Adult
Encephalitis
- HIV testing and MRI brain is indicated
- Always discuss with Micro/ID
- Consider Meningitis see: Meningitis: community-acquired
- For cases with a relevant travel history in the last 3 months consider cerebral malaria
- In the immunosuppressed the differential diagnosis is broad – Discuss with Micro/ID
Preferred empirical treatment
aciclovir 10mg/kg iv tds (use ideal body weight for obese patients)
In cases of meningoencephalitis see Meningitis:community-acquired
Confirmed Herpes simplex encephalitis (HSE)
For cases of confirmed or probable HSE. This includes patients with:
- compatible clinical finding
- CSF PCR for HSV is positive
- Radiology finding – Brain imaging consistent with HSE
aciclovir 10mg/kg iv tds (use adjusted body weight for obese patients) for 21 days
Cases with poor response to treatment or patient is immunosuppressed: MUST be discussed with Micro/ID, prolonged treatment or higher doses or repeat CSF maybe indicated.
Discuss discharge options with Micro/ID who may recommend valaciclovir oral 1g tds OR Aciclovir elastomeric via the COPAT service (AHAH)