Table 4

Practical approach to history taking in infective rhomboencephalitis

Specific questionsInfective agent
Have you eaten any unpasteurised cheeses or milks, cured meats, pâtés, smoked fish, cooked shellfish or non-supermarket ice creams recently? Listeria monocytogenes or brucellosis
Are you taking any medications to suppress your immune system?All but particularly HHV-6 and Listeria monocytogenes
Travel history:

  • Travel destination (including rural/urban)

  • Reason for travelling

  • Travel dates and time from returning to symptoms

  • Sexual history, including HIV risk factors and recreational drugs

  • Pretravel vaccinations and prophylaxis

  • Animal contact (especially pigs, bats, dogs, cats) and mosquito/tick bites

  • Fresh water contact

  • Japanese encephalitis (Pacific rim, eastern and southern Asia)

  • Enterovirus-71 (Asian-Pacific countries)

  • Scrub typhus (Southeast Asia, Indonesia, China, Japan, India and northern Australia)

  • West Nile virus (Africa, the Middle East, Asia and Australia)

  • Rabies encephalitis (all continents except Antarctica)

Any unwell contacts? Any children with viral infections including hand, foot and mouth?Enterovirus-71
Any recent mouth or genital ulcers?HSV-1 and HSV-2 (note Behçet’s or SLE can cause ulcers)
Any recent sore throats or neck swelling?Epstein-Barr virus and cytomegalovirus
Any diarrhoea, pain on swallowing (suggesting oesophageal ulcers), blurred or loss of night vision (suggesting retinitis), productive cough?Cytomegalovirus

  • HHV-6, human herpes virus-6; SLE, systemic lupus erythematosus.