Herpes simplex virus encephalitis can be treated with three methods

Herpes simplex encephalitis is a common disease in many people nowadays. Generally speaking, after people find out that they have herpes simplex virus encephalitis, they can use the following methods to treat it.

Antiviral drug treatment

a) Acyclovir: A guanine derivative that can inhibit the synthesis of viral DNA. Acyclovir is first converted into acyclovir monophosphate by viral thymidine kinase in virus-infected cells, and then converted into acyclovir triphosphate by kinase in host cells, competing with 2′-deoxyuridine, a substrate for DNA synthesis, to block the synthesis of viral DNA chains. The commonly used dose is 15~30 mg/(kg·d), divided into 3 doses of intravenous drip for 14~21 days. If the condition is serious, the treatment time can be extended or repeated for another course. Adverse reactions include delirium, tremor, rash, hematuria, and temporary increase in serum transaminases. Acyclovir can be used for diagnostic treatment in cases where the diagnosis is clinically suspected but there is no condition for cerebrospinal fluid etiology examination. In recent years, HSV strains resistant to acyclovir have been discovered. Such patients can try treatment with sodium foscarnet and cidofovir.

b) Ganciclovir: Its anti-HSV efficacy is 25 to 100 times that of acyclovir, with stronger and broader anti-HSV effects and lower toxicity. HSV mutants that are resistant to acyclovir and have DNA polymerase changes are also sensitive to ganciclovir. The dosage is 5~10 mg/(kg·d), once every 12 hours, intravenous drip, and the course of treatment is 14 to 21 days. The main adverse reactions are renal impairment and bone marrow suppression (neutropenia and thrombocytopenia), which are dose-related and recoverable after drug discontinuation.

Immunotherapy

a) Interferon: Interferon is a group of highly active glycoproteins produced by cells after viral infection. It has broad-spectrum antiviral activity and causes minimal damage to host cells. The therapeutic dose of α-interferon is 60×106 IU/d, continuously injected intramuscularly for 30 days; β-interferon can also be used in combination with systemic administration and intrathecal injection.

b) Transfer factor: It can sensitize normal lymphocytes and convert them into immune lymphocytes. The therapeutic dose is 1 injection subcutaneously, 1 to 2 times a week.

Adrenal cortex hormone

There is still controversy over the use of glucocorticoids to treat this disease, but adrenal cortex hormones can control the inflammatory response of HSE and reduce edema. They can be used as appropriate for patients with critical conditions, hemorrhagic necrotic foci shown on head CT, and a significant increase in white and red blood cells in cerebrospinal fluid. Dexamethasone 10-15 mg, intravenous drip, once a day, for 10-14 days; or methylprednisolone 800-1000 mg, intravenous drip, once a day, for 3-5 days, then switch to oral prednisone, 60 mg per day, taken in the morning, and then gradually reduce the dose.