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