Sandbox g23

# Encephalitis
- Empiric antimicrobial therapy
- Preferred regimen: Acyclovir 10 mg/kg IV q8h for 1421 days
- Specific epidemiologic considerations
- Agammaglobulinemia  Enteroviruses, Mycoplasma pneumoniae
- Age
- Neonates  Herpes simplex virus type 2, cytomegalovirus, rubella virus, Listeria monocytogenes, Treponema pallidum, Toxoplasma gondii
- Infants and children  Eastern equine encephalitis virus, Japanese encephalitis virus, Murray Valley encephalitis virus, influenza virus, La Crosse virus
- Elderly persons  Eastern equine encephalitis virus, St. Louis encephalitis virus, West Nile virus, sporadic CJD, L. monocytogenes
- Animal contact
- Bats  Rabies virus, Nipah virus
- Birds  West Nile virus, Eastern equine encephalitis virus, Western equine encephalitis virus, Venezuelan equine encephalitis virus, St. Louis encephalitis virus, Murray Valley encephalitis virus, Japanese encephalitis virus, Cryptococcus neoformans (bird droppings)
- Cats  Rabies virus, Coxiella burnetii, Bartonella henselae, T. gondii
- Dogs  Rabies virus
- Horses  Eastern equine encephalitis virus, Western equine encephalitis virus, Venezuelan equine encephalitis virus, Hendra virus
- Old World primates  B virus
- Raccoons  Rabies virus, Baylisascaris procyonis
- Rodents  Eastern equine encephalitis virus (South America), Venezuelan equine encephalitis virus, tickborne encephalitis virus, Powassan virus (woodchucks), La Crosse virus (chipmunks and squirrels), Bartonella quintana
- Sheep and goats  C. burnetii
- Skunks  Rabies virus
- Swine  Japanese encephalitis virus, Nipah virus
- White-tailed deer  Borrelia burgdorferi
- Immunocompromised persons  Varicella zoster virus, cytomegalovirus, human herpesvirus 6, West Nile virus, HIV, JC virus, L. monocytogenes, Mycobacterium tuberculosis, C. neoformans, Coccidioides species, Histoplasma capsulatum, T. gondii
- Ingestion
- Raw or partially cooked meat  T. gondii
- Raw meat, fish, or reptiles  Gnanthostoma species
- Unpasteurized milk  Tickborne encephalitis virus, L. monocytogenes, C. burnetii
- Insect contact
- Mosquitoes  Eastern equine encephalitis virus, Western equine encephalitis virus, Venezuelan equine encephalitis virus, St. Louis encephalitis virus, Murray Valley encephalitis virus, Japanese encephalitis virus, West Nile virus, La Crosse virus, Plasmodium falciparum
- Sandflies  Bartonella bacilliformis
- Ticks  Tickborne encephalitis virus, Powassan virus, Rickettsia rickettsii, Ehrlichia chaffeensis, Anaplasma phagocytophilum, C. burnetii (rare), B. burgdorferi
- Tsetse flies  Trypanosoma brucei gambiense, Trypanosoma brucei rhodesiense
- Occupation
- Exposure to animals  Rabies virus, C. burnetii, Bartonella species
- Exposure to horses  Hendra virus
- Exposure to Old World primates  B virus
- Laboratory workers  West Nile virus, HIV, C. burnetii, Coccidioides species
- Physicians and health care workers  Varicella zoster virus, HIV, influenza virus, measles virus, M. tuberculosis
- Veterinarians  Rabies virus, Bartonella species, C. burnetii
- Person-to-person transmission  Herpes simplex virus (neonatal), varicella zoster virus, Venezuelan equine encephalitis virus (rare), poliovirus, nonpolio enteroviruses, measles virus, Nipah virus, mumps virus, rubella virus, Epstein-Barr virus, human herpesvirus 6, B virus, West Nile virus (transfusion, transplantation, breast feeding), HIV, rabies virus (transplantation), influenza virus, M. pneumoniae, M. tuberculosis, T. pallidum
- Recent vaccination  Acute disseminated encephalomyelitis
- Recreational activities
- Camping/hunting  Agents transmitted by mosquitoes and ticks
- Sexual contact  HIV, T. pallidum
- Spelunking  Rabies virus, H. capsulatum
- Swimming  Enteroviruses, Naegleria fowleri
- Season
- Late summer/early fall  Agents transmitted by mosquitoes and ticks, enteroviruses
- Winter  Influenza virus
- Transfusion and transplantation  Cytomegalovirus, Epstein-Barr virus, West Nile virus, HIV, tickborne encephalitis virus, rabies virus, iatrogenic CJD, T. pallidum, A. phagocytophilum, R. rickettsii, C. neoformans, Coccidioides species, H. capsulatum, T. gondii
- Travel
- Africa  Rabies virus, West Nile virus, P. falciparum, T. brucei gambiense, T. brucei rhodesiense
- Australia  Murray Valley encephalitis virus, Japanese encephalitis virus, Hendra virus
- Central America  Rabies virus, Eastern equine encephalitis virus, Western equine encephalitis virus, Venezuelan equine encephalitis virus, St. Louis encephalitis virus, R. rickettsii, P. falciparum, Taenia solium
- Europe  West Nile virus, tickborne encephalitis virus, A. phagocytophilum, B. burgdorferi
- India, Nepal  Rabies virus, Japanese encephalitis virus, P. falciparum
- Middle East  West Nile virus, P. falciparum
- Russia  Tickborne encephalitis virus
- South America  Rabies virus, Eastern equine encephalitis virus, Western equine encephalitis virus, Venezuelan equine encephalitis virus, St. Louis encephalitis virus, R. rickettsii, B. bacilliformis (Andes mountains), P. falciparum, T. solium
- Southeast Asia, China, Pacific Rim  Japanese encephalitis virus, tickborne encephalitis virus, Nipah virus, P. falciparum, Gnanthostoma species, T. solium
- Unvaccinated status  Varicella zoster virus, Japanese encephalitis virus, poliovirus, measles virus, mumps virus, rubella virus
- Specific clinical considerations
- General findings
- Hepatitis  Coxiella burnetii
- Lymphadenopathy  HIV, Epstein-Barr virus, cytomegalovirus, measles virus, rubella virus, West Nile virus, Treponema pallidum, Bartonella henselae and other Bartonella species, Mycobacterium tuberculosis, Toxoplasma gondii, Trypanosoma brucei gambiense
- Parotitis  Mumps virus
- Rash  Varicella zoster virus, B virus, human herpesvirus 6, West Nile virus, rubella virus, some enteroviruses, HIV, Rickettsia rickettsii, Mycoplasma pneumoniae, Borrelia burgdorferi, T. pallidum, Ehrlichia chaffeensis, Anaplasma phagocytophilum
- Respiratory tract findings  Venezuelan equine encephalitis virus, Nipah virus, Hendra virus, influenza virus, adenovirus, M. pneumoniae, C. burnetii, M. tuberculosis, Histoplasma capsulatum
- Retinitis  Cytomegalovirus, West Nile virus, B. henselae, T. pallidum
- Urinary symptoms  St. Louis encephalitis virus
- Neurologic findings
- Cerebellar ataxia  Varicella zoster virus (children), Epstein-Barr virus, mumps virus, St. Louis encephalitis virus, Tropheryma whipplei, T. brucei gambiense
- Cranial nerve abnormalities  Herpes simplex virus, Epstein-Barr virus, Listeria monocytogenes, M. tuberculosis, T. pallidum, B. burgdorferi, T. whipplei, Cryptococcus neoformans, Coccidioides species, H. capsulatum
- Dementia  HIV, human transmissible spongiform encephalopathies (sCJD and vCJD), measles virus (SSPE), T. pallidum, T. whipplei
- Myorhythmia  T. whipplei (oculomasticatory)
- Parkinsonism  Japanese encephalitis virus, St. Louis encephalitis virus, West Nile virus, Nipah virus, T. gondii, T. brucei gambiense
- Poliomyelitis-like flaccid paralysis  Japanese encephalitis virus, West Nile virus, tickborne encephalitis virus; enteroviruses (enterovirus-71, coxsackieviruses), poliovirus
- Rhombencephalitis  Herpes simplex virus, West Nile virus, enterovirus 71, L. monocytogenes
- Pathogen-directed antimicrobial therapy
- Viruses
- Adenovirus
- Preferred regimen: supportive
- B virus (herpes B virus)
- Established disease
- Preferred regimen: Valacyclovir 1,000 mg PO tid OR Ganciclovir 5 mg/kg IV q12h for  14 days until resolution of neurologic symptoms, then Acyclovir 800 mg PO 5 times daily indefinitely OR Valacyclovir 1 g PO tid indefinitely
- Alternative regimen: Acyclovir 15 mg/kg IV q8h for  14 days until resolution of neurologic symptoms, then Acyclovir 800 mg PO 5 times daily OR Valacyclovir 1 g PO tid indefinitely
- Prophylaxis after bite or scratch
- Preferred regimen: Valacyclovir 1,000 mg PO tid
- Cytomegalovirus (CMV)
- Preferred regimen: Ganciclovir 5 mg/kg IV q12h for 1421 days, followed by 5 mg/kg IV qd for maintenance AND Foscarnet 90 mg/kg IV q12h for 1421 days, followed by 90-120 mg/kg IV qd for maintenance
- Eastern equine encephalitis virus
- Preferred regimen: supportive
- Epstein-Barr virus (EBV)
- Preferred regimen: supportive  Corticosteroids
- Hendra virus
- Preferred regimen: supportive
- HSV-1 and HSV-2
- Preferred regimen: Acyclovir 10 mg/kg IV q8h for 1421 days
- Preferred regimen (neonates): Acyclovir 20 mg/kg IV q8h for 21 days
- Human herpesvirus 6 (HHV-6)
- Preferred regimen: Ganciclovir 5 mg/kg IV q12h for 1421 days, followed by 5 mg/kg IV qd for maintenance OR Foscarnet 90 mg/kg IV q12h for 1421 days, followed by 90-120 mg/kg IV qd for maintenance
- Human immunodeficiency virus (HIV)
- Preferred regimen: HAART
- Influenza virus
- Preferred regimen: Oseltamivir 75 mg PO bid
- Japanese encephalitis virus
- Preferred regimen: supportive
- JC virus
- Preferred regimen: Reversal or control of immunosuppression OR HAART in patients with AIDS
- La Crosse virus
- Preferred regimen: supportive
- Measles virus
- Life-threatening disease
- Preferred regimen: Ribavirin
- SSPE
- Preferred regimen: Ribavirin intrathecal
- Mumps virus
- Preferred regimen: supportive
- Murray Valley encephalitis virus
- Preferred regimen: supportive
- Nipah virus
- Preferred regimen: supportive
- Alternative regimen: Ribavirin
- Nonpolio enteroviruses
- Preferred regimen: supportive
- Poliovirus
- Preferred regimen: supportive
- Powassan virus
- Preferred regimen: supportive
- Rabies virus
- Preferred regimen: supportive
- Rubella virus
- Preferred regimen: supportive
- St. Louis encephalitis virus
- Preferred regimen: supportive
- Alternative regimen: IFN--2b
- Tickborne encephalitis virus
- Preferred regimen: supportive
- Vaccinia
- Preferred regimen: supportive  Corticosteroids (if suggestive of post-immunization)
- Venezuelan equine encephalitis virus
- Preferred regimen: supportive
- Varicella zoster virus (VZV)
- Preferred regimen: Acyclovir 1015 mg/kg IV q8h for 1014 days  Corticosteroids
- Alternative regimen: Ganciclovir 5 mg/kg IV q12h for 1421 days, followed by 5 mg/kg IV qd for maintenance  Corticosteroids
- West Nile virus
- Preferred regimen: supportive
- Western equine encephalitis virus
- Preferred regimen: supportive
- Bacteria
- Anaplasma phagocytophilum (human granulocytotrophic ehrlichiosis)
- Preferred regimen: Doxycycline
- Bartonella bacilliformis (Oroya fever, Carrion's disease)
- Preferred regimen: Chloramphenicol OR Ciprofloxacin] OR Doxycycline OR Ampicillin OR Trimethoprim-Sulfamethoxazole
- Bartonella henselae (cat scratch disease)
- Preferred regimen: Doxycycline OR Azithromycin  Rifampin
- Borrelia burgdorferi (Lyme disease)
- Preferred regimen: Ceftriaxone OR Cefotaxime OR Penicillin G
- Coxiella burnetii (Q fever)
- Preferred regimen:  Doxycycline AND Fluoroquinolone AND Rifampin
- Ehrlichia chaffeensis (human monocytotrophic ehrlichiosis)
- Preferred regimen: Doxycycline
- Listeria monocytogenes
- Preferred regimen: Ampicillin AND Gentamicin
- Alternative regimen: Trimethoprim-Sulfamethoxazole
- Mycobacterium tuberculosis
- Preferred regimen: (Isoniazid AND Rifampin AND Pyrazinamide AND Ethambutol)  Dexamethasone (if suggestive of meningitis)
- Mycoplasma pneumoniae
- Preferred regimen: Azithromycin OR Doxycycline OR Fluoroquinolone
- Rickettsia rickettsii (Rocky Mountain spotted fever)
- Preferred regimen: Doxycycline
- Alternative regimen: Chloramphenicol (for pregnant patients)
- Treponema pallidum (syphilis)
- Preferred regimen: Penicillin G
- Alternative regimen: Ceftriaxone
- Tropheryma whipplei (Whipple's disease)
- Preferred regimen: Ceftriaxone for 24 weeks, followed by Trimethoprim-Sulfamethoxazole for 12 years OR Cefixime for 12 years
- Fungi
- Coccidioides
- Preferred regimen: Fluconazole
- Alternative regimen: Itraconazole OR Voriconazole OR Amphotericin B (intravenous and intrathecal)
- Cryptococcus neoformans
- Preferred regimen (1): Amphotericin B deoxycholate AND Flucytosine for 2 weeks, followed by Fluconazole for 8 weeks
- Preferred regimen (2): Amphotericin B lipid complex AND Flucytosine for 2 weeks, followed by Fluconazole for 8 weeks
- Preferred regimen (3): Amphotericin B deoxycholate AND Flucytosine for 610 weeks, followed by Fluconazole for 8 weeks
- Histoplasma capsulatum
- Preferred regimen: Amphotericin B liposomal for 46 weeks, followed by Itraconazole for at least 1 year and until resolution of CSF abnormalities
- Protozoa
- Acanthamoeba
- Preferred regimen (1): Trimethoprim-Sulfamethoxazole AND Rifampin AND Ketoconazole
- Preferred regimen (2): Fluconazole AND Sulfadiazine AND Pyrimethamine
- Balamuthia mandrillaris
- Preferred regimen: (Azithromycin OR Clarithromycin) AND Pentamidine AND Flucytosine AND Fluconazole AND Sulfadiazine AND (Thioridazine OR Trifluoperazine)
- Naegleria fowleri
- Preferred regimen: Amphotericin B (intravenous and intrathecal) AND Rifampin AND (Azithromycin OR Sulfisoxazole OR Miconazole)
- Plasmodium falciparum
- Preferred regimen: Quinine OR Quinidine OR Artesunate OR Artemether
- Alternative regimen (1): Atovaquone-Proguanil
- Alternative regimen (2): Exchange transfusion (for > 10% parasitemia or cerebral malaria)
- Toxoplasma gondii
- Preferred regimen: Pyrimethamine AND Sulfadiazine OR Clindamycin
- Alternative regimen (1): Trimethoprim-sulfamethoxazole
- Alternative regimen (2): Pyrimethamine AND (Atovaquone OR Clarithromycin OR Azithromycin OR Dapsone
- Trypanosoma brucei gambiense (West African trypanosomiasis)
- Preferred regimen: Eflornithine OR Melarsoprol
- Trypanosoma brucei rhodesiense (East African trypanosomiasis)
- Preferred regimen: Melarsoprol
- Helminths
- Baylisascaris procyonis
- Preferred regimen: Albendazole AND Diethylcarbamazine AND Corticosteroids
- Gnathostoma
- Preferred regimen: Albendazole OR Ivermectin
- Taenia solium (cysticercosis)
- Preferred regimen: Albendazole AND Corticosteroids
- Alternative regimen: Praziquantel AND Corticosteroids
- Prion
- Human transmissible spongiform encephalopathy
- Preferred regimen: supportive
-  Tunkel, Allan R.; Glaser, Carol A.; Bloch, Karen C.; Sejvar, James J.; Marra, Christina M.; Roos, Karen L.; Hartman, Barry J.; Kaplan, Sheldon L.; Scheld, W. Michael; Whitley, Richard J.; Infectious Diseases Society of America (2008-08-01). "The management of encephalitis: clinical practice guidelines by the Infectious Diseases Society of America". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 47 (3): 303327. doi:10.1086/589747. ISSN 1537-6591. PMID 18582201..mw-parser-output cite.citation{font-style:inherit}.mw-parser-output q{quotes:"\"""\"""'""'"}.mw-parser-output code.cs1-code{color:inherit;background:inherit;border:inherit;padding:inherit}.mw-parser-output .cs1-lock-free a{background:url("")no-repeat;background-position:right .1em center}.mw-parser-output .cs1-lock-limited a,.mw-parser-output .cs1-lock-registration a{background:url("")no-repeat;background-position:right .1em center}.mw-parser-output .cs1-lock-subscription a{background:url("")no-repeat;background-position:right .1em center}.mw-parser-output .cs1-subscription,.mw-parser-output .cs1-registration{color:#555}.mw-parser-output .cs1-subscription span,.mw-parser-output .cs1-registration span{border-bottom:1px dotted;cursor:help}.mw-parser-output .cs1-hidden-error{display:none;font-size:100%}.mw-parser-output .cs1-visible-error{display:none;font-size:100%}.mw-parser-output .cs1-subscription,.mw-parser-output .cs1-registration,.mw-parser-output .cs1-format{font-size:95%}.mw-parser-output .cs1-kern-left,.mw-parser-output .cs1-kern-wl-left{padding-left:0.2em}.mw-parser-output .cs1-kern-right,.mw-parser-output .cs1-kern-wl-right{padding-right:0.2em}
-  Tunkel, Allan R.; Glaser, Carol A.; Bloch, Karen C.; Sejvar, James J.; Marra, Christina M.; Roos, Karen L.; Hartman, Barry J.; Kaplan, Sheldon L.; Scheld, W. Michael; Whitley, Richard J.; Infectious Diseases Society of America (2008-08-01). "The management of encephalitis: clinical practice guidelines by the Infectious Diseases Society of America". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 47 (3): 303327. doi:10.1086/589747. ISSN 1537-6591. PMID 18582201.
-  Tunkel, Allan R.; Glaser, Carol A.; Bloch, Karen C.; Sejvar, James J.; Marra, Christina M.; Roos, Karen L.; Hartman, Barry J.; Kaplan, Sheldon L.; Scheld, W. Michael; Whitley, Richard J.; Infectious Diseases Society of America (2008-08-01). "The management of encephalitis: clinical practice guidelines by the Infectious Diseases Society of America". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 47 (3): 303327. doi:10.1086/589747. ISSN 1537-6591. PMID 18582201.
-  Tunkel, Allan R.; Glaser, Carol A.; Bloch, Karen C.; Sejvar, James J.; Marra, Christina M.; Roos, Karen L.; Hartman, Barry J.; Kaplan, Sheldon L.; Scheld, W. Michael; Whitley, Richard J.; Infectious Diseases Society of America (2008-08-01). "The management of encephalitis: clinical practice guidelines by the Infectious Diseases Society of America". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 47 (3): 303327. doi:10.1086/589747. ISSN 1537-6591. PMID 18582201.