2018 年 35 巻 4 号 p. 529-534
Prompt recognition and treatment of herpes simplex virus encephalitis (HSVE) is potentially lifesaving in the care of patients. However, no new antiviral drugs have been introduced in nearly 30 years. Although acyclovir treatment for HSVE is highly effective, the rate of poor outcomes, including advanced sequelae, remains high at 33–53%, and the rate of return to normal living is less than 50%. Clinical care guidelines around a simple algorithm, supported by an evidence base, would improve the outcomes of patients with HSVE. In Japan, the guidelines for the clinical management of HSVE were revised in 2017. Three major points were revised in the guidelines. First, a simple algorithm for examination and treatment has been presented at the beginning of the guidelines, to enable prompt management of encephalitis as an emergency. Second, the guidelines in Japan recommend that initiation of therapy should not be delayed beyond 6 hours of the patient's arrival at the hospital. Third, the management of clinically resistant herpes simplex virus has been clarified. We review here the revisions of the Japanese guidelines for the clinical management of HSVE, that were revised in 2017.