Progressive rubella panencephalitis
Progressive rubella panencephalitis (PRP) is a neurological disorder which may occur in a child with congenital rubella. 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.
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.
Although no specific treatment exists, the disease can be managed with anticonvulsants, physiotherapy, etc.
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
- PEDBASE.org – The Pediatric Database – Progressive Rubella Panencephalitis
- Wiley InterScience – Characterization of immune complexes in progressive rubella panencephalitis
- PubMed – Progressive rubella panencephalitis. Late onset after congenital rubella.
- The Merck Manual – Rubella
- A Practical Guide to Clinical Virology (Second Edition) – 40. Slow viruses: CONVENTIONAL SLOW VIRUS INFECTIONS – SUBACUTE SCLEROSING PANENCEPHALITIS (SSPE)