Neonatal herpes

Alternate names

Neonatal herpes simplex virus infection; Neonatal HSV infection

Summary

Herpes simplex virus (HSV) infection in newborn infants can present with the following manifestations:<ref>Fernandes ND, Arya K, Ward R. Congenital Herpes Simplex. [Updated 2021 Jan 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507897/</ref>[1].

• Disseminated disease involving multiple organs, most prominently liver and lungs (25%)
• Localized central nervous system (CNS) disease, with or without skin involvement (30%)
• Disease limited to the skin, eyes, and/or mouth (SEM disease) (45%)

Epidemiology

The incidence of neonatal HSV infection is estimated to range between 1 in 3000 to 1 in 20,000 live births.

Cause

• Two distinct HSV types exist: HSV-1 and HSV-2. <ref>Fernandes ND, Arya K, Ward R. Congenital Herpes Simplex. [Updated 2021 Jan 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507897/</ref>[2].
• However, either type of virus can be found in either area, and both HSV-1 and HSV-2 cause herpes disease in neonates.
• As with all human herpesviruses, HSV-1 and HSV-2 establish latency following primary infection, with periodic reactivation to cause recurrent symptomatic disease or asymptomatic viral shedding.

Transmission

• HSV is transmitted to a neonate most commonly during birth through an infected maternal genital tract but can be caused by an ascending infection through ruptured or intact amniotic membranes.
• Other less common sources of neonatal infection include postnatal transmission from a parent or other caregiver, most often from a non-genital lesion, for example on the mouth or hands. <ref>Fernandes ND, Arya K, Ward R. Congenital Herpes Simplex. [Updated 2021 Jan 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507897/</ref>[3].

Signs and symptoms

Signs and symptoms may include:

• Mucocutaneous vesicles
• Sepsis-like illness (fever or hypothermia, irritability, lethargy, respiratory distress, apnea, abdominal distension, hepatomegaly, ascites)
• CSF pleocytosis
• Seizures
• Focal neurologic signs
• Abnormal neuroimaging
• Respiratory distress, apnea, or progressive pneumonitis
• Thrombocytopenia
• Elevated liver transaminases, viral hepatitis, or acute liver failure
• Conjunctivitis, excessive tearing, or painful eye symptoms

Diagnosis

To diagnose neonatal HSV infection, the following specimens should be obtained:

• Swab specimens from the mouth, nasopharynx, conjunctivae, and anus (“surface cultures”) for HSV culture and, if desired, for HSV PCR assay;
• Specimens of skin vesicles for HSV culture and, if desired, for PCR assay
• CSF sample for HSV PCR assay
• Whole blood sample for HSV PCR assay and
• Whole blood sample for measuring alanine aminotransferase (ALT).

Positive cultures obtained from any of the surface sites more than 12 to 24 hours after birth indicate viral replication and are, therefore, suggestive of infant infection rather than merely contamination after intrapartum exposure.<ref>Fernandes ND, Arya K, Ward R. Congenital Herpes Simplex. [Updated 2021 Jan 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507897/</ref>[4].

Treatment

• Parenteral acyclovir is the treatment for neonatal HSV infections.
• Parenteral acyclovir should be administered to all neonates with HSV disease, regardless of manifestations and clinical findings.<ref>Fernandes ND, Arya K, Ward R. Congenital Herpes Simplex. [Updated 2021 Jan 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507897/</ref>[5].

References

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NIH genetic and rare disease info

• NIH info on Neonatal herpes

Neonatal herpes is a rare disease.

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