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Viral Meningitis – Supportive Management — SCE Neurology MCQ

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HardCNS InfectionsViral Meningitis – Supportive ManagementSCE Neurology

An immunocompetent adult has PCR-confirmed HSV-1 encephalitis and improves during intravenous aciclovir. On treatment day 14, repeat CSF remains HSV PCR positive. What is the most appropriate plan?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Continue intravenous aciclovir and repeat CSF HSV PCR weekly until negative

Explanation lettering: B = shown as A · C = shown as B · D = shown as C · E = shown as D · A = shown as E

A treats the minimum duration as an absolute stop point. B uses oral step-down despite persistent intrathecal viral DNA. C is not routine and withdraws essential antiviral therapy. D may still stop despite ongoing PCR positivity. E is correct: proven HSV encephalitis receives IV aciclovir for 14–21 days, with repeat LP; if PCR remains positive, IV treatment continues with weekly PCR until clearance.

Reference: ABN/BIA guideline: management of suspected viral encephalitis in adults: https://encephalitis.info/wp-content/uploads/2023/11/Management-of-Viral-Encephalitis-in-Adults.pdf