Treatment of complicated forms of herpes
Ophthalmic and complicated herpes are accompanied by severe pain syndrome and profuse rashes. In such situations, immediate antiviral therapy is required.
The primary drug is aciclovir. The dosage regimen varies depending on severity:
- Oral: 600–800 mg per day, divided into 4–5 doses.
- Intravenous: 5 mg per 1 kg of the patient's body weight 3 times a day.
The standard course of treatment is 7 to 10 days.
Alternative antiviral agents include:
- Ganciclovir: prescribed at 500 mg 3 times a day.
- Valaciclovir: administered at 1000 mg 3 times a day; the course lasts exactly one week.
Treatment of postherpetic neuralgia
Postherpetic neuralgia is a severe complication requiring a specific approach to pain management, as classical analgesics are ineffective for neuropathic pain.
Two main groups of drugs are used to relieve pain:
- Antidepressants: for example, amitriptyline at a dosage of 50–75 mg per day.
- Anticonvulsants:
- pregabalin (150–300 mg/day);
- gabapentin (high doses: from 1200 to 3600 mg/day);
- carbamazepine (200–600 mg/day).
Parasitic CNS infections
Parasitic infections of the central nervous system are quite rare in clinical practice. The predominant nosologies include cysticercosis and schistosomiasis.
Infection often occurs when swimming in freshwater rivers and lakes, which are habitats for freshwater snails acting as intermediate hosts for the parasites.
The diagnostic algorithm is based on two pillars:
- Instrumental methods (CT or MRI): imaging reveals characteristic rounded lesions, which typically have a well-defined capsule.
- Laboratory methods: serological tests confirm the presence of helminths in the body (positive result).
Specific treatment involves long courses of anthelmintic drugs (from 15 to 30 days):
- Praziquantel: orally at 50 mg per 1 kg of body weight.
- Albendazole: 5 mg 3 times a day.
Mnemonic for neuralgia medications: APGC (Amitriptyline, Pregabalin, Gabapentin, Carbamazepine) — "Antidepressants Help Alleviate Agony".
Class and exam questions
What are the prescribed doses of gabapentin for postherpetic neuralgia?
The dosage of gabapentin ranges from 1200 to 3600 mg per day depending on the intensity of the pain syndrome.
What do we look for on MRI when suspecting a parasitic CNS infection?
We look for characteristic rounded, typically encapsulated lesions of the brain tissue.
How can one contract schistosomiasis or cysticercosis?
In some cases, infection occurs during swimming in freshwater bodies (rivers, lakes) inhabited by infected snails.
What else to study on this topic
- Mechanisms of action of antiviral drugs (aciclovir, ganciclovir)
- Pathogenesis of neuropathic pain development following herpes infection
- Life cycle of the causative agents of cysticercosis and schistosomiasis
- Differential MRI diagnosis of encapsulated brain lesions
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Other topics in "Chapter 23. Infectious Diseases of the Nervous System"
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