Response

We welcome this comment regarding our CME articles on encephalitis and meningitis. As we suggest on p 156 of the article about acute encephalitis, ‘all patients with suspected brain infection should have an HIV test’. This view is also supported by national guidelines on encephalitis and meningitis.^1,2 We agree that testing is vital in this patient group, as not only can meningoencephalitis occur at HIV seroconversion, but HIV infection also widens the potential differential diagnosis of neurological infections. We suggest that it is also valuable to establish risk factors for HIV infection during history taking, as in the period of acute HIV infection diagnostic testing may be negative. However, we agree that this is not always possible, either due to encephalopathy or patient reticence.

We also agree that syphilis testing is indicated in selected cases of encephalitis and meningitis, particularly in those with exposure history, subacute or chronic meningitis, infarcts or cranial nerve involvement.