This review states [correctly] that herpes encephalitis requires
empirical
treatment, whereas herpes meningitis is a self-limiting condition. This
raises
two questions.
The review used two illustrative cases of herpes meningitis, in each
of which
treatment was given: contradicting the "self-limiting" statement.
Current
problems with bacterial resistance reflect gross over-use of antibiotics
in the
past, we should not encourage the same behaviour with anti-viral drugs.
Secondly, if you treat encephalitis and do not treat meningitis, what
is the
purpose of testing the CSF for HSV? The result does not distinguish
between
these two conditions, and hence does not help in management of the
patient.
This should be the main reason for undertaking any investigation,
especially
those which are expensive and slow. By contrast Gram-stain and culture
are
quick, cheap, and may alter management.
Rapid Response:
viral meningitis: clinical review
This review states [correctly] that herpes encephalitis requires
empirical
treatment, whereas herpes meningitis is a self-limiting condition. This
raises
two questions.
The review used two illustrative cases of herpes meningitis, in each
of which
treatment was given: contradicting the "self-limiting" statement.
Current
problems with bacterial resistance reflect gross over-use of antibiotics
in the
past, we should not encourage the same behaviour with anti-viral drugs.
Secondly, if you treat encephalitis and do not treat meningitis, what
is the
purpose of testing the CSF for HSV? The result does not distinguish
between
these two conditions, and hence does not help in management of the
patient.
This should be the main reason for undertaking any investigation,
especially
those which are expensive and slow. By contrast Gram-stain and culture
are
quick, cheap, and may alter management.
Competing interests:
None declared
Competing interests: No competing interests