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Response

Mark Ellul, Michael Griffiths, Fiona Mcgill and Tom Solomon
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DOI: https://doi.org/10.7861/clinmedicine.18-3-269a
Clin Med June 2018
Mark Ellul
The Walton Centre NHS Foundation Trust, Liverpool, UK
Institute of Infection and Global Health, University of Liverpool, UK
Roles: Specialist registrar in neurology, Clinical research fellow
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Michael Griffiths
Alder Hey Children's NHS Foundation Trust, Liverpool, UK
Institute of Infection and Global Health, University of Liverpool, UK
Roles: Honorary consultant in paediatric neurology, Senior clinical lecturer
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Fiona Mcgill
Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
Institute of Infection and Global Health, University of Liverpool, UK
Roles: SpR in microbiology and infectious diseases, Clinical lecturer
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Tom Solomon
The Walton Centre NHS Foundation Trust, Liverpool, UK
Institute of Infection and Global Health, University of Liverpool, UK
Roles: Honorary consultant neurologist, Professor of neurological sciences
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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.

  • © Royal College of Physicians 2018. All rights reserved.

References

  1. ↵
    1. Solomon T
    , Michael BD, Smith PE, et al. Management of suspected viral encephalitis in adults – Association of British Neurologists and British Infection Association National Guidelines. J Infect 2012;64:347–73.
    OpenUrlCrossRefPubMed
  2. ↵
    1. McGill F
    , Heyderman RS, Michael BD, et al. The UK joint specialist societies guideline on the diagnosis and management of acute meningitis and meningococcal sepsis in immunocompetent adults. J Infect 2016;72:405–38.
    OpenUrlCrossRefPubMed
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Response
Mark Ellul, Michael Griffiths, Fiona Mcgill, Tom Solomon
Clinical Medicine Jun 2018, 18 (3) 269-270; DOI: 10.7861/clinmedicine.18-3-269a

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Response
Mark Ellul, Michael Griffiths, Fiona Mcgill, Tom Solomon
Clinical Medicine Jun 2018, 18 (3) 269-270; DOI: 10.7861/clinmedicine.18-3-269a
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