197.2 📚 國考版

197.2.0.1 必背 — 2 Types

  • HSV-1: oral (classical), increasingly anogenital young adults
  • HSV-2: genital, lifelong latency in sacral ganglia

197.2.0.2 必背 — Latency

  • Trigeminal ganglia (oral) + sacral ganglia (genital)
  • LAT (latency-associated transcripts)

197.2.0.3 必背 — HSV Encephalitis

  • Temporal lobe predilection + hemorrhagic + necrotizing
  • HSV-1 adult
  • MRI temporal lobe T2 hyperintensity
  • EEG PLEDs in temporal
  • HSV PCR of CSF = gold standard
  • Acyclovir 10 mg/kg IV q8h × 14-21d — start immediately

197.2.0.4 必背 — Neonatal HSV

  • SEM (skin/eye/mouth), CNS, Disseminated
  • Acyclovir 20 mg/kg IV q8h × 14d SEM / 21d CNS/Diss
  • PO suppression × 6 mo after IV

197.2.0.5 必背 — Dx

  • PCR lesion / blood / CSF — most sensitive
  • Tzanck smear quick bedside (low sens, no type distinguish)
  • Type-specific serology (gG1/gG2)

197.2.0.6 必背 — Treatment

Form Tx
Orolabial recurrent Valacyclovir 2 g bid × 1 day (or 5d)
Genital primary Valacyclovir 1 g bid × 7-10d
Genital recurrent Valacyclovir 500 bid × 3d
Suppression Valacyclovir 500 qd
Encephalitis Acyclovir 10 mg/kg IV q8h × 14-21d
Neonatal Acyclovir 20 mg/kg IV q8h × 14-21d
Resistant Foscarnet or cidofovir

197.2.0.7 必背 — Keratitis

  • Dendritic ulcer on cornea
  • Trifluridine + oral acyclovir
  • NO topical steroid unless ophthalmology

197.2.0.8 必背 — Pregnancy

  • Acyclovir 36 wk gestation for recurrent
  • Cesarean if active genital lesions at delivery