(Disclaimer: This article is for scientific use only, and the information in the following content has been processed to protect patient privacy)
Abstract: The patient was an 80-year-old male who presented 1 week ago with persistent low-grade fever without apparent cause, accompanied by intractable headache. At that time, the family thought it was an upper respiratory tract infection, but the patient’s headache continued to worsen and he became unconscious before realizing the severity of his condition. The patient was rushed to the hospital and diagnosed with infectious encephalitis after completion of relevant tests. After medication, the symptoms were significantly relieved and the patient was discharged after his condition stabilized.
Basic information】Male, 80 years old
Disease Type】Infectious encephalitis
Hospital】Shandong Provincial Third Hospital
Date of consultation】May 2022
Treatment plan】Medication (mannitol injection + dexamethasone sodium phosphate injection + ceftriaxone sodium for injection + ribavirin injection)
Treatment period】Inpatient treatment for 14 days, outpatient follow-up after 1 month
Treatment effect】Stable condition and improvement of symptoms
I. Initial consultation
Master Wang developed a persistent low-grade fever with a body temperature between 37℃-38℃ after having cold symptoms 1 week ago. It was accompanied by headache, which was unbearable. Three days after the onset of the disease, there was drowsiness, still with a low fever, accompanied by nausea and vomiting, the family realized the seriousness of the disease, considering that it should be more than just a common cold, so the patient was sent to the hospital to improve the relevant examination, neurological examination on the outpatient clinic, suggesting drowsiness, can be awakened by calling, but can not cooperate with the completion of neurological examination, suggesting hospitalization, considering intracranial disease encephalitis The possibility of encephalitis is high. Further cranial magnetic resonance examination and lumbar puncture for cerebrospinal fluid examination are needed. The family expressed their understanding and actively cooperated with the treatment.
II. Treatment history
After the patient was admitted to the hospital, routine blood, liver and kidney function, ion, lipid, blood glucose, anti-nuclear antibody 15 items, and C-reactive protein examination were completed. The patient’s condition was considered to be serious, so it was recommended to improve the cerebrospinal fluid examination, which showed leukocytes 856×10^6/L, cerebrospinal fluid protein 9.5 g/L, and cerebrospinal fluid pressure as high as 210 mm Hg. Infectious encephalitis was considered in combination with the cerebrospinal fluid laboratory results. Mannitol injection for dehydration and lowering cranial pressure, dexamethasone sodium phosphate injection, ceftriaxone sodium for injection and ribavirin injection for anti-infection treatment were given. The patient’s condition was serious, and we communicated in detail with the patient’s family about his condition, the current level of infection was serious and there was a risk of life, and complications such as pulmonary infection and heart failure might occur secondary to the treatment process, and the patient’s family expressed understanding and actively cooperated with the treatment.
III. Treatment effect
After 7 days of systemic treatment, the patient’s condition improved, the body temperature dropped to normal, the symptoms of headache, nausea and vomiting were significantly relieved, and the mental clarity turned clear, but there were still symptoms of unresponsiveness. At 14 days of treatment, cognitive function was assessed to be mildly impaired and limb muscle tone was normal. This suggested that the patient’s condition had basically stabilized and was discharged from the hospital. 1 month later, the hospital conducted a telephone follow-up visit and learned that the patient’s condition did not fluctuate, had no other special discomfort, and was recovering well.
IV. Precautions
We are truly happy for the patient that he has recovered to this extent because of his age and serious condition. The patient and his family were instructed to monitor his body temperature daily after discharge, pay attention to his consciousness and cognitive function, and assess his limb strength and projection function, and to follow up with the hospital if any of these dysfunctions occur. The patient should be instructed to drink more water, eat a light diet, eat high quality protein food that can be easily digested and absorbed, and avoid spicy, cold and hard food; do appropriate activities, such as walking; massage the patient’s limbs to effectively avoid the formation of deep vein thrombosis in the lower limbs.
V. Personal insight
Infectious encephalitis is an acute and critical neurological disease, which can leave sequelae if treatment is delayed, seriously affecting the patient’s daily life and bringing a heavy burden to the family. The family of the patient in this case was very wise to detect the change of symptoms and send the elderly to the hospital in time. Therefore, the family members should actively pay attention to the symptoms of the elderly, such as headache, nausea, and desire to vomit accompanied by poor mental health, they should be sent to the hospital immediately for symptomatic treatment and care to avoid aggravation of the disease. The doctor of such patients should actively improve the relevant examination, after clarifying the pathogen that causes infectious encephalitis, give reasonable and standardized treatment, which will help the recovery of the disease. It is also important to improve the immune system, pay attention to nutrition and exercise to reduce the occurrence of such diseases.