Acute Encephalitis 15 points total HPI NC is an 83 yo male s

Acute Encephalitis (15 points total) HPI. N.C. is an 83 y/o male seen by his PCP because a mosquito bite has caused the area around his right eye to swell. He was recently camping in the Rocky Mountains and received the bite approximately 96 hours ago. Periorbital edema has become progressively worse where the patient’s right eye is now shut. The patient also has a mild fever and a mild headache, both of which developed last evening. ROS. The patient is alert and oriented. He denies fatigue, body aches, tremors, skin rashes, neck stiffness, muscle weakness, photophobia or general malaise. His physician suspects that N.C. has developed an arthropod-transmitted infection and refers him to both a neurologist and infectious disease specialist for immediate follow-up the next morning. He also instructs the patient to take OTC ibuprofen for his fever and headache, to apply ice to the swollen area around the eye to decrease swelling, and to go directly to the urgent care clinic if his condition worsens. VS. BP 140/95, HR 90, RR 16, Tmax 99.4F, Ht 5’9’’, Wt 165#

Question 1. What is the pathophysiology of the right eye swelling in this case? (2pts)

Question 2. Does this patient need a lumbar puncture (spinal tap)? What information would that provide you with? (2 pts)

Solution

Answer 1

The mosquito bite around eye causes inflammation which has caused lot of fluid accumulation around the right eye. Species of mosquito may also inject saliva which is non venomous . The fluid accumulation may be victim\'s immune response to mosquito bite.

Answer 2

The patient needs a lumbar puncture to obtain cerebrospinal fluid from lumbar region for diagnostic testing. The test would help to diagnose disease of central nervous system including brain and spine. This test helps to diagonise conditions like encephalitis and meningitis.