Sandbox encephalitis

Viral Encephalitis Adapted from The management of encephalitis: clinical practice guidelines by the Infectious Diseases Society of America

Viral Encephalitis

▸ Herpes simplex virus

▸ Varicella zoster virus

▸ Cytomegalovirus

▸ Epstein-Barr virus

▸ Human herpesvirus 6

▸ B Virus

▸ Inﬂuenza virus

▸ Measles virus

▸ Nipah virus

▸ West Nile virus

▸ Japanese encephalitis virus

▸ St. Louis encephalitis virus

▸ HIV

▸ JC virus

Herpes simplex virus
patients with normal renal function
▸ Acyclovir 10 mg/kg IV q8h(for 14-21 days)
neonates
▸ Acyclovir 20 mg/kg IV q8h(for 21 days)

Varicella zoster virus
Preferred Regimen
▸ acyclovir 10–15 mg/kg IV q8h (for 10–14 days)
PLUS
▸ Cefotaxime 50 mg/kg IV q6—8h
Alternative Regimen
▸ Ganciclovir

Cytomegalovirus
Preferred Regimen
▸ Ganciclovir 5 mg/kg IV q12 h
PLUS
▸ Foscarnet 60 mg/kg IV q8h or 90 mg/kg IV q12h

Epstein-Barr virus
Preferred Regimen
▸ Valacyclovir 5 mg/kg IV q12 h
Alternative Regimen
▸ Ganciclovir
AND
▸ Acyclovir

Human herpesvirus 6
Immunocompromised Patients
▸ Ganciclovir 5 mg/kg IV q12 h
OR
▸ Foscarnet 60 mg/kg IV q8h or 90 mg/kg IV q12h
Immunocompetent Patients
▸ No good data on effectiveness yet

B virus
Preferred Regimen
▸ Valacyclovir 5 mg/kg IV q12 h
Alternative Regimen
▸ Ganciclovir
AND
▸ Acyclovir

Inﬂuenza virus
Preferred Regimen
▸ Oseltamivir

Measles virus
Preferred Regimen

Nipah virus
Preferred Regimen

West Nile virus
Preferred Regimen

Japanese encephalitis virus
Preferred Regimen
▸ IFN-a is not recommended

St. Louis encephalitis virus
Preferred Regimen
▸ IFN-2a

HIV
Preferred Regimen
▸ HAART

JC virus
Preferred Regimen
▸ HARRT

Bacteria Encephalitis

▸ Bartonella bacilliformis

▸ Bartonella henselae

▸ Listeria monocytogenes

▸ Mycoplasma pneumoniae

▸ Tropheryma whipplei

Bartonella bacilliformis
Preferred Regiem
▸ chloramphenicol OR ▸ ciproﬂoxacin OR ▸ doxycycline OR ▸ ampicillin OR ▸ trimethoprim-sulfamethoxazole

Bartonella henselae
Preferred Regiem
▸ Doxycycline OR ▸ Azithromycin
PLUS OR NOT
▸ Rifampin

Listeria monocytogenes
Preferred Regiem
▸ Ampicillin
PLUS
▸ gentamicin
Alternative Regiem(for penicillin-allergic patient)
▸ trimethoprim-sulfamethoxazole

Mycoplasma pneumoniae
Preferred Regiem
▸ azithromycin OR ▸Doxycycline OR ▸ FLuoroquinolone

Tropheryma whipplei
Preferred Regiem
▸ ceftriaxone
PLUS
▸ trimethoprim-sulfamethoxazole OR ▸Ceﬁxime

M. tuberculosis
Intensive Phase(for 9-12 mo)
▸ Rifampicin 8-12 mg/kg/day PO daily max: 600mg OR 8-12mg/kg/day PO 3 times per week x:600mg
PLUS
▸ Isoniazid 4-6 mg/kg/day PO daily max: 300mg OR 8-12mg/kg/day PO 3 times per week daily max:900mg
PLUS
▸ Pyrazinamide 20-30 mg/kg/day PO OR 30-40mg/kg/day PO 3 times per week
PLUS
▸ Streptomycin 12-18 mg/kg/day IM OR 25-35mg/kg/day PO 3 times per week daily max:1000mg

Rickettsioses and ehrlichioses

▸ Anaplasma phagocytophilum

▸ Ehrlichia chaffeensis

▸ Rickettsia rickettsii

▸ Coxiella burnetii

Anaplasma phagocytophilum
Preferred Regimen
▸ doxycycline

Ehrlichia chaffeensis
Preferred Regimen
▸ doxycycline

Rickettsia rickettsii
Preferred Regimen
▸ doxycycline
Alternative Regimen
▸ chloramphenicol

Coxiella burnetii
Preferred Regimen
▸ doxycycline
PLUS
▸ ﬂuoroquinolone
PLUS
▸ rifampin

Spirochetes

▸ Borrelia burgdorferi

▸ Treponema pallidum

Borrelia burgdorferi
Preferred Regimen
▸ Ceftriaxone OR ▸ Cefotaxime OR ▸ Penicillin G

Treponema pallidum
Preferred Regimen
▸ Penicillin G
Alternative Regimen
▸ Ceftriaxone

Fungal Encephalitis

▸ Coccidioides species

▸ Cryptococcus neoformans

▸ Histoplasma capsulatum

Borrelia burgdorferi
Preferred Regimen
▸ Fuconazole
Alternative Regimen
▸ Itraconazole OR ▸ Voriconazole ▸ Amphotericin B (intravenous and intrathecal

Cryptococcus neoformans
Preferred Regimen
▸ *Amphotericin B deoxycholate*
PLUS
▸ Flucytosine
Alternative Regimen
▸ *lipid formulation of amphotericin B*
PLUS
▸ Flucytosine

Histoplasma capsulatum
Preferred Regimen
▸ *Liposomal Amphotericin B*
FOLLOWED BY
▸ *Itraconazole*

Protozoa

▸ Acanthamoeba

▸ Balamuthia mandrillaris

▸ Naegleria fowleri

▸ Plasmodium falciparum

▸ Toxoplasma gondii

▸ Trypanosoma brucei gambiense

▸ Trypanosoma brucei rhodesiense

Acanthamoeba
Preferred Regimen
▸ Trimethoprim-sulfamethoxazole
PLUS
▸ Rifampin
PLUS
▸ Ketoconazole
Alternative Regimen
▸ Fuconazole
PLUS
▸ Sulfadiazine
PLUS
▸ Pyrimethamine

Balamuthia mandrillaris
Preferred Regimen
▸ Pentamidine
PLUS
▸Azithromycin OR ▸Clarithromycin OR ▸ Fuconazole OR ▸Sulfadiazine OR ▸Fucytosine OR ▸ Phenothiazine

Naegleria fowleri
Preferred Regimen
▸ Amphotericin B IV intrathecal OR ▸ *Rifampin*
PLUS
▸

Plasmodium falciparum
Preferred Regimen
▸ Quinine OR ▸Quinidine OR ▸Artemether
Alternative Regimen
▸ atovaquone-proguanil

Toxoplasma gondii
Preferred Regimen
▸ Pyrimethamine
PLUS
▸ Sulfadiazine OR ▸ Clindamycin
Alternative Regimen 1
▸ Trimethoprim-Sulfamethoxazole
Alternative Regimen 2
▸ Pyrimethamine
PLUS
▸Atovaquone OR ▸clarithromycin OR ▸ Azithromycin OR ▸ Dapsone

Trypanosoma brucei gambiense
Preferred Regimen
▸ Eﬂornithine
Alternative Regimen
▸ Melarsoprol

Trypanosoma brucei rhodesiense
Preferred Regimen
▸ Melarsoprol

Helminths

▸ Baylisascaris procyonis

▸ Gnathostoma species

▸ Taenia solium

Baylisascaris procyonis
Preferred Regimen
▸ Albendazole
PLUS
▸ Diethycarbamazine

Taenia solium
Preferred Regimen
▸ Albendazole
PLUS
▸ Albendazole OR ▸ Ivermectin

Gnathostoma species
Preferred Regimen
▸ Albendazole
Alternative Regimen 2
▸ Praziquantel

Postinfectious/postvaccination status Acute Disseminated Encephalomyelitis
Preferred Regimen
▸ Corticosteroids
Alternative Regimen
▸ Immunoglobulin IV OR ▸ Plasma Exchange