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Herpes simplex encephalitis — SCE Acute Medicine MCQ

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HardSepsis and Infectious EmergenciesHerpes simplex encephalitisSCE Acute Medicine

A 63-year-old man presents with fever, neck stiffness, confusion and a non-blanching rash. Intravenous access is obtained immediately; blood cultures can be taken without delay. There is no focal neurological deficit or papilloedema. Which treatment sequence is most appropriate?

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Reveal the answer and explanation

Correct answer: B — Take cultures, give dexamethasone, then give ceftriaxone immediately

Suspected bacterial meningitis with meningococcal features requires immediate parenteral antibiotics. Blood cultures should be obtained first only if this causes no delay. Dexamethasone is given before or with the first antibiotic dose when bacterial meningitis is suspected. Neither CT nor lumbar puncture should delay treatment in an unstable or high-risk presentation.

Reference: https://www.nice.org.uk/guidance/NG240/chapter/recommendations