Sandbox encephalitis

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

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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

▸ 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

▸ ciproﬂoxacin

▸ doxycycline

▸ ampicillin

▸ trimethoprim-sulfamethoxazole

| Bartonella henselae

Preferred Regiem
▸ Doxycycline

▸ 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

▸Doxycycline

▸ FLuoroquinolone
| Tropheryma whipplei

Preferred Regiem
▸ ceftriaxone
PLUS
▸ trimethoprim-sulfamethoxazole

▸Ceﬁxime

| M. tuberculosis

Intensive Phase(for 9-12 mo)
▸ Rifampicin 8-12 mg/kg/day PO daily max: 600mg

8-12mg/kg/day PO 3 times per week x:600mg
PLUS
▸ Isoniazid 4-6 mg/kg/day PO daily max: 300mg

8-12mg/kg/day PO 3 times per week daily max:900mg
PLUS
▸ Pyrazinamide 20-30 mg/kg/day PO

30-40mg/kg/day PO 3 times per week
PLUS
▸ Streptomycin 12-18 mg/kg/day IM

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

▸ Cefotaxime

▸ 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

▸ 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

▸Clarithromycin

▸ Fuconazole

▸Sulfadiazine

▸Fucytosine

▸ Phenothiazine
| Naegleria fowleri

Preferred Regimen
▸ Amphotericin B  IV intrathecal

▸ Rifampin
PLUS

| Plasmodium falciparum

Preferred Regimen
▸ Quinine

▸Quinidine

▸Artemether
Alternative Regimen
▸ atovaquone-proguanil
| Toxoplasma gondii

Preferred Regimen
▸ Pyrimethamine
PLUS
▸ Sulfadiazine

▸ Clindamycin
Alternative Regimen 1
▸ Trimethoprim-Sulfamethoxazole
Alternative Regimen 2
▸ Pyrimethamine
PLUS
▸Atovaquone

▸clarithromycin

▸ Azithromycin

▸ 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

▸ Ivermectin
| Gnathostoma species

Preferred Regimen
▸ Albendazole
Alternative Regimen 2
▸ Praziquantel

| Postinfectious/postvaccination status
Acute Disseminated Encephalomyelitis

Preferred Regimen
▸ Corticosteroids
Alternative Regimen
▸ Immunoglobulin  IV

▸ Plasma Exchange