A renal transplant patient on tacrolimus develops encephalitis. MRI shows T2 hyperintensities in the temporal lobe. CSF PCR for HSV-1 DNA is positive. The appropriate treatment regimen is:
- A IV acyclovir 10 mg/kg 8-hourly for 14–21 days ✓
- B Oral valacyclovir 1 g thrice daily for 7 days
- C IV ganciclovir 5 mg/kg 12-hourly for 14 days
- D IV foscarnet 60 mg/kg 8-hourly for 14 days
Correct answer: A. IV acyclovir 10 mg/kg 8-hourly for 14–21 days
Explanation
HSV encephalitis, the most common sporadic viral encephalitis, requires IV acyclovir at 10 mg/kg every 8 hours (30 mg/kg/day) for a minimum of 14–21 days. CSF HSV PCR is the gold standard diagnostic test with high sensitivity and specificity. Oral valacyclovir lacks sufficient CNS penetration for encephalitis. IV ganciclovir is for CMV disease. IV foscarnet is reserved for acyclovir-resistant HSV (rare, occurs in prolonged immunosuppression).
Reference: Ananthanarayan & Paniker's Textbook of Microbiology, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.