Viral encephalitis medical therapy: Difference between revisions

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Latest revision as of 00:40, 30 July 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Priyamvada Singh, MBBS [2]; João André Alves Silva, M.D. [3]; Anthony Gallo, B.S. [4]

Overview

Empiric therapy for encephalitis includes Acyclovir and it should be administered to all patients with suspected encephalitis as early as possible to reduce the risk of neurologic sequelae. Doxycycline should be added to the empirical regimen if epidemiological or clinical clues suggest rickettsial or ehrlichial infection.^[1] Despite the wide range of viruses that cause encephalitis, specific antiviral agents are generally limited to infections caused by the herpesviridae and human immunodeficiency virus (HIV). Treatment for other viral encephalitis is largely supportive.

Medical Therapy

General Considerations

Reliably tested specific antiviral agents are available only for a few viral agents (e.g. acyclovir or ganciclovir for herpes simplex virus and varicella-zoster encephalitis). Administer the first dose of acyclovir as soon as possible (in the emergency department itself). Acyclovir can be initiated with or without antibiotics or steroids.The advantages of an early antiviral drug administration are:
- Decreases disease duration
- Decreases development of latency
- Decreases development of complications
- Decreases recurrence
- Decreases transmission from infected person
Treatment for Toxoplasma gondii and cytomegalovirus encephalitis are available but are used with limited success
Treatment is usually symptomatic. In patients who are very sick, supportive treatment, such as mechanical ventilation, is equally important.
Systemic complications like hypotension, shock, hypoxemia, electrolyte imbalances (hyponatremia, SIADH should be treated promptly.
Neuroimaging with MRI or CT scan should be done before lumbar puncture especially if raised intracranial pressure is suspected.
Lab tests like blood samples should be taken before initiation of therapy.
Bed rest, plenty of fluids and anti-inflammatory drugs to relieve headache and fever should be used.

Treatment for Increased Intracranial Pressure

General

Elevation of head end of the bed
Hyperventilation may be used to decrease intra-cranial pressure on emergency basis
Constant monitoring of neurological status
Avoid increase in intra cranial pressure i.e. control of straining and coughing
Antipyretics and analgesic for fever and pain.
Monitoring and preventing seizures and hypotension.

Drug Therapy

Furosemide 20 mg iv and mannitol 1 gm/kg intravenously for diuresis (blood pressure and CVP should be monitored while administrating these drugs)
Dexamethasone 10mg intravenously 6 hourly to decrease cerebral edema.

Encephalitis Drug Summary

Acyclovir

It is effective for HSV1, HSV2 and varicella zoster.
It is selectively taken up by the body cells infected with HSV and varicella zoster
Prompt treatment with acyclovir is useful in decreasing complications, latency and communicability
Side effects may include nausea, vomiting, diarrhea, loss of appetite, and muscle or joint pain. Rarely, serious adverse effects may include renal and liver functions abnormalities or suppression of bone marrow activity.

Foscarnet

It is effective against HSV 1, HSV 2 and CMV
It is useful in patients who have developed resistance or are non-responders against acyclovir for e.g. HIV positive patients
Drug dosage depends on the renal function of the patient as Foscarnet is excreted through kidneys.

Dexamethasone

It is used in post-infectious and disseminated encephalitis.
It may be used as an adjunct with the antiviral agents

Furosemide

It is used to in encephalitis associated with increased intracranial pressure. The mechanism of action is:
- It decreases the production of CSF by inhibiting carbonic anhydrase enzymes
- Decreases cerebral sodium uptake
- Inhibits cellular membrane chloride pumps
The dose should be individualized for patients

Mannitol

Used only on short term basis.
The doses should be individualized based on renal function.

Lorazepam

It is used for treatment of seizures associated with encephalitis.

Antimicrobial Regimen

1. Empiric antimicrobial therapy^[2]

Preferred regimen: Acyclovir 10 mg/kg IV q8h for 14–21 days
Note (1): Acyclovir should be initiated in all patients with suspected encephalitis, pending results of diagnostic studies.
Note (2): Other empiric antimicrobial agents should be administered on the basis of specific epidemiologic or clinical clues.

2. Specific epidemiologic considerations^[2]

2.1 Agammaglobulinemia — Enteroviruses, Mycoplasma pneumoniae
2.2 Age

2.2.1 Neonates — Herpes simplex virus type 2, cytomegalovirus, rubella virus, Listeria monocytogenes, Treponema pallidum, Toxoplasma gondii
2.2.2 Infants and children — Eastern equine encephalitis virus, Japanese encephalitis virus, Murray Valley encephalitis virus, influenza virus, La Crosse virus
2.2.3 Elderly persons — Eastern equine encephalitis virus, St. Louis encephalitis virus, West Nile virus, sporadic CJD, L. monocytogenes

2.3 Animal contact

2.3.1 Bats — Rabies virus, Nipah virus
2.3.2 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)
2.3.3 Cats — Rabies virus, Coxiella burnetii, Bartonella henselae, T. gondii
2.3.4 Dogs — Rabies virus
2.3.5 Horses — Eastern equine encephalitis virus, Western equine encephalitis virus, Venezuelan equine encephalitis virus, Hendra virus
2.3.6 Old World primates — B virus
2.3.7 Raccoons — Rabies virus, Baylisascaris procyonis
2.3.8 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
2.3.9 Sheep and goats — C. burnetii
2.3.10 Skunks — Rabies virus
2.3.11 Swine — Japanese encephalitis virus, Nipah virus
2.3.12 White-tailed deer — Borrelia burgdorferi

2.4 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

2.5 Ingestion

2.5.1 Raw or partially cooked meat — T. gondii
2.5.2 Raw meat, fish, or reptiles — Gnanthostoma species
2.5.3 Unpasteurized milk — Tickborne encephalitis virus, L. monocytogenes, C. burnetii

2.6 Insect contact

2.6.1 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
2.6.2 Sandflies — Bartonella bacilliformis
2.6.3 Ticks — Tickborne encephalitis virus, Powassan virus, Rickettsia rickettsii, Ehrlichia chaffeensis, Anaplasma phagocytophilum, C. burnetii (rare), B. burgdorferi
2.6.4 Tsetse flies — Trypanosoma brucei gambiense, Trypanosoma brucei rhodesiense

2.7 Occupation

2.7.1 Exposure to animals — Rabies virus, C. burnetii, Bartonella species
2.7.2 Exposure to horses — Hendra virus
2.7.3 Exposure to Old World primates — B virus
2.7.4 Laboratory workers — West Nile virus, HIV, C. burnetii, Coccidioides species
2.7.5 Physicians and health care workers — Varicella zoster virus, HIV, influenza virus, measles virus, M. tuberculosis
2.7.6 Veterinarians — Rabies virus, Bartonella species, C. burnetii

2.8 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

2.9 Recent vaccination — Acute disseminated encephalomyelitis

2.10 Recreational activities

2.10.1 Camping/hunting — Agents transmitted by mosquitoes and ticks
2.10.2 Sexual contact — HIV, T. pallidum
2.10.3 Spelunking — Rabies virus, H. capsulatum
2.10.4 Swimming — Enteroviruses, Naegleria fowleri

2.11 Season

2.11.1 Late summer/early fall — Agents transmitted by mosquitoes and ticks, enteroviruses
2.11.2 Winter — Influenza virus

2.12 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

2.13 Travel

2.13.1 Africa — Rabies virus, West Nile virus, P. falciparum, T. brucei gambiense, T. brucei rhodesiense
2.13.2 Australia — Murray Valley encephalitis virus, Japanese encephalitis virus, Hendra virus
2.13.3 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
2.13.4 Europe — West Nile virus, tickborne encephalitis virus, A. phagocytophilum, B. burgdorferi
2.13.5 India, Nepal — Rabies virus, Japanese encephalitis virus, P. falciparum
2.13.6 Middle East — West Nile virus, P. falciparum
2.13.7 Russia — Tickborne encephalitis virus
2.13.8 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
2.13.9 Southeast Asia, China, Pacific Rim — Japanese encephalitis virus, tickborne encephalitis virus, Nipah virus, P. falciparum, Gnanthostoma species, T. solium
2.13.10 Unvaccinated status — Varicella zoster virus, Japanese encephalitis virus, poliovirus, measles virus, mumps virus, rubella virus

3. Specific clinical considerations^[2]

3.1 General findings

3.1.1 Hepatitis — Coxiella burnetii
3.1.2 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
3.1.3 Parotitis — Mumps virus
3.1.4 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
3.1.5 Respiratory tract findings — Venezuelan equine encephalitis virus, Nipah virus, Hendra virus, influenza virus, adenovirus, M. pneumoniae, C. burnetii, M. tuberculosis, Histoplasma capsulatum
3.1.6 Retinitis — Cytomegalovirus, West Nile virus, B. henselae, T. pallidum
3.1.7 Urinary symptoms — St. Louis encephalitis virus

3.2 Neurologic findings

3.2.1 Cerebellar ataxia — Varicella zoster virus (children), Epstein-Barr virus, mumps virus, St. Louis encephalitis virus, Tropheryma whipplei, T. brucei gambiense
3.2.2 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
3.2.3 Dementia — HIV, human transmissible spongiform encephalopathies (sCJD and vCJD), measles virus (SSPE), T. pallidum, T. whipplei
3.2.4 Myorhythmia — T. whipplei (oculomasticatory)
3.2.5 Parkinsonism — Japanese encephalitis virus, St. Louis encephalitis virus, West Nile virus, Nipah virus, T. gondii, T. brucei gambiense
3.2.6 Poliomyelitis-like flaccid paralysis — Japanese encephalitis virus, West Nile virus, tickborne encephalitis virus; enteroviruses (enterovirus-71, coxsackieviruses), poliovirus
3.2.7 Rhombencephalitis — Herpes simplex virus, West Nile virus, enterovirus 71, L. monocytogenes

4. Pathogen-directed antimicrobial therapy^[2]

4.1 Viruses

4.1.1 Adenovirus

Preferred regimen: supportive

4.1.2 B virus (herpes B virus)

4.1.2.1 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

4.1.2.2 Prophylaxis after bite or scratch

Preferred regimen: Valacyclovir 1,000 mg PO tid

4.1.3 Cytomegalovirus (CMV)

Preferred regimen: Ganciclovir 5 mg/kg IV q12h for 14–21 days, followed by 5 mg/kg IV qd for maintenance AND Foscarnet 90 mg/kg IV q12h for 14–21 days, followed by 90-120 mg/kg IV qd for maintenance

4.1.4 Chikungunya virus

Preferred regimen: supportive

4.1.5 Eastern equine encephalitis virus

Preferred regimen: supportive

4.1.6 Epstein-Barr virus (EBV)

Preferred regimen: supportive ± Corticosteroids
Note: Acyclovir is not recommended.

4.1.7 Hendra virus

Preferred regimen: supportive

4.1.8 HSV-1 and HSV-2

Preferred regimen: Acyclovir 10 mg/kg IV q8h for 14–21 days
Preferred regimen (neonates): Acyclovir 20 mg/kg IV q8h for 21 days

4.1.9 Human herpesvirus 6 (HHV-6)

Preferred regimen (1): Ganciclovir 5 mg/kg IV q12h for 14–21 days, followed by 5 mg/kg IV qd for maintenance

Preferred regimen (2): Foscarnet 90 mg/kg IV q12h for 14–21 days, followed by 90-120 mg/kg IV qd for maintenance

4.1.10 Human immunodeficiency virus (HIV)

Preferred regimen: HAART

4.1.11 Influenza virus

Preferred regimen: Oseltamivir 75 mg PO bid

4.1.12 Japanese encephalitis virus

Preferred regimen: supportive
Note: Interferon alpha is not recommended.

4.1.13 JC virus

Preferred regimen: Reversal or control of immunosuppression OR HAART in patients with AIDS

4.1.14 La Crosse virus

Preferred regimen: supportive

4.1.15 Louping ill virus

Preferred regimen: supportive

4.1.16 Lymphocytic choriomeningitis virus (LCMV)

Preferred regimen: supportive

4.1.17 Me Tri virus

Preferred regimen: supportive

4.1.18 Measles virus

Preferred regimen: supportive
Note: Ribavirin is not approved by the US Food and Drug Administration (FDA) for this indication, and such use should be considered experimental.

4.1.19 Monkeypox virus

Preferred regimen: supportive
Alternative regimen: Cidofovir OR vaccinia immune globulin

4.1.20 Mumps virus

Preferred regimen: supportive

4.1.21 Murray Valley encephalitis virus

Preferred regimen: supportive

4.1.22 Nipah virus

Preferred regimen: supportive
Alternative regimen: Ribavirin

4.1.23 Nonpolio enteroviruses

Preferred regimen: supportive
Note: Consider intraventricular γ-globulin for chronic and/or severe disease.

4.1.24 Poliovirus

Preferred regimen: supportive

4.1.25 Powassan virus

Preferred regimen: supportive

4.1.26 Rabies virus^[3]

4.1.26.1 Not previously vaccinated

Preferred regimen (1): Wound cleansing with soap and water followed by povidine-iodine solution irrigation if available.
Preferred regimen (2): Human rabies immune globulin (HRIG) 20 IU/kg
Preferred regimen (3): Human diploid cell vaccine (HDCV) or purified chick embryo cell vaccine (PCECV) 1.0 mL, IM (deltoid area), 1 each on days 0, 3, 7, and 14

4.1.26.2 Previously vaccinated

Preferred regimen (1): Wound cleansing with soap and water followed by povidine-iodine solution irrigation if available.
Preferred regimen (2): Human diploid cell vaccine (HDCV) or purified chick embryo cell vaccine (PCECV) 1.0 mL, IM (deltoid area), 1 each on days 0 and 3
Note: If anatomically feasible, the full dose of HRIG should be infiltrated around and into the wounds, and any remaining volume should be administered at an anatomical site intramuscularly distant from vaccine administration. In addition, HRIG should not be administered in the same syringe as vaccine. Because RIG might partially suppress active production of rabies virus antibody, no more than the recommended dose should be administered.

4.1.27 Rocio virus

Preferred regimen: supportive

4.1.28 Rubella virus

Preferred regimen: supportive

4.1.29 Snowshoe hare virus

Preferred regimen: supportive

4.1.30 St. Louis encephalitis virus

Preferred regimen: supportive
Alternative regimen: IFN-α-2b

4.1.31 Tickborne encephalitis virus

Preferred regimen: supportive

4.1.32 Toscana virus

Preferred regimen: supportive

4.1.33 Vaccinia

Preferred regimen: supportive ± Corticosteroids (if suggestive of post-immunization)

4.1.34 Venezuelan equine encephalitis virus

Preferred regimen: supportive

4.1.35 Varicella zoster virus (VZV)

Preferred regimen: Acyclovir 10–15 mg/kg IV q8h for 10–14 days ± Corticosteroids
Alternative regimen: Ganciclovir 5 mg/kg IV q12h for 14–21 days THEN 5 mg/kg IV qd for maintenance ± Corticosteroids

4.1.36 West Nile virus

Preferred regimen: supportive

4.1.37 Western equine encephalitis virus

Preferred regimen: supportive

4.2 Bacteria

4.2.1 Anaplasma phagocytophilum (human granulocytotrophic ehrlichiosis)

Preferred regimen: Doxycycline 100 mg PO/IV bid for 8 weeks

4.2.2 Bartonella bacilliformis (Oroya fever, Carrion's disease)

Preferred regimen: Chloramphenicol 25 mg/kg q6h for 14 days OR Doxycycline 100 mg PO/IV bid for 8 weeks OR Ampicillin 2 mg IV q4h for 3-6 weeks OR Trimethoprim-Sulfamethoxazole 4 mg/kg IV q6h for 3-6 weeks

4.2.3 Bartonella henselae (cat scratch disease)

Preferred regimen: Doxycycline 100 mg PO/IV bid for 8 weeks OR Azithromycin 250 mg PO qd for 8 weeks ± Rifampin 300 mg PO bid for 8 weeks

4.2.4 Borrelia burgdorferi (Lyme disease)

Preferred regimen: Ceftriaxone 2g IV q24h for 2-4 weeks OR Cefotaxime 2g IV q8h for 2-4 weeks OR Penicillin G 20MU IV q4hr in divided doses for 2-4 weeks

4.2.5 Coxiella burnetii (Q fever)

Preferred regimen: Doxycycline 100 mg IV/PO bid for 8 weeks AND Ciprofloxacin 500-750 mg PO bid for 8 weeks AND Rifampin 300 mg PO bid for 8 weeks

4.2.6 Ehrlichia chaffeensis (human monocytotrophic ehrlichiosis)

Preferred regimen: Doxycycline 100 mg IV/PO bid for 8 weeks

4.2.7 Listeria monocytogenes

Preferred regimen: Ampicillin 2 mg IV q4h for 3-6 weeks AND Gentamicin 5 mg/kg/day IV divided q8h for 3-6 weeks
Alternative regimen: Trimethoprim-Sulfamethoxazole 4 mg/kg IV q6h for 3-6 weeks

4.2.8 Mycobacterium tuberculosis

Preferred regimen: (Isoniazid 300 mg PO qd for 10-12 months AND Rifampicin 450-600 mg PO qd for 10-12 months AND Pyrazinamide 1.5-2g mg PO qd for 2 months AND Ethambutol 15 mg/kg PO qd for 2 month) ± Dexamethasone (if suggestive of meningitis)^[4]

4.2.9 Mycoplasma pneumoniae

Preferred regimen: Azithromycin 250 mg PO qd for 8 weeks OR Doxycycline 100 mg PO/IV bid for 8 weeks

4.2.10 Rickettsia rickettsii (Rocky Mountain spotted fever)

Preferred regimen: Doxycycline 100 mg PO/IV bid for 8 weeks
Alternative regimen, pregnant patient: Chloramphenicol 25 mg/kg q6h for 14 days

4.2.11 Treponema pallidum (syphilis)

Preferred regimen: Penicillin G 20MU IV q4hr in divided doses for 2-4 weeks
Alternative regimen: Ceftriaxone 2g IV q24h for 2-4 weeks

4.2.12 Tropheryma whipplei (Whipple's disease)

Preferred regimen: Ceftriaxone 2g IV q24h for 2-4 weeks, followed by Trimethoprim-Sulfamethoxazole for 1–2 years OR Cefixime for 1–2 years

4.3 Fungi

4.3.1 Coccidioides

Preferred regimen: Fluconazole 400-800 mg IV qd for 3-4 weeks
Alternative regimen: Itraconazole 200 mg IV bid for 2 days THEN 200 mg IV qd for 12 days OR Voriconazole OR Amphotericin B (intravenous and intrathecal)

4.3.2 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 6–10 weeks, followed by Fluconazole for 8 weeks
Note: Consider placement of lumbar drain or VP shunt.

4.3.3 Histoplasma capsulatum

Preferred regimen: Amphotericin B liposomal for 4–6 weeks, followed by Itraconazole for at least 1 year and until resolution of CSF abnormalities

4.4 Protozoa

4.4.1 Acanthamoeba

Preferred regimen (1): Trimethoprim-Sulfamethoxazole AND Rifampin AND Ketoconazole
Preferred regimen (2): Fluconazole AND Sulfadiazine AND Pyrimethamine 100-200 mg PO once THEN 50-100 mg PO qd for 6 weeks

4.4.2 Balamuthia mandrillaris

Preferred regimen: (Azithromycin OR Clarithromycin) AND Pentamidine AND Flucytosine AND Fluconazole AND Sulfadiazine AND (Thioridazine OR Trifluoperazine)

4.4.3 Naegleria fowleri

Preferred regimen: Amphotericin B (intravenous and intrathecal) AND Rifampin AND (Azithromycin OR Sulfisoxazole OR Miconazole)

4.4.4 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)

4.4.5 Toxoplasma gondii

Preferred regimen: Pyrimethamine AND Sulfadiazine OR Clindamycin 900 mg IV q 6hr qd for 6 weeks
Alternative regimen (1): Trimethoprim-sulfamethoxazole
Alternative regimen (2): Pyrimethamine AND (Atovaquone OR Clarithromycin OR Azithromycin OR Dapsone)

4.4.6 Trypanosoma brucei gambiense (West African trypanosomiasis)

Preferred regimen: Eflornithine OR Melarsoprol 2-3.6 mg/kg IV q24h for 3 days THEN repeat the same regimen after 7 days THEN repeat the same regimen again (total of 3 regimens after 7 days of the 2nd regimen

4.4.7 Trypanosoma brucei rhodesiense (East African trypanosomiasis)

Preferred regimen: Melarsoprol

4.5 Helminths

4.5.1 Baylisascaris procyonis

Preferred regimen: Albendazole AND Diethylcarbamazine AND Corticosteroids

4.5.2 Gnathostoma

Preferred regimen: Albendazole OR Ivermectin

4.5.3 Taenia solium (cysticercosis)

Preferred regimen: Albendazole AND Corticosteroids
Alternative regimen: Praziquantel AND Corticosteroids

4.6 Prion

4.6.1 Human transmissible spongiform encephalopathy

Preferred regimen: supportive

References

↑ 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): 303–327. doi:10.1086/589747. ISSN 1537-6591. PMID 18582201.
↑ ^2.0 ^2.1 ^2.2 ^2.3 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): 303–327. doi:10.1086/589747. ISSN 1537-6591. PMID 18582201.
↑ Rupprecht, Charles E.; Briggs, Deborah; Brown, Catherine M.; Franka, Richard; Katz, Samuel L.; Kerr, Harry D.; Lett, Susan M.; Levis, Robin; Meltzer, Martin I.; Schaffner, William; Cieslak, Paul R.; Centers for Disease Control and Prevention (CDC) (2010-03-19). "Use of a reduced (4-dose) vaccine schedule for postexposure prophylaxis to prevent human rabies: recommendations of the advisory committee on immunization practices". MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control. 59 (RR-2): 1–9. ISSN 1545-8601. PMID 20300058.
↑ Thwaites G, Fisher M, Hemingway C, Scott G, Solomon T, Innes J; et al. (2009). "British Infection Society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system in adults and children". J Infect. 59 (3): 167–87. doi:10.1016/j.jinf.2009.06.011. PMID 19643501.

References

[1] 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): 303–327. doi:10.1086/589747. ISSN 1537-6591. PMID 18582201.

[Guidelines2008-2] 2.0 ^2.1 ^2.2 ^2.3 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): 303–327. doi:10.1086/589747. ISSN 1537-6591. PMID 18582201.

[3] Rupprecht, Charles E.; Briggs, Deborah; Brown, Catherine M.; Franka, Richard; Katz, Samuel L.; Kerr, Harry D.; Lett, Susan M.; Levis, Robin; Meltzer, Martin I.; Schaffner, William; Cieslak, Paul R.; Centers for Disease Control and Prevention (CDC) (2010-03-19). "Use of a reduced (4-dose) vaccine schedule for postexposure prophylaxis to prevent human rabies: recommendations of the advisory committee on immunization practices". MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control. 59 (RR-2): 1–9. ISSN 1545-8601. PMID 20300058.

[pmid19643501-4] Thwaites G, Fisher M, Hemingway C, Scott G, Solomon T, Innes J; et al. (2009). "British Infection Society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system in adults and children". J Infect. 59 (3): 167–87. doi:10.1016/j.jinf.2009.06.011. PMID 19643501.

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-{{Encephalitis}}
+{{Viral encephalitis}}
-{{CMG}}; '''Associate Editors-In-Chief:''' [[Priyamvada Singh|Priyamvada Singh, MBBS]] [mailto:psingh13579@gmail.com]; {{JS}}
+{{CMG}}; {{AE}} [[Priyamvada Singh|Priyamvada Singh, MBBS]] [mailto:psingh13579@gmail.com]; {{JS}}; {{AG}}
 ==Overview==
-Encephalitis is an [[Acute (medical)|acute]] [[inflammation]] of the [[brain]], commonly caused by a [[virus|viral]] [[infection]]. Sometimes, encephalitis can result from a [[bacteria]]l infection, such as bacterial [[meningitis]], or it may be a complication of other infectious diseases like [[rabies]] (viral) or [[syphilis]] (bacterial). Certain [[parasitic]] or [[protozoa]]l infestations, such as [[toxoplasmosis]], [[malaria]], or [[primary amoebic meningoencephalitis]], can also cause encephalitis in people with [[immune deficiency|compromised]] [[immune system]]s. Treatment with acyclovir with or without steroids and antibiotics should be initiated as soon as possible.<ref name="pmid2195341">{{cite journal |author=Whitley RJ |title=Viral encephalitis |journal=[[The New England Journal of Medicine]] |volume=323 |issue=4 |pages=242–50 |year=1990 |month=July |pmid=2195341 |doi=10.1056/NEJM199007263230406 |url=http://www.nejm.org/doi/abs/10.1056/NEJM199007263230406?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed |accessdate=2012-02-14}}</ref> Antiviral agent like [[acyclovir]] has been useful in treatment of [[encephalitis]] due to [[herpes simplex virus]] and [[varicella zoster]]. Treatment for other causative agents of [[encephalitis]] is mostly supportive.
+Empiric therapy for encephalitis includes [[Acyclovir]] and it should be administered to all patients with suspected encephalitis as early as possible to reduce the risk of neurologic sequelae.  [[Doxycycline]] should be added to the empirical regimen if epidemiological or clinical clues suggest [[rickettsial]] or [[ehrlichial]] infection.<ref>{{Cite journal| doi = 10.1086/589747| issn = 1537-6591| volume = 47| issue = 3| pages = 303–327| last1 = Tunkel| first1 = Allan R.| last2 = Glaser| first2 = Carol A.| last3 = Bloch| first3 = Karen C.| last4 = Sejvar| first4 = James J.| last5 = Marra| first5 = Christina M.| last6 = Roos| first6 = Karen L.| last7 = Hartman| first7 = Barry J.| last8 = Kaplan| first8 = Sheldon L.| last9 = Scheld| first9 = W. Michael| last10 = Whitley| first10 = Richard J.| last11 = Infectious Diseases Society of America| title = The management of encephalitis: clinical practice guidelines by the Infectious Diseases Society of America| journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America| date = 2008-08-01| pmid = 18582201}}</ref>  Despite the wide range of viruses that cause encephalitis, specific antiviral agents are generally limited to infections caused by the [[herpesviridae]] and [[human immunodeficiency virus]] (HIV).  Treatment for other viral encephalitis is largely supportive.
 ==Medical Therapy==
 ===General Considerations===
 * Reliably tested specific antiviral agents are available only for a few viral agents (e.g. [[acyclovir]] or [[ganciclovir]] for [[herpes simplex virus]] and [[varicella-zoster]] encephalitis). Administer the first dose of [[acyclovir]] as soon as possible (in the emergency department itself). [[Acyclovir]] can be initiated with or without antibiotics or steroids.The advantages of an early antiviral drug administration are:
 ** Decreases disease duration
@@ Line 21: / Line 22: @@
 * Bed rest, plenty of fluids and anti-inflammatory drugs to relieve headache and fever should be used.
-===Empirical Treatment Regimen===
+===Treatment for Increased Intracranial Pressure===
-* '''Adult & Pediatrics''' - '''[[Acyclovir]]''', 10 mg/kg body weight, 8hourly, intravenous,  for 2-3 weeks.
-* '''Neonatal HSV''' - '''[[Acyclovir]]''' 10-15 mg/kg 8hourly, intravenous, for neonatal HSV
-* '''HIV Positive''' - '''[[Foscarnet]]''' is generally the treatment of choice given the high incidence of acyclovir resistance in these group of patients.
-===Treatment for Increased Intracranial Pressure===
 ====General====
 * Elevation of head end of the bed
@@ Line 40: / Line 37: @@
 ==Encephalitis Drug Summary==
 ===Acyclovir===
 * It is effective for HSV1, HSV2 and varicella zoster.
@@ Line 50: / Line 48: @@
 * It is useful in patients who have developed resistance or are non-responders against acyclovir for e.g. HIV positive patients
 * Drug dosage depends on the renal function of the patient as [[Foscarnet]] is excreted through kidneys.
 ===Dexamethasone===
 * It is used in post-infectious and disseminated encephalitis.
 * It may be used as an adjunct with the antiviral agents
 ===Furosemide===
-* It is used to in encephalitis associated with increased intracranial pressure. The mechanism of action  is;
+* It is used to in encephalitis associated with increased intracranial pressure. The mechanism of action is:
-** It decreases the production of CSF by inhibiting carbonic anhydrase enzymes.
+** It decreases the production of CSF by inhibiting carbonic anhydrase enzymes
 ** Decreases cerebral sodium uptake
-** Inhibits cellular membrane chloride pumps.
+** Inhibits cellular membrane chloride pumps
 * The dose should be individualized for patients
 ===Mannitol===
 * Used only on short term basis.
-* The doses should be individualized based on renal function
+* The doses should be individualized based on renal function.
 ===Lorazepam===
 * It is used for treatment of seizures associated with [[encephalitis]].
-==Empiric Therapy <SMALL><SMALL><SMALL><SMALL><SMALL><ref>{{Cite book  | last1 = Longo | first1 = Dan L. (Dan Louis) | title = Harrison's principles of internal medici | date = 2012 | publisher = McGraw-Hill | location = New York | isbn = 978-0-07-174889-6 | pages =  }}</ref> <ref name="pmid18582201">{{cite journal| author=Tunkel AR, Glaser CA, Bloch KC, Sejvar JJ, Marra CM, Roos KL et al.| title=The management of encephalitis: clinical practice guidelines by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2008 | volume= 47 | issue= 3 | pages= 303-27 | pmid=18582201 | doi=10.1086/589747 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18582201  }} </ref></SMALL></SMALL></SMALL></SMALL></SMALL>==
+==Antimicrobial Regimen==
-<SMALL><font color="#FF4C4C">'''▸ Click on the following categories to expand treatment regimens.'''</font></SMALL>
-{|
-| valign=top |
-<div style="border-radius: 5px 5px 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 305px; background: #A1BCDD; text-align: center;">
-<font color="#FFF">
-'''Empiric Therapy'''
-</font>
-</div>
-<div class="mw-customtoggle-table01" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 305px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Suspected encephalitis'''''
-</font>
-</div>
-<div class="mw-customtoggle-table02" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 305px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Antimicrobials based on epidemiology/clinic'''''
-</font>
-</div>
-<div class="mw-customtoggle-table03" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 305px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Rickettsial/ Ehrlichial infection'''''
-</font>
-</div>
-<div class="mw-customtoggle-table04" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px#20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 305px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Acute Disseminated Encephalomyelitis'''''
-</font>
-</div>
-| valign=top |
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table01" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Suspected encephalitis}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Acyclovir]] 10 mg/kg IV q8h for 14-21 days, in children and adults with normal renal function'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Acyclovir]] 20 mg/kg IV q8h for 21 days, in neonates'''''
-|-
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table02" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Antimicrobials based on epidemiology/clinic}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''Please refer to Pathogen-based therapy according to epidemiology and clinical evaluation'''''
-|-
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table03" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Rickettsial/ Ehrlichial infection}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Acyclovir]] 10 mg/kg IV q8h in children and adults with normal renal function'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Acyclovir]] 20 mg/kg IV q8h in neonates'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Doxycycline]] 200 mg/d in two divided doses'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; text-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" align=center | Alternative Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Tetracycline]] 25-50 mg/kg per day Oral, in four divided doses'''''
-|-
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table04" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Acute Disseminated Encephalomyelitis}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Acyclovir]] 10 mg/kg IV q8h in children and adults with normal renal function'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Acyclovir]] 20 mg/kg IV q8h in neonates'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Corticosteroids]] ([[dexamethasone]]) initial 10 mg IV, then 4 mg IM q6h or 2 mg PO 2x-3x/day'''''<ref> {{cite book | last1 = russ | title = Drug pocket 2011/12 | isbn = 978-1-59103-258-8}}</ref>
-|-
-|}
-|}
-|}
-==Pathogen-Based Therapy — Viruses <SMALL><SMALL><SMALL><SMALL><SMALL><ref>{{Cite book  | last1 = Longo | first1 = Dan L. (Dan Louis) | title = Harrison's principles of internal medici | date = 2012 | publisher = McGraw-Hill | location = New York | isbn = 978-0-07-174889-6 | pages =  }}</ref> <ref name="pmid18582201">{{cite journal| author=Tunkel AR, Glaser CA, Bloch KC, Sejvar JJ, Marra CM, Roos KL et al.| title=The management of encephalitis: clinical practice guidelines by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2008 | volume= 47 |issue= 3 | pages= 303-27 | pmid=18582201 | doi=10.1086/589747 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18582201  }} </ref></SMALL></SMALL></SMALL></SMALL></SMALL>==
-<SMALL><font color="#FF4C4C">'''▸ Click on the following categories to expand treatment regimens.'''</font></SMALL>
-{|
-| valign=top |
-<div style="border-radius: 5px 5px 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 305px; background: #A1BCDD; text-align: center;">
-<font color="#FFF">
-'''Viruses'''
-</font>
-</div>
-<div class="mw-customtoggle-table05" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 305px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Herpes simplex'''''
-</font>
-</div>
-<div class="mw-customtoggle-table06" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 305px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Varicella-zoster virus'''''
-</font>
-</div>
-<div class="mw-customtoggle-table07" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 305px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Cytomegalovirus'''''
-</font>
-</div>
-<div class="mw-customtoggle-table08" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 305px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Epstein-Barr virus'''''
-</font>
-</div>
-<div class="mw-customtoggle-table09" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 305px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Human herpesvirus 6'''''
-</font>
-</div>
-<div class="mw-customtoggle-table10" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 305px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''B virus'''''
-</font>
-</div>
-<div class="mw-customtoggle-table11" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 305px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Influenza virus'''''
-</font>
-</div>
-<div class="mw-customtoggle-table12" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 305px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Measles virus'''''
-</font>
-</div>
-<div class="mw-customtoggle-table13" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 305px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Nipah virus'''''
-</font>
-</div>
-<div class="mw-customtoggle-table14" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 305px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''West Nile virus'''''
-</font>
-</div>
-<div class="mw-customtoggle-table15" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 305px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Japanese encephalitis virus'''''
-</font>
-</div>
-<div class="mw-customtoggle-table16" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 305px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''St. Louis encephalitis virus'''''
-</font>
-</div>
-<div class="mw-customtoggle-table17" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 305px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''HIV'''''
-</font>
-</div>
-<div class="mw-customtoggle-table18" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px#20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 305px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''JC virus'''''
-</font>
-</div>
-| valign=top |
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table05" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Herpes simplex}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Acyclovir]] 10 mg/kg IV q8h for 14-21 days, in children and adults with normal renal function'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Acyclovir]] 20 mg/kg IV q8h for 21 days, in neonates'''''
-|-
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table06" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Varicella-zoster virus}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Acyclovir]] 10-15 mg/kg IV q8h for 10-14 days, in children and adults with normal renal function'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Acyclovir]] 20 mg/kg IV q8h in neonates'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Corticosteroids]] ([[dexamethasone]]) initial 10 mg IV, then 4 mg IM q6h or 2 mg PO 2x-3x/day'''''<ref> {{cite book | last1 = russ | title = Drug pocket 2011/12 | isbn = 978-1-59103-258-8}}</ref>
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Ganciclovir]] 5 mg/kg IV q12h for 14-21 days'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Corticosteroids]] ([[dexamethasone]]) initial 10 mg IV, then 4 mg IM q6h or 2 mg PO 2x-3x/day'''''<ref> {{cite book | last1 = russ | title = Drug pocket 2011/12 | isbn = 978-1-59103-258-8}}</ref>
-|-
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table07" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Cytomegalovirus}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Ganciclovir]] 5 mg/kg IV q12h for 14-21 days, then [[valganciclovir]] 900 mg PO q24h'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Foscarnet]] 60 mg/kg IV q8h or 90 mg/kg IV q12h for 14-21 days; then 90-120 mg/kg IV q24h.'''''
-|-
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table08" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Epstein-Barr virus}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Corticosteroids]] ([[dexamethasone]]) initial 10 mg IV, then 4 mg IM q6h or 2 mg PO 2x-3x/day'''''<ref> {{cite book | last1 = russ | title = Drug pocket 2011/12 | isbn = 978-1-59103-258-8}}</ref>
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=left | <SMALL><sup>†</sup> May be beneficial, however potential risks must be considered.</SMALL>
-|-
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table09" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Human herpesvirus 6}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''<sup>†</sup>
-|-
- | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Ganciclovir]] 5 mg/kg IV q12h for 14-21 days'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''<sup>†</sup>
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Foscarnet]] 60 mg/kg IV q8h or 90 mg/kg IV q12h for 14-21 days; then 90-120 mg/kg IV q24h.'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=left | <SMALL><sup>†</sup> Used in immunocompromised patients; no good data on effectiveness in immunocompetent patients.</SMALL>
-|-
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table10" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|B virus}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Postexposure prophylaxis'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Valacyclovir]] 1 gm PO q8h, for 14 days'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | OR
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Acyclovir]] 800 mg PO 5x/day, for 14 days'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Treatment of disease (Absent CNS symptoms)'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Ganciclovir]] 5 mg/kg IV q12h'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | OR
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Acyclovir]] 12.5-15 mg/kg IV q8h'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Treatment of disease (Presenting CNS symptoms)'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Ganciclovir]] 5 mg/kg IV q12h'''''
-|-
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table11" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Influenza virus}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Oseltamivir]] 75 mg/day, for at least 10 days'''''
-|-
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table12" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Measles virus}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''<sup>†</sup>
-|-
- | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Ribavirin]]'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=left | <SMALL><sup>†</sup> Consider intrathecal [[ribavirin]] in patients with subacute sclerosing panencephalitis</SMALL>
-|-
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table13" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Nipah virus}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
-|-
- | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Ribavirin]]'''''
-|-
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table14" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|West Nile virus}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''<sup>†</sup>
-|-
- | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=left | <SMALL><sup>†</sup> [[Ribavirin]] is not recommended</SMALL>
-|-
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table15" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Japanese encephalitis virus}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''<sup>†</sup>
-|-
- | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=left | <SMALL><sup>†</sup> [[IFN-α]] is not recommended</SMALL>
-|-
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table16" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|St. Louis encephalitis virus}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
-|-
- | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ [[IFN-2α]]
-|-
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table17" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|HIV}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
-|-
- | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ [[HAART]]
-|-
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table18" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|JC virus}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
-|-
- | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ Reversal of immunosuppression
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | OR
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[HAART]]'''''<sup>†</sup>
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=left | <SMALL><sup>†</sup> In HIV-infected patients</SMALL>
-|-
-|}
-|}
-|}
-==Pathogen-Based Therapy — Bacteria <SMALL><SMALL><SMALL><SMALL><SMALL><ref>{{Cite book  | last1 = Longo | first1 = Dan L. (Dan Louis) | title = Harrison's principles of internal medici | date = 2012 | publisher = McGraw-Hill | location = New York | isbn = 978-0-07-174889-6 | pages =  }}</ref> <ref name="pmid18582201">{{cite journal| author=Tunkel AR, Glaser CA, Bloch KC, Sejvar JJ, Marra CM, Roos KL et al.| title=The management of encephalitis: clinical practice guidelines by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2008| volume= 47 |issue= 3 | pages= 303-27 | pmid=18582201 | doi=10.1086/589747 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18582201  }} </ref></SMALL></SMALL></SMALL></SMALL></SMALL>==
-<SMALL><font color="#FF4C4C">'''▸ Click on the following categories to expand treatment regimens.'''</font></SMALL>
-{|
-| valign=top |
-<div style="border-radius: 5px 5px 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 305px; background: #A1BCDD; text-align: center;">
-<font color="#FFF">
-'''Bacteria'''
-</font>
-</div>
-<div class="mw-customtoggle-table19" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 305px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Bartonella bacilliformis'''''
-</font>
-</div>
-<div class="mw-customtoggle-table20" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 305px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Bartonella henselae'''''
-</font>
-</div>
-<div class="mw-customtoggle-table21" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 305px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Listeria monocytogenes'''''
-</font>
-</div>
-<div class="mw-customtoggle-table22" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 305px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Mycoplasma pneumoniae'''''
-</font>
-</div>
-<div class="mw-customtoggle-table23" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 305px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Tropheryma whipplei'''''
-</font>
-</div>
-<div style="border-radius: 0 0 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 305px; background: #A1BCDD; text-align: center;">
-<font color="#FFF">
-'''Mycobacteria'''
-</font>
-</div>
-<div class="mw-customtoggle-table24" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 305px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Mycobacterium tuberculosis'''''
-</font>
-</div>
-<div style="border-radius: 0 0 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 305px; background: #A1BCDD; text-align: center;">
-<font color="#FFF">
-'''Rickettsioses and ehrlichioses'''
-</font>
-</div>
-<div class="mw-customtoggle-table25" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 305px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Anaplasma phagocytophilum'''''
-</font>
-</div>
-<div class="mw-customtoggle-table26" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 305px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Ehrlichia chaffeensis'''''
-</font>
-</div>
-<div class="mw-customtoggle-table27" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 305px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Rickettsia rickettsii'''''
-</font>
-</div>
-<div class="mw-customtoggle-table28" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 305px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Coxiella burnetii'''''
-</font>
-</div>
-<div style="border-radius: 0 0 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 305px; background: #A1BCDD; text-align: center;">
-<font color="#FFF">
-'''Spirochetes'''
-</font>
-</div>
-<div class="mw-customtoggle-table29" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 305px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Borrelia burgdorferi'''''
-</font>
-</div>
-<div class="mw-customtoggle-table30" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 305px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Treponema pallidum'''''
-</font>
-</div>
-| valign=top |
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table19" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Bartonella bacilliformis}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
-|-
- | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Chloramphenicol]]50 mg/kg/day IV q6h. Resistant strains might require up to 100 mg/kg/day'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Ciprofloxacin]] 500 mg PO q12h'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | OR
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Doxycycline]] 100 mg/day PO q12h'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | OR
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Ampicillin]] 250-500 mg/day PO q6h'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | OR
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Trimethoprim]]-[[Sulfametoxazole]] 10-20 mg TMP/kg/day IV divided q6-12h'''''
-|-
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table20" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Bartonella henselae}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''<sup>†</sup>
-|-
- | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Azithromycin]] Adults: 500 mg PO, 1x, then 250 mg/day PO for 4 days; Children: 10 mg/kg 1x, then 5 mg/kg/day PO for 4 days'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Doxycycline]] 100 mg PO 2x/day for 8 weeks'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=left | <SMALL><sup>†</sup> With or without [[Rifampin]] 300 mg PO 2x/day.</SMALL>
-|-
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table21" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Listeria monocytogenes}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
-|-
- | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Ampicillin]] 250-500 mg PO q6h or 1-2 g IV/IM q4-6h'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Gentamicin]] 1-2.5 mg/kg/dose IV/IM q8-12h'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''<sup>†</sup>
-|-
- | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Trimethoprim]]-[[Sulfametoxazole]] 10-20 mg TMP/kg/day IV divided q6-12h'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=left | <SMALL><sup>†</sup> In the [[penicillin]]-allergic patient</SMALL>
-|-
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table22" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Mycoplasma pnumoniae}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
-|-
- | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Azithromycin]] 500 mg PO once, then 250 mg 1x/day, for 4 days'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
-|-
- | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Doxycycline]] 200 mg/day BID PO or IV 1x/day, then 100-200 mg/day qDay or divided q12h PO/IV'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | OR
-|-
- | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Fluoroquinolone]] 500 mg PO/IV 1x/day, for 7-14 days or 750 mg PO/IV 1x/day, for 5 days'''''
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table23" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Tropheryma whipplei}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
-|-
- | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Ceftriaxone]] 1-2 g/day IV/IM 1x/day or divided q12h, for 4-14 days'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
-|-
- | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Trimethoprim]]-[[Sulfametoxazole]] 10-20 mg TMP/kg/day IV divided q6-12h'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | OR
-|-
- | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Cefixime]] 400 mg/day PO 1x/day or divided q12h'''''
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table24" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Mycobacterium tuberculosis}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
-|-
- | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Isoniazid]] 300 mgPO qDay, for 9 months'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
-|-
- | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Rifampin]] 10 mg/kg/day PO or 10 mg/kg PO 2x/week (do not exceed 600 mg/day) (DOT)'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
-|-
- | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Ethambutol]] 15 mg/kg PO qDay'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
-|-
- | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Pyrazinamide]] 15-30 mg/kg PO qDay; not exceeding 2 g/day or 50 mg/kg PO 2x/weekly, not exceeding 2 g/dose '''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Dexamethasone]] 10mg IV q6h'''''<sup>†</sup>
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=left | <SMALL><sup>†</sup> Add in patients with [[meningitis]]</SMALL>
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table25" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Anaplasma phagocytophilum}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
-|-
- | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Doxycycline]]  100 mg PO 2x/day for 30-60 days'''''
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table26" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Ehrlichia chaffeensis}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
-|-
- | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Doxycycline]] 100 mg PO 2x/day for 30-60 days'''''
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table27" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Rickettsia rickettsii}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
-|-
- | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Doxycycline]] 100 mg PO 2x/day for 30-60 days'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
-|-
- | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Chloramphenicol]] 50 mg/kg/day IV divided q6hr'''''<sup>†</sup>
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=left | <SMALL><sup>†</sup> In certain clinical scenarios ([[pregnancy]])</SMALL>
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table28" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Coxiella burnetii}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
-|-
- | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Doxycycline]] 100 mg PO 2x/day for 30-60 days'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
-|-
- | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Fluoroquinolone]] 500 mg PO q12h or 400 mg IV q12h for 10 days'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
-|-
- | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Rifampin]] 600 mg q12hr for 2 days'''''
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table29" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Borrelia burgdorferi}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
-|-
- | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Ceftriaxone]] 1-2 g/day IV/IM 1x/day or divided q12h, for 4-14 days'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | OR
-|-
- | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Cefotaxime]] 2 g IV q4h, up to 12 g/day'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | OR
-|-
- | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Penicillin G benzathine]] 2.4 million units/4mL syringe IM qWeek x3'''''<ref name="pmid978-1-59103-258-8">{{cite journal| author=Swett C| title=Outpatient phenothiazine use and bone marrow depression. A report from the drug epidemiology unit and the Boston collaborative drug surveillance program. | journal=Arch Gen Psychiatry | year= 1975 | volume= 32 | issue= 11 | pages= 1416-8 | pmid=978-1-59103-258-8 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=978  }} </ref>
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table30" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Treponema pallidum}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
-|-
- | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Penicillin G benzathine]] 2.4 million units/4mL syringe IM qWeek x3'''''<ref name="pmid978-1-59103-258-8">{{cite journal| author=Swett C| title=Outpatient phenothiazine use and bone marrow depression. A report from the drug epidemiology unit and the Boston collaborative drug surveillance program. | journal=Arch Gen Psychiatry | year= 1975 | volume= 32 | issue= 11 | pages= 1416-8 | pmid=978-1-59103-258-8 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=978  }} </ref>
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
-|-
- | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Ceftriaxone]] 1-2 g/day IV/IM 1x/day or divided q12h, for 4-14 days'''''
-|}
-|}
-|}
-==Pathogen-Based Therapy — Fungi, Protozoa and Helminths <SMALL><SMALL><SMALL><SMALL><SMALL><ref>{{Cite book  | last1 = Longo | first1 = Dan L. (Dan Louis) | title = Harrison's principles of internal medici | date = 2012 | publisher = McGraw-Hill | location = New York | isbn = 978-0-07-174889-6 | pages =  }}</ref> <ref name="pmid18582201">{{cite journal| author=Tunkel AR, Glaser CA, Bloch KC, Sejvar JJ, Marra CM, Roos KL et al.| title=The management of encephalitis: clinical practice guidelines by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2008| volume= 47 |issue= 3 | pages= 303-27 | pmid=18582201 | doi=10.1086/589747 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18582201  }} </ref></SMALL></SMALL></SMALL></SMALL></SMALL>==
-<SMALL><font color="#FF4C4C">'''▸ Click on the following categories to expand treatment regimens.'''</font></SMALL>
-{|
-| valign=top |
-<div style="border-radius: 5px 5px 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 305px; background: #A1BCDD; text-align: center;">
-<font color="#FFF">
-'''Fungi'''
-</font>
-</div>
-<div class="mw-customtoggle-table31" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 305px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Coccidioides species'''''
-</font>
-</div>
-<div class="mw-customtoggle-table32" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 305px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Cryptococcus neoformans'''''
-</font>
-</div>
-<div class="mw-customtoggle-table33" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 305px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Histoplasma capsulatum'''''
-</font>
-</div>
-<div style="border-radius: 0 0 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 305px; background: #A1BCDD; text-align: center;">
-<font color="#FFF">
-'''Protozoa'''
-</font>
-</div>
-<div class="mw-customtoggle-table34" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 305px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Acanthamoeba'''''
-</font>
-</div>
-<div class="mw-customtoggle-table35" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 305px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Balamuthia mandrillaris'''''
-</font>
-</div>
-<div class="mw-customtoggle-table36" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 305px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Naegleria fowleri'''''
-</font>
-</div>
-<div class="mw-customtoggle-table37" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 305px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Plasmodium falciparum'''''
-</font>
-</div>
-<div class="mw-customtoggle-table38" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 305px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Toxoplasma gondii'''''
-</font>
-</div>
-<div class="mw-customtoggle-table39" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 305px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Trypanosoma brucei gambiense'''''
-</font>
-</div>
-<div class="mw-customtoggle-table40" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 305px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Trypanosoma brucei rhodesiense'''''
-</font>
-</div>
-<div style="border-radius: 0 0 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 305px; background: #A1BCDD; text-align: center;">
-<font color="#FFF">
-'''Helminths'''
-</font>
-</div>
-<div class="mw-customtoggle-table41" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 305px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Baylisascaris procyonis'''''
-</font>
-</div>
-<div class="mw-customtoggle-table42" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 305px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Gnathostoma species'''''
-</font>
-</div>
-<div class="mw-customtoggle-table43" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 305px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Taenia solium'''''
-</font>
-</div>
-| valign=top |
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table31" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Coccidioides species}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Fluconazole]] 400 mg PO on day 1, followed by 200 mg PO qDay'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Itraconazole]] 200 mg PO q8hr for 3-4 days, followed by 200-400 mg/day for at least 3 months'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | OR
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Voriconazole]] 6 mg/kg IV q12hr for 24 hours, followed by 4 mg/kg IV q12hr or 200 mg PO q12hr'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | OR
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Amphotericin B]] (IV or Intratechal) start with load dose: 0.25-0.5 mg/kg IV infused over 2-6h, followed by maintenance dose: 0.25-1 mg/kg IV qDay'''''
-|-
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table32" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Cryptococcus neoformans}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
-|-
- | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Amphotericin B]] start with load dose: 0.25-0.5 mg/kg IV infused over 2-6h, followed by maintenance dose: 0.25-1 mg/kg IV qDay'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Flucytosine]] 50-150 mg/kg/day PO divided q6hr'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''Lipid formulation of [[amphotericin B]] 6 mg/kg IV qDay'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Flucytosine]] 50-150 mg/kg/day PO divided q6hr'''''
-|-
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table33" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Histoplasma capsulatum}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
-|-
- | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''Liposomal [[Amphotericin B]] 6 mg/kg IV qDay'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Itraconazole]] 200 mg PO q8hr for 3-4 days, followed by 200-400 mg/day for at least 3 months'''''
-|-
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table34" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Acanthamoeba}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
-|-
- | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Trimethoprim]]-[[Sulfametoxazole]] 10-20 mg TMP/kg/day IV divided q6-12h'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Rifampin]] 600 mg q12hr for 2 days'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Ketoconazole]] 200-400 mg/day PO'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Fluconazole]] 400 mg PO on Day 1, then 200 mg PO qDay'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Sulfadiazine]] 1-1.5 g 4x/day, for 3-4 weeks; prophylaxis in HIV patients: 0.5-1 g q6h with pyrimethamine (25-75 mg/day PO) & Folinic acid (10-25 mg/day PO)'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Pyrimethamine]] 50-75 mg qDay PO, for 1-3 weeks; then 25-37.5 mg qDay PO for 4-5 weeks'''''
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table35" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Balamuthia mandrillaris}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
-|-
- | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Pentamidine]] 2-4 mg/kg IM q24-48hr'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Macrolide]] ([[Azithromycin]] 500 mg PO once, then 250 mg once daily; or [[Clarithromycin]] 500 mg PO q12hr)'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Fluconazole]] 400 mg PO on Day 1, then 200 mg PO qDay'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Sulfadiazine]] 1-1.5 g 4x/day, for 3-4 weeks; prophylaxis in HIV patients: 0.5-1 g q6h with pyrimethamine (25-75 mg/day PO) & Folinic acid (10-25 mg/day PO)'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Flucytosine]] 50-150 mg/kg/day PO divided q6hr'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Phenothiazine]]'''''
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table36" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Naegleria fowleri}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
-|-
- | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Amphotericin B]] 1.5 mg/kg/day IV divided in 2 doses, for 3 days; then 1 mg/kg/day for 6 days + 1.5 mg/day intrathecal for 2 days; then 1 mg/day intrathecal for 8 days'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Rifampin]] 600 mg q12hr for 2 days'''''
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table37" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Plasmodium falciparum}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''<sup>†</sup>
-|-
- | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Quinine]] 648 mg PO q8hr, for 3-7 days'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | OR
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Quinidine]] 300-600 mg or 10 mg/kg PO q8hr, for 5-7 days'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | OR
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Artemether]] Administer 24 tablets over 3 days: Day 1: 4 tablets initially and 4 tablets after 8h; Day 2 and 3: 4 tablets 2x/day (1 tablet= 20mg/120mg)'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Atovaquone]]-[[proguanil]] 1 g/400 mg PO daily, for 3 days'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=left | <SMALL><sup>†</sup> Exchange transfusion recommended for patients with cerebral malaria or more than 10% parasitemia.</SMALL>
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table38" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Toxoplasma gondii}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
-|-
- | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Pyrimethamine]] 50-75 mg qDay PO for 1-3 weeks, then 25-37.5 mg qDay PO for 4-5 weeks'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Sulfadiazine]] 1-1.5 g 4x/day, for 3-4 weeks; prophylaxis in HIV patients: 0.5-1 g q6h with pyrimethamine (25-75 mg/day PO) & Folinic acid (10-25 mg/day PO)'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | OR
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Clindamycin]] 300 mg PO 4x/day, for 6 weeks'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Trimethoprim]] 10 mg/kg/day - [[Sulfametoxazole]] 50 mg/kg/day, for 4 weeks'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | OR
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Pyrimethamine]] 100mg loading dose PO followed by 25-50 mg/day, for 6 weeks'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Atovaquone]] 750 mg 2x/day, for 6 weeks'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | OR
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Clarithromycin]] 500 mg PO q12hr'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | OR
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Azithromycin]] 500 mg/day, for 6 weeks'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | OR
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Dapsone]] 100 mg PO qDay'''''
-|-
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table39" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Trypanosoma brucei gambiense}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
-|-
- | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Eflornithine]] 400 mg/kg/day IV divided 4x/day, for 14 days, then 300 mg/kg/day PO, for 3-4 weeks'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Melarsoprol]] 2-3.6 mg/kg/day IV, for 3 days; after 1 week: 3.6 mg/kg/day IV, for 3 days; then repeat again after 10-21 days: 3.6 mg/kg/day'''''
-|-
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table40" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Trypanosoma brucei rhodesiense}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
-|-
- | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Melarsoprol]] 2-3.6  mg/kg/day IV for 3 days; then repeat after 7 days; then repeat for 3rd time, 7 days after the 2nd course'''''
-|-
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table41" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Baylisascaris procyonis}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''<sup>†</sup>
-|-
- | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Albendazole]] 400 mg PO x1 day'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Diethycarbamazine]]'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=left | <SMALL><sup>†</sup> Consider adjunctive [[corticosteroids]]</SMALL>
-|-
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table42" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Gnathostoma species}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
-|-
- | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Albendazole]] 400 mg PO q24h or twice a day, for 21 days'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | OR
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Ivermectin]] 200 μg/kg/day PO, for 2 days'''''
-|-
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table43" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Taenia solium}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''<sup>†</sup>
-|-
- | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Albendazole]] (more than 60 kgs) 400 mg PO 2x/day, for 8-30 days; (less than 60 kg) 15 mg/kg/day PO divided 2x/day, for 8-30 days; no more than 800 mg/day'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Corticosteroids]]'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Praziquantel]] 10-20 mg/kg x1'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=left | <SMALL><sup>†</sup> Evaluate need for treatment</SMALL>
-|-
-|}
-|}
-|}
-==Pathogen-Based Therapy — Postinfectious or Postvaccination status <SMALL><SMALL><SMALL><SMALL><SMALL><ref>{{Cite book  | last1 = Longo | first1 = Dan L. (Dan Louis) | title = Harrison's principles of internal medici | date = 2012 | publisher = McGraw-Hill | location = New York | isbn = 978-0-07-174889-6 | pages =  }}</ref> <ref name="pmid18582201">{{cite journal| author=Tunkel AR, Glaser CA, Bloch KC, Sejvar JJ, Marra CM, Roos KL et al.| title=The management of encephalitis: clinical practice guidelines by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2008| volume= 47 |issue= 3 | pages= 303-27 | pmid=18582201 | doi=10.1086/589747 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18582201  }} </ref></SMALL></SMALL></SMALL></SMALL></SMALL>==
-<SMALL><font color="#FF4C4C">'''▸ Click on the following categories to expand treatment regimens.'''</font></SMALL>
-{|
-| valign=top |
-<div style="border-radius: 5px 5px 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 305px; background: #A1BCDD; text-align: center;">
-<font color="#FFF">
-'''Postinfectious/postvaccination status'''
-</font>
-</div>
-<div class="mw-customtoggle-table44" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px#20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 305px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Acute disseminated encephalomyelitis'''''</font>
-</div>
-| valign=top |
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table44" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Acute Disseminated Encephalomyelitis}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''<sup>†</sup>
-|-
- | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''High dose [[Corticosteroids]]'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Plasma exchange]]'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | OR
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''Intravenous [[immunoglobulin]]'''''
-|-
-|}
-|}
-|}
-==Follow Up Therapy==
-* Physiotherapy
-* Occupational therapy
-* Speech therapy
-* Psychotherapy
+{{ID-Encephalitis}}
 ==References==
 {{Reflist|2}}
-[[Category:Primary care]]
+[[Category:Infectious Disease Project]]
 [[Category:Disease]]
 [[Category:Neurological disorders]]
-[[Category:Infectious disease]]
 [[Category:Inflammations]]
-[[Category:Overview complete]]
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Viral encephalitis medical therapy: Difference between revisions

Latest revision as of 00:40, 30 July 2020

Overview

Medical Therapy

General Considerations

Treatment for Increased Intracranial Pressure

General

Drug Therapy

Encephalitis Drug Summary

Acyclovir

Foscarnet

Dexamethasone

Furosemide

Mannitol

Lorazepam

Antimicrobial Regimen

References

References

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