Question

Causative Agent: HSV:1

A 13 year old boy was taken to the hospital's emergency room by ambulance. His mother had called 911 as he had a generalized fit that morning. Since that time he had been very drowsy. His mother reported that he was well until 24 hours previously, when he started acting strangely- including wandering around the house not knowing where he was. He vomited once the previous evening, but otherwise, had not complained of any specific problems. On examination, he was drowsy but responsive. He was unable to give a coherent history, and had difficulty in understanding where he was. He was febrile (38.5°C), but had no other abnormal physical signs. An intravenous line was set up and he was started on antibiotic therapy. A CT scan of his brain was performed later in the day, which the radiologist reported as showing "an area of low attenuation in the right temporal lobe extending into the frontal lobe gray matter. There was mass effect with displacement of the right middle cerebral artery." A lumbar puncture was performed later that evening. The CSF showed 500 x 106 red blood cells /L, 57 x 106 white cells/L (predominately lymphocytes), a normal CSF sugar, and a CSF protein level of 4.8 g/L. No organisms were seen in a Gram stain.

Answer 1

5.* The diagnosis of the patient is herpes simplex encephalitis.The causative agent is HSV1 so antibiotic therapy to be discontinued and start immediately antiviral tharapy {aciclovir therapy}.There is no prophylactic vaccine against HSV infection.

*The LONGER TERM EFFECTS are;

-memory problems

-personality changes

-speech problems

-epilepsy

-partial paralysis{hemiparesis}

-hallucination