Clinical Case Database / Category: Patient Management

A febrile and confused patient

Publication details

Alastair McGregor, Michael Brown
Foundation Years Journal, volume 3, issue 1, p.18 (123Doc Education, London, February 2009)

Abstract

The confused and febrile patient is a staple of acute medical takes. The differential is often wide, ranging from the common but relatively trivial to the rare but life-threatening. Below we present a typical case, discuss the causes not to miss, how to recognise these patients and how to ensure that they are managed optimally.

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Authors

Alastair McGregor

Infectious Diseases and Microbiology
Royal Free Hospital
London

Michael Brown

Hospital for Tropical Diseases
University College London Hospitals NHS Trust
London

References

1. Gordon B, Selnes OA, Hart J, Hanley DF, et al. Long-term cognitive sequelae of aciclovir treated herpes simplex encephalitis. Arch Neurol, 1990, 47:646.
2. Benson PC, Swadron SP. Empiric aciclovir is infrequently initiated in the emergency department to patients ultimately diagnosed with encephalitis. Ann Emerg Med, 2006, 47:100.
3. Misra UK, Kalita J. Neurophysiological studies in herpes simplex encephalitis. Electromyogr Clin Neurophysiol, 1998, 38:177.
4. Levitz RE. Herpes simplex encephalitis: A review. Heart Lung, 1998, 27:209.
5. Domingues RB, Fink MC, Tsanaclis AM, et al. Diagnosis of herpes simplex encephalitis by magnetic resonance imaging and polymerase chain reaction assay of cerebrospinal fluid. J Neurol Sci, 1998, 157:148.
6. Kupila L, Vuorinen t, Vainionpaa R, et al. Etiology of aseptic meningitis and encephalitis in an adult population. Neurology, 2006, 66:75.
7. Lakeman FD, Whitley RJ. Diagnosis of herpes simplex encephalitis: Application of polymerase chain reaction to cerebrospinal fluid from brain-biopsied patients and correlation with disease. National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group. J Infect Dis, 1995, 171:857.
8. Valencia I, Miles DK, Melvin J, et al. Relapse of herpes encephalitis after aciclovir therapy: report of two new cases and review of the literature. Neuropediatrics, 2004, 35:371.
9. Tyler KL. Herpes simplex virus infections of the central nervous system: encephalitis and meningitis, including Mollaret's. Herpes, 2004, suppl 11, 2:57A.
10. Hjalmarsson A, Blomqvist P, Skoldenberg B. Herpes simplex encephalitis in Sweden, 1990–2001: incidence, morbidity, and mortality. Clin Infect Dis, 2007, 45:875.

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About the Clinical Cases Database

T​he Foundation Years Clinical Cases Database is​ a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.

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