Table 2.
Hypothetical Case Presentation and Associated Treatment Decisions
| Case Presentation | ||
| It's after midnight and a 30-year-old previously healthy male is admitted with headache, photophobia, neck stiffness, and a normal conscious state. Vitals show a temperature of 39.1°C and are otherwise within normal ranges. Blood C-reactive protein is 42 mg/L and B-leukocytes are 12 × 109/L. Lumbar puncture shows a CSF white blood cell count of 400 × 106/L with 80% lymphocytes. | ||
| Would you treat this patient empirically with any of these options?a | no./No. | (%) |
| Noneb | 56/223 | (25) |
| Acyclovir | 108/223 | (48) |
| Dexamethasone | 50/223 | (22) |
| Antibiotics for bacterial meningitis | 98/223 | (44) |
| Other | 10/223c | (4) |
| Case Presentation—Continued | ||
| The meningitis patient was started on empiric IV acyclovir by the admitting doctors. Two days later, the symptoms have regressed considerably, although he still has nausea, slight photophobia, intermittent spikes of fever, and requires analgetics for his headache. PCR of the CSF is positive for HSV-2. | ||
| How would you manage this patient? | no./No. | (%) |
| Stop antiviral treatmentb | 37/188 | (20) |
| Continue IV acyclovir throughout treatment | 14/188 | (7) |
| Continue IV acyclovir for now (switch to oral valacyclovir after further improvement) | 47/188 | (25) |
| Switch to oral valacyclovir | 90/188 | (48) |
Abbreviations: CSF, cerebrospinal fluid; HSV-2, herpes simplex virus type 2; IV, intravenous; PCR, polymerase chain reaction.
a
Several choices possible.
b
Automatically excludes other answers.
c
Other treatments included analgetics (n = 3) and valacyclovir (n = 2).
c
Others required further information before treatment decisions could be made (eg, CSF microscopy, glucose, and protein levels, suspicion of neuroborreliosis or not, and Hoen score).