Herpes Simplex Encephalitis

Detection of HSV DNA in CSF by polymerase chain reaction is the diagnostic gold standard for herpes simplex encephalitis and has supplanted brain biopsy. Wolters KluwerWolters KluwerHerpes Simplex Virus Infections of the Central Nervous System In reported HSE cases, MRI abnormalities involving medial temporal and hippocampal regions have accompanied CSF HSV-1 PCR positivity. Wolters KluwerWolters KluwerCIDSCON 2023 Selected Abstracts

CSF results can be inflammatory but are not independently diagnostic. A reported confirmed case had 22 CSF leukocytes, markedly elevated protein of 250 mg/dL, and opening pressure of 39 cm H2O before HSV PCR returned positive. accessdata fdaaccessdata fdacenter for drug evaluation and research - accessdata.fda.gov Do not use a nonspecific CSF profile to defer HSV PCR or antiviral treatment when the clinical syndrome remains concerning.

NIH opportunistic-infection guidance lists acyclovir 10 mg/kg IV every 8 hours for HSV encephalitis for 14-21 days. The same guidance notes that some clinicians extend treatment according to clinical response and degree of immunosuppression. clinicalinfo hivclinicalinfo hivHerpes Simplex Virus: Adult and Adolescent OIs | NIH The available excerpts do not support a routine oral step-down regimen for HSE.

Renal toxicity prevention and dose adjustment are integral to administration. Give IV fluids with IV acyclovir to reduce nephrotoxicity risk. Monitor renal function at treatment initiation and at least once or twice weekly during treatment when stable; adjust dosing for renal function. clinicalinfo hiv+2clinicalinfo hivHerpes Simplex Virus: Adult and Adolescent OIs | NIHclinicalinfo hivGuidelines for the Prevention and Treatment of Opportunistic ...clinicalinfo hivTables: Recommended Dosing Adjustments of Drugs Used ...

Published series and reviews estimate HSE relapse after an initial episode at approximately 5%-27%; one case-series report cites relapse in up to 12% of adults and 14%-35% of children despite antiviral therapy. PubMed+1PubMedPostherpes simplex encephalitis: a case series of viral-triggered autoimmunity, synaptic autoantibodies and response to therapy - PMCPubMedImmunomodulatory Strategies in Herpes Simplex Virus Encephalitis - PMC These estimates are derived from observational literature and should not be treated as a precise individual risk prediction.

A true virologic relapse is suggested by HSV DNA detection in CSF and may be accompanied by new necrotic or hemorrhagic lesions on brain imaging. PubMedPubMedImmunomodulatory Strategies in Herpes Simplex Virus Encephalitis - PMC In contrast, post-HSE autoimmune relapse often has negative CSF HSV PCR and may reflect immune responses to CNS antigens exposed by HSV-related injury. PubMed+1PubMedPostherpes simplex encephalitis: a case series of viral-triggered autoimmunity, synaptic autoantibodies and response to therapy - PMCPubMedImmunomodulatory Strategies in Herpes Simplex Virus Encephalitis - PMC

In a post-HSE case series, serum and CSF were tested for anti-NMDAR, GABA-B receptor, AMPAR, LGI1, CASPR2, and DPPX antibodies. PubMedPubMedPostherpes simplex encephalitis: a case series of viral-triggered autoimmunity, synaptic autoantibodies and response to therapy - PMC The available evidence supports targeted evaluation for autoimmune encephalitis in a compatible relapse syndrome but does not provide an adult U.S. immunotherapy regimen. Pediatric consensus guidance states that NMDA receptor antibody encephalitis following HSE should be treated similarly to idiopathic NMDA receptor antibody encephalitis. NeurologyNeurologyInternational Consensus Recommendations for the Treatment of Pediatric NMDAR Antibody Encephalitis

For high-dose IV acyclovir, renal function monitoring and renal dose adjustment are specifically recommended at treatment initiation and once or twice weekly during therapy when stable. clinicalinfo hiv+1clinicalinfo hivHerpes Simplex Virus: Adult and Adolescent OIs | NIHclinicalinfo hivGuidelines for the Prevention and Treatment of Opportunistic ... Hydration is recommended to reduce acyclovir-associated nephrotoxicity. clinicalinfo hiv+1clinicalinfo hivGuidelines for the Prevention and Treatment of Opportunistic ...clinicalinfo hivTables: Recommended Dosing Adjustments of Drugs Used ...

After acute HSE, counsel patients and caregivers that relapse can occur despite antiviral therapy. PubMed+1PubMedPostherpes simplex encephalitis: a case series of viral-triggered autoimmunity, synaptic autoantibodies and response to therapy - PMCPubMedImmunomodulatory Strategies in Herpes Simplex Virus Encephalitis - PMC New neurologic, behavioral, cognitive, movement, or seizure manifestations should trigger reassessment for recurrent HSV and postinfectious autoimmune encephalitis rather than automatic attribution to fixed post-encephalitic deficits. Wolters Kluwer+2Wolters KluwerCIDSCON 2023 Selected AbstractsPubMedPostherpes simplex encephalitis: a case series of viral-triggered autoimmunity, synaptic autoantibodies and response to therapy - PMCPubMedImmunomodulatory Strategies in Herpes Simplex Virus Encephalitis - PMC