Case Study #7   1  2  3  4  5  6  7  8  9  10  11  12  13 Clinical Course in our patient Received acyclovir continuously after repeat MRI result Transferred from ICU to floor on POD#3 Speech-language pathology evaluation on POD#3 “fluent aphasia syndrome characterized by moderate deficits in verbal expression and auditory comprehension” ID recommendation for 21 days on IV acyclovir Discharged to home with PICC line on hospital day #14, POD#12 Prognosis in Herpes Encephalitis outcome is poor for patients with: Glasgow coma score less than 6 patients > 30 years old untreated encephalitis > four days critical to institute therapy before semicoma/coma develops acyclovir is standard therapy purine nucleoside analogue, (9-[2-hydroxyethoxymethyl] guanine) 10 mg/kg every 8 hours for 10-14 days 19% mortality at 6 months vs. ~ 50% with vidarabine most acyclovir-treated survivors have neurologic impairment NIAID Collaborative Antiviral Study Group (Whitley, RJ) Hokkanen L, Lounes J. Neuropsychol Rev 10:151, 2000 McGrath N et al. J Neurol Neurosurg Psychiatry 63:321, 1997 Herpes simplex virus 1 capsid: A T=16 icosahedral structure composed of the major capsid protein arranged in hexons (blue) and pentons (darker blue), and two minor capsid proteins forming triplexes (green). COURTESY OF Alsadiar Steven, Ph.D. Laboratory of Structural Biology Research, NIAMS, NIH