A 32 years old Bengali women had fever since 48 hours with history of irrelevant talk and 2 episodes of tonic clonic seizures on succession on the way to hospital. She was previously alright. Which of the following drug can be given while rest of the investigations were being carried out?
Ans. d. IV acyclovir (Ref: Harrison 19/e p893. 18/e)A 32 years old Bengali women had fever since 48 hours with history of irrelevant talk and 2 episodes of tonic clonic seizures on succession on the way to hospital. She was previously alright. This patient is most probably suffering from viral encephalitis. Acyclovir is of benefit in the treatment of HSV and should be started empirically in patients with suspected viral encephalitis, especially if focal features are present, while awaiting viral diagnostic studies.Acyclovir is of benefit in the treatment of HSV and should be started empirically in patients with suspected viral encephalitis, especially if focal features are present, while awaiting viral diagnostic studies. Harrison 18/eViral EncephalitisIn encephalitis the brain parenchyma is involved.Many patients with encephalitis also have evidence of associated meningitis (meningoencephalitis) and, in some cases, involvement of the spinal cord or nerve roots (encephalomyelitis, encephalomyeloradiculitis).Clinical Features:In addition to the acute febrile illness with evidence of meningeal involvement, an altered level of consciousnessQ (confusion, behavioral abnormalities), or a depressed level of consciousness ranging from mild lethargy to coma, and evidence of either focal or diffuse neurologic signs and symptomsQ.Focal or generalized seizuresQ occur in many patients with encephalitis.MC encountered focal findings are aphasia, ataxia, upper or lower motor neuron patterns of weakness, involuntary movements (e.g., myoclonic jerks, tremor), and cranial nerve deficitsQ (e.g., ocular palsies, facial weakness).Diagnosis:CSF PCR has become the primary diagnostic test for CIVS infections caused by CMV, EBV. HHV-6. and enterovirusesQThe sensitivity (~ 96%) and specificity (~ 99%) of HSV CSF PCR is equivalent to or exceeds that of brain biopsyQ.Patients with suspected encephalitis almost invariably undergo neuroimaging studies and often EEGQ.Focal findings in a patient with encephalitis should always raise the possibility of HSV encephalitisQ.Treatment:Specific antiviral therapy should be initiated when appropriateQ.Basic management and supportive therapy should include careful monitoring of ICP, fluid restriction, avoidance of hypotonic intravenous solutions, and suppression of fever.Seizures should be treated with standard anticonvulsant regimensQ, and prophylactic therapy should be considered in view of the high frequency of seizures in severe cases of encephalitis.Acyclovir is of benefit in the treatment of HSV and should be started empirically in patients with suspected viral encephalitis, especially if focal features are present, while awaiting viral diagnostic studies.
IV mannitol
IV amphotericin B
IV penicillin
IV acyclovir
Seizures and Epilepsy