Treatment of Viral Encephalitis in Varicella-Zoster Virus (VZV) Encephalitis
Varicella-zoster virus encephalitis is a serious neurological complication of VZV infection requiring prompt recognition and directed treatment. The clinical approach is guided by the specific viral aetiology.
Clinical scenario
This protocol addresses varicella-zoster virus encephalitis — encephalitis attributable to VZV — within the broader category of viral encephalitis (ICD-11 1C80 / ICD-10 A85; A86).
Treatment approach
Management centres on intravenous antiviral therapy as the cornerstone of treatment, with adjunctive corticosteroids considered in selected cases. An alternative antiviral agent exists for situations where the primary agent is not suitable.
Full regimen details, agent selection criteria, and sequencing are available in the complete protocol.
References
- Varicella-zoster virus: acyclovir is recommended (B-III); ganciclovir can be considered an alternative (C-III); adjunctive corticosteroids can be considered (C-III).
- Although no clinical trial has established the efficacy of antiviral therapy for varicella zoster virus–associated encephalitis, on the basis of case reports and small series, acyclovir (10–15 mg/kg intravenously every 8 h for 10–14 days) is the drug of choice.
- Ganciclovir has shown efficacy in some patients with varicella zoster virus meningoencephalitis and can be considered as an alternative agent for treatment.
- Corticosteroids have been proposed for primary varicella zoster virus encephalitis and in immunocompetent patients with severe varicella zoster virus encephalitis and vasculopathy, but there are no reliable data to support their use.
DOI: 10.1086/589747
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