A Review of the Treatment of Herpes Simplex Virus-1 Encephalitis in Six Immunocompetent Patients

Abstract

The optimal treatment regimen for herpes simplex-1 (HSV-1) encephalitis is ill-defined. Current guidelines recommend the initiation of acyclovir in all suspected cases of encephalitis; however, there is limited research regarding the details of acyclovir treatment or the adjuvant use of corticosteroids. Specifically, there is a paucity of evidence-based guidelines detailing the optimal management of HSV-1 encephalitis in immunocompetent patients. In this study, we conducted a review of cases of immunocompetent patients with HSV-1 encephalitis to compare patterns in treatment and outcomes. MethodsA review of the literature was performed using PubMed using the terms herpes encephalitis, HSV, herpes zoster, and immunocompetent to identify cases of HSV-1 encephalitis in immunocompetent patients. The results were screened for cases describing the treatment regimen of HSV-1 encephalitis-positive, immunocompetent patients. ResultsSix cases were identified. All six patients were treated with acyclovir with one patient receiving adjuvant corticosteroid therapy. Additionally, three patients were found to have acyclovir resistance and were transitioned to foscarnet. Eventually, one patient expired, two patients recovered with chronic morbidities of varying severity, and three patients made a full recovery. DiscussionInconsistencies in the patient's disease course, therapeutic regimen, and comorbidities could all play a role in the varying case outcomes. While the optimal timing and composition of therapies in HSV-1 encephalitis in immunocompetent patients are still unclear, it seems the timely administration of antiviral treatment remains essential. Further research is needed to optimize HSV-1 encephalitis therapeutic regimens and improve patient outcomes.

Antiviral Therapy for Herpes Simplex Virus Encephalitis: Systematic Review

“…Increased intracranial pressure is the most dangerous complication of HSE, and it can lead to uncal and / or transtentorial herniation. 15,16 Recent research conducted by Kiyani and colleagues looked into the mortality rate of patients diagnosed with viral encephalitis, as well as the costs associated with providing treatment to these patients. Over 8,000 people in the MarketScan database were diagnosed with viral encephalitis between 2008 and 2015, and of them, 38.3% were confirmed to have HSV-1 encephalitis.…”