What is the treatment of herpes simplex encephalitis (HSE) with recurrent lesions or other organ system involvement?

Updated: Jul 17, 2018
  • Author: Wayne E Anderson, DO, FAHS, FAAN; Chief Editor: Niranjan N Singh, MBBS, MD, DM, FAHS, FAANEM  more...
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Except where otherwise specified, this article describes HSE as it occurs in older children and adults (as opposed to neonatal HSE). HSE must be distinguished from herpes simplex meningitis, which is more commonly caused by HSV-2 than by HSV-1 and which often occurs in association with a concurrent herpetic genital infection. Like other forms of viral meningitis, herpes simplex meningitis usually has a benign course and is not discussed in this article.

Patients with HSV may require long-term antiviral treatment if they have recurrent lesions or if other organ systems are involved (as in herpes simplex keratitis). HSV remains dormant in the nervous system; rarely, it presents as encephalitis, possibly by direct transmission through peripheral nerves to the central nervous system (CNS). This encephalitis is a neurologic emergency and the most important neurologic sequela of HSV.

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