View source for WBR1097

 {{WBRQuestion
|QuestionAuthor=Chetan Lokhande
|ExamType=USMLE Step 3
|SubCategory=Neurology, Infectious Disease
|SubCategory=Neurology, Infectious Disease
|SubCategory=Neurology, Infectious Disease
|SubCategory=Neurology, Infectious Disease
|SubCategory=Neurology, Infectious Disease
|SubCategory=Neurology, Infectious Disease
|SubCategory=Neurology, Infectious Disease
|SubCategory=Neurology, Infectious Disease
|Prompt=An 11-month-old previously healthy African American female from Haiti comes to Emergency room(ER) with generalized tonic clonic seizures with 1-day history of lethargy, fever and altered mental status. Enroute to hospital, emergency medical team intubated her and gave a dose of diazepam, with no remission. In the ER 1 more dose of diazepam was given and patient was transferred to ICU for further management, where vitals were within normal limits. Overnight EEG showed a pattern of status epileptics. The patient was medically paralyzed and put on a ventilator. Complete blood count, Chem 10 and CT scan all are within normal limits. She was given a dose of quinine for malaria, but stopped due to negative thick and thin smear. A Lumbar puncture was done which revealed:

CSF Glucose 60 mg/dl <br>
CSF protein 90 mg/dl <br>
CSF WBC 70 cell/ml <br>
Culture negative for any organism <br>
Opening pressure normal <br>

A CSF antibody test revealed positive for HSV-1. What is the best treatment for this patient?
|Explanation=Herpesviral Encephalitis can be treated with high-dose intravenous aciclovir. Without treatment, HSE results in rapid death in approximately 70% of cases; survivors suffer severe neurological damage. When treated, HSE is still fatal in one-third of cases, and causes serious long-term neurological damage in over half of survivors. Twenty percent of treated patients recover with minor damage. Only a small population of survivors (2.5%) regain completely normal brain function. Earlier treatment (within 48 hours of symptom onset) improves the chances of a good recovery. Rarely, treated individuals can have relapse of infection weeks to months later. While the herpes virus can be spread, encephalitis itself is not infectious. Other viruses can cause similar symptoms of encephalitis, though usually milder (human herpes virus-6, varicella zoster virus, Epstein-Barr, cytomegalovirus, coxsackievirus, etc.).
|AnswerA=Ganciclovir plus acyclovir for 2 weeks.
|AnswerAExp=Ganciclovir is indicated in cytomegalovirus infection. There are no indications for adding acyclovir to ganciclovir in patient of HSV-1.
|AnswerB=Acyclovir for 4 weeks.
|AnswerBExp=Acyclovir is used to treat for HSV-encephalitis. The patient is treated for 3-4 weeks for a minimum.
|AnswerC=Acyclovir for 1 week.
|AnswerCExp=There are no indications to use acyclovir for one week. Acyclovir is used to treat HSV encephalitis.
|AnswerD=Acyclovir plus ganciclovir for 4 weeks.
|AnswerDExp=Ganciclovir is used to treat CMV, HSV, VZV, and HHV-6, HHV-7, and HHV-8. It is used alone to treat these viral infections. 
|AnswerE=Acyclovir for 6 months.
|AnswerEExp=Acyclovir for 6 months is indicated in recurrent genital herpes.
|EducationalObjectives=Acyclovir is used to treat for HSV-encephalitis. The patient is treated for 3-4 weeks for a minimum.
|RightAnswer=B
|WBRKeyword=HSV, Acyclovir
|Approved=Yes
}}