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HSV Encephalitis — SCE Infectious Diseases MCQ

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ModerateCNS InfectionHSV EncephalitisSCE Infectious Diseases

A 50-year-old woman presents with Herpes simplex encephalitis confirmed by CSF HSV-1 PCR. She completes 14 days of IV Aciclovir with clinical improvement. What is the recommended follow-up plan?

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Correct answer: E — Repeat LP with CSF HSV PCR before stopping Aciclovir; if still positive, extend treatment

For immunocompetent patients with HSV encephalitis, 14 days of IV Aciclovir is standard. However, some experts and NICE guidelines suggest repeat CSF HSV PCR before stopping therapy. If CSF PCR remains positive at the end of treatment, extending IV Aciclovir for an additional 7 days is recommended. This is particularly important in immunocompromised patients (who receive 21 days routinely). Clinical relapse of HSV encephalitis occurs in approximately 5–25% of cases and may be immune-mediated.

Reference: NICE CG102 2010 – Encephalitis; BHIVA 2022 – OI guidelines