Herpes simplex virus encephalitis is a serious cause of viral encephalitis associated with high morbidity and mortality even when treatment is initiated. This page outlines the clinical scenario and primary goals of the evidence-based treatment protocol for this specific presentation.

Clinical Scenario

This protocol is directed at patients with viral encephalitis in whom herpes simplex virus is the identified causative organism. Antiviral therapy targeting this pathogen is strongly recommended at the highest evidence level (A-I).

Treatment Approach

Antiviral therapy with acyclovir is the established treatment of choice for herpes simplex encephalitis. The full protocol specifies the complete regimen, including patient-specific parameters — access it below.

Clinical Goal

The primary endpoint of therapy is a negative CSF herpes simplex virus PCR at the end of treatment. Persistent positivity at treatment completion indicates the need for continued antiviral management.

References

DOI: 10.1086/589747

Herpes simplex virus: acyclovir is recommended (A-I).
Acyclovir is the treatment of choice for patients with herpes simplex encephalitis, but morbidity and mortality remain high (mortality at 18 months after treatment, 28%).
A negative CSF PCR result at the end of therapy was associated with a better outcome, suggesting that another CSF specimen should be subjected to PCR for herpes simplex virus at the end of therapy in patients who have not had the appropriate clinical response; if the result is positive, antiviral therapy should be continued.

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Treatment of Viral Encephalitis in Herpes Simplex Virus Encephalitis

Clinical Scenario

Treatment Approach

Clinical Goal

References