephalitis is recognized worldwide as the most frequent infectious encephalitis with a validated specific treatment. Encephalitis following some viral infections such as measles or rabies can be prevented by vaccination. 1 Kneen R. Michael B.D. Menson E. Mehta B. Easton A. Hemingway C. et al. Management of suspected viral encephalitis in children – association of British neurologists and British paediatric allergy, immunology and infection group national guidelines. J Infect. 2012; 64: 449-477 Abstract Full Text Full Text PDF PubMed Scopus (117) Google Scholar Rubella occurs worldwide and is normally a mild childhood disease. Rubella infection sometimes leads to serious complications, including bleeding disorders, Guillain-Barre Syndrome (GBS), and encephalitis. 2 Chabchoub I. Mejdoub I. Maalej B. Abid D. Aloulou H. Kamoun T. et al. Congenital rubella still exists in Tunisia!. Arch Pediatr. 2011 Nov; 18 ([Epub 2011 Oct 1]): 1191-1195 Crossref PubMed Scopus (3) Google Scholar , 3 Lau K.K. Lai S.T. Lai J.Y. Yan W.W. So T.M. Wong T.Y. Acute encephalitis complicating rubella. Hong Kong Med J. 1998 Sep; 4: 325-328 PubMed Google Scholar In Tunisia, since the Libyan Revolution (February 2011), more than 500,000 refugees with several nationalities fled across the Tunisian border, posing further burdens on state expenditure, despite the influx of international aid. As consequence of this popular invasion, a high number of viral infections (in particular with rubella) were recorded in our country. Finally, in our knowledge the management of severe rubella encephalitis requiring intensive care unit admission was not previously reported. We aimed to detailing the management of severe rubella encephalitis requiring intensive care admission admitted to a medical intensive care unit (ICU) of Habib Bourguiba University hospital (Sfax- Tunisia). Between February 2011 and Mayo 2012, 26 patients with severe rubella encephalitis were admitted to our ICU. The diagnosis of rubella encephalitis was suspected on neurological manifestations associated with a positive history of contact with rubella. Moreover, the diagnosis suspicion, take into the development of fever and a maculopapular rash on ICU and/or a few days before their ICU admission. The positive diagnosis of rubella encephalitis is obtained when serum immunoglobulin (Ig) M antibodies against rubella virus were positive and/or cerebrospinal fluid anti-rubella virus IgM were also positive. The diagnosis of acute encephalitis due to herpes simplex was excluded by a negative serological reaction and/or a negative Polymerase Chain Reaction (PCR). The cerebrospinal fluid (CSF) was analyzed in all cases and bacterial meningitis were also excluded.