A 24-year-old woman presents with acute onset fever, headache, and photophobia for 2 days. Neck stiffness is present. CSF shows glucose 3.8 mmol/L (serum 5.5), protein 0.8 g/L, WBC 150 cells (90% lymphocytes), and negative Gram stain. PCR for enterovirus is positive. Which statement regarding the management of this condition is correct?
- A Supportive care with analgesics and antiemetics is the mainstay, as most cases are self-limiting ✓
- B IV acyclovir should be started pending herpes simplex virus PCR
- C Empirical IV ceftriaxone and vancomycin should be started until bacterial cultures return negative at 48 hours
- D IV ampicillin should be added to cover Listeria monocytogenes
Explanation
Viral meningitis, most commonly caused by enteroviruses in young adults, is typically self-limited and managed with supportive care. The CSF profile shows lymphocytic pleocytosis, mildly elevated protein, and normal glucose. Once enterovirus PCR is positive and the clinical picture is consistent, antibiotics can be safely discontinued. While empirical antibiotics are often started acutely, they are not required for confirmed viral meningitis. IV acyclovir is indicated only if HSV encephalitis is suspected. Ampicillin for Listeria is reserved for neonates, elderly, and immunocompromised patients.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.