American Board of Internal Medicine (ABIM) Certification Practice Exam

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How many days should a cerebrospinal fluid polymerase chain reaction assay be repeated for herpes simplex encephalitis?

2-4 days
3-7 days
1-5 days
5-10 days

The correct answer is: 3-7 days

For herpes simplex encephalitis (HSE), if a cerebrospinal fluid (CSF) polymerase chain reaction (PCR) assay is initially negative but clinical suspicion remains high, it is recommended to repeat the assay within a timeframe of 3-7 days. This interval is based on clinical guidelines that take into account the dynamics of viral shedding and the potential for the infection to be present but not yet detectable at the initial testing. Herpes simplex virus (HSV) can be intermittently present in the CSF, and a repeat PCR test allows for the possibility of detecting the virus if it has become more present or if the initial viral load was below the threshold of detection. Waiting 3-7 days aligns with the natural course of the disease, allowing adequate time for changes in viral load while also promptly addressing a potentially life-threatening condition. This timeframe also balances the need for timely treatment with the knowledge that testing too soon might not yield reliable results. Therefore, repeating the assay within this specified period optimizes the diagnostic response to HSE, ensuring that the patient receives appropriate management based on the evolving clinical picture.