3. Travel and Infectious History
Travel and Infectious History
- Ten days before admission, the patient returned from 2 months of
travel in Asia - He prepared his own food, used only boiled water, and did not swim
in any river or lake - He was in his usual state of good health on return to the US
- He received Japanese encephalitis vaccine prior to the trip
- Outdoor cats at home, no scratches on patient
- No tick or mosquito bites and no sick contacts reported
- Japanese encephalitis usually demonstrates bilateral thalamic lesions,
especially hemorrhage on MRI
(Kumar S et al. Neuroradiology 39:180, 1997)
Physical Exam
- afebrile, vital signs stable
- lethargic, but oriented to time and place
- no rash
- no facial asymmetry or focal neurologic deficits
- increased tone in the left leg but 5/5 strength in all extremities
- Babinski reflex downgoing, no Brudzinski’s sign
- no lymphadenopathy
Admission Labs
| Na+ | 134 | (135-145 mmol/L) | |
| K+ | 3.8 | (3.5-4.5 mmol/L) | |
| Cl- | 98 | (96-106 mmol/L) | |
| C02 | 26 | (22-30 mmol/L) | |
| BUN | 11 | (8-18 mg/dL) | |
| Cr | 1 | (0.5-1.2 mg/dL) | |
| Ca ++ | 8.8 | (8.8-10.2 mg/dL) | |
| Mg + + | 3 | (1.8-3.0 mg/dL) | |
| PO4- | 2.2 | (3.1-4.5 mg/dL) | |
| Phenytoin | 9 | (10-20 mg/mL) | |
| WBC | 7.1 | (4-10K/mL) | |
| Hb | 15 | (14-18 g/dL) | |
| Hct | 45 | (40-52%) | |
| PLT | 265 | (150-350K/mL) | |
| Seg | 76 | (38-81%) | |
| Lymph | 14 | (14-46%) | |
| Mono | 10 | (2-15%) | |
Breakpoint #3
- How would you proceed at this point?
