CASE HISTORY 4

A 16 year-old white male presented to the ER in August with fever and unresponsiveness. He was reportedly well until two days prior to admission, when he developed low grade fever and lethargy. He gradually became more somnolent. The patient lived in a rural area, and had been playing football frequently in a field next to an old tire dump. In the ER, he was responsive only to deep pain. There were no focal neurologic defects and no other abnormalities on physical examination except for numerous mosquito bites. A CT scan of the head showed no abnormalities. LP showed 400 WBC, 90% lymphocytes, O RBC; protein 40, glucose 60 (both normal) CSF gram stain and culture were negative. EEG showed diffuse slow wave activity, nonfocal. Acute and convalescent viral titers to La Cross virus were negative and 1:640, respectively. After 3 days, the patient became responsive and completely recovered 7 days after onset of illness.

1. Should this patient be isolated?   Answer

2. What is known about the pathogenesis of the infection?   Answer

3. Describe how the viral infection was detected? Prior to the serology, what key laboratory findings pointed to a viral encephalitis?  Answer

4. What is the appropriate treatment for this infection?  Answer

5. Are there any long term consequences associated with this viral infection?  Answer