What is the preferred management of VZV menigitis without encephelitis or rash?

Rakel: Textbook of Family Medicine, 8th ed. Copyright © 2011 Saunders, An Imprint of Elsevier Central Nervous System Infection and Inflammation

“Treatment is mainly supportive, with the exception of herpesvirus (herpes simplex virus [HSV]) and HIV, for which specific antiviral therapy is available. Data regarding herpes meningitis treatment are limited, and both high-dose acyclovir (60 mg/kg/day) and lower-dose therapies have been advocated (Kohlhoff et al., 2004). For HIV and acquired immunodeficiency syndrome (AIDS)–dementia complex (ADC), many antiviral combinations have been suggested. The factors to be considered when choosing a combination therapy for ADC include toxicity, the many potential drug interactions, CNS penetration, and resistance. Because the treatments for HIV and its complications are often changing, consultation with an infectious disease specialist should be considered.

With the exception of HSV encephalitis and ADC, the prognosis is generally very good for other viral meningitides. Children seem to recover within 1 to 2 weeks, whereas adults may take several months.”

Box 42-11: Causes of Viral Meningitis:

Herpesviruses
-Herpes simplex virus (HSV) types 1 and 2
-Varicella-zoster virus (VZV)

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