Neonatal HSV - Revision history

Aidan: /* Clinical Manifestations */

2020-08-05T13:58:01Z

Clinical Manifestations

← Older revision		Revision as of 13:58, 5 August 2020
Line 18:		Line 18:
	==Clinical Manifestations==		==Clinical Manifestations==

	*Incubation period 7 to 21 days post-partum, with range from birth to 6 weeks		*Incubation period [[Usual incubation period::7 to 21 days]] post-partum, with range from [[Incubation period range::birth to 6 weeks]]
	*Spectrum of disease from cutaneous to disseminated		*Spectrum of disease from cutaneous to disseminated

Aidan: Text replacement - "Clinical Presentation" to "Clinical Manifestations"

2020-07-21T18:43:15Z

Text replacement - "Clinical Presentation" to "Clinical Manifestations"

← Older revision		Revision as of 18:43, 21 July 2020
Line 16:		Line 16:
	*Localized CNS infection is thought to occur by retrograde axonal transmission		*Localized CNS infection is thought to occur by retrograde axonal transmission

	==Clinical ~~Presentation~~==		==Clinical Manifestations==

	*Incubation period 7 to 21 days post-partum, with range from birth to 6 weeks		*Incubation period 7 to 21 days post-partum, with range from birth to 6 weeks

Aidan: /* Management */

2020-07-21T02:30:27Z

Management

← Older revision		Revision as of 02:30, 21 July 2020
Line 45:		Line 45:
	*Usually presents in the first or second week of life		*Usually presents in the first or second week of life

	== Diagnosis ==		==Diagnosis==

	* Most commonly diagnosed with PCR of lesions or ~~CSF~~		*Most commonly diagnosed with PCR of lesions, CSF, or mucosal membranes (conjunctivae, mouth, nasopharynx)
	** Do not send superficial swabs for PCR during the first 24 hours of life, since this can generate false positive from superficial contamination from the birthing process		**Do not send superficial swabs for PCR during the first 24 hours of life, since this can generate false positive from superficial contamination from the birthing process
	** Early CSF PCR may be falsely negative; consider continuing acyclovir and repeating at 72 hours if high clinical suspicion		**Early CSF PCR may be falsely negative; consider continuing acyclovir and repeating at 72 hours if high clinical suspicion

	==Management==		==Management==

			=== Diagnosed neonates ===

			*Obtain CSF (± blood PCR), and transaminases to determine if the disease involves CSF and is disseminated
	*'''Disseminated disease:''' high-dose [[Is treated with::acyclovir]] 60 mg/kg/day IV divided q8h for at least 21 days		*'''Disseminated disease:''' high-dose [[Is treated with::acyclovir]] 60 mg/kg/day IV divided q8h for at least 21 days
	**If CNS disease, repeat lumbar puncture at the end of therapy to document resolution of CSF parameters and ensure that PCR is negative		**If CNS disease, repeat lumbar puncture at the end of therapy to document resolution of CSF parameters and ensure that PCR is negative
Line 58:		Line 61:
	*'''Localized skin, eye, and mouth disease:''' high-dose [[Is treated with::acyclovir]] 60 mg/kg/day IV divided q8h for at least 14 days		*'''Localized skin, eye, and mouth disease:''' high-dose [[Is treated with::acyclovir]] 60 mg/kg/day IV divided q8h for at least 14 days
	**For eye involvement, consult and ophthalmologist to add topical trifluridine, idoxuridine, or vidarabine		**For eye involvement, consult and ophthalmologist to add topical trifluridine, idoxuridine, or vidarabine

			=== Exposed neonates ===

			* First-episode genital HSV at delivery
			** Rupture of membranes before vaginal or cesarean delivery
			*** Swab mucous membranes for PCR either at birth or at 24 hours
			*** Start empiric [[acyclovir]] IV for 10 days
			*** If swabs confirm HSV infection, follow management above for diagnosed neonates
			*** If swabs are negative, complete the 10-day course regardless
			** Cesarean delivery prior to rupture of membranes
			*** Swab mucous membranes or blood PCR at 24 hours
			*** Counsel caregiver on signs and symptoms, and discharge
			*** If swabs confirm HSV infection, readmit to complete investigations and manage as above for diagnosed neonates
			* Recurrent genital HSV at delivery
			** Swab mucous membranes for PCR at 24 hours
			** Counsel caregiver on signs and symptoms, and discharge
			** If swabs confirm HSV infection, readmit to complete investigations and manage as above for diagnosed neonates

	==Prognosis==		==Prognosis==

Aidan at 01:55, 21 July 2020

2020-07-21T01:55:47Z

← Older revision		Revision as of 01:55, 21 July 2020
Line 3:		Line 3:
	*See also [[Herpes simplex virus]]		*See also [[Herpes simplex virus]]

	=== Epidemiology ===		===Epidemiology===

	*Risk of transmission is determined by maternal serostatus at time of maternal genital infection		*Risk of transmission is determined by maternal serostatus at time of maternal genital infection
Line 44:		Line 44:
	*Localized to skin, eyes, and/or mouth		*Localized to skin, eyes, and/or mouth
	*Usually presents in the first or second week of life		*Usually presents in the first or second week of life

			== Diagnosis ==

			* Most commonly diagnosed with PCR of lesions or CSF
			** Do not send superficial swabs for PCR during the first 24 hours of life, since this can generate false positive from superficial contamination from the birthing process
			** Early CSF PCR may be falsely negative; consider continuing acyclovir and repeating at 72 hours if high clinical suspicion

	==Management==		==Management==

Aidan: /* Epidemiology */

2020-07-21T01:48:24Z

Epidemiology

← Older revision		Revision as of 01:48, 21 July 2020
Line 8:		Line 8:
	**Newly acquired		**Newly acquired
	***First-episode primary infection (mother has no serum antibodies to HSV-1 or -2 at onset): risk of transmission is about 60%		***First-episode primary infection (mother has no serum antibodies to HSV-1 or -2 at onset): risk of transmission is about 60%
	***First-episode nonprimary infection (mother has a new infection with one HSV type in the presence of antibodies to the other type): risk of transmission is less than 40%		***First-episode nonprimary infection (mother has a new infection with one HSV type in the presence of antibodies to the other type): risk of transmission is less than 30%
	**Recurrent (mother has pre-existing antibodies to the HSV type that is isolated from the genital tract): risk of transmission is less than 2%		**Recurrent (mother has pre-existing antibodies to the HSV type that is isolated from the genital tract): risk of transmission is less than 2%

Aidan: /* Background */ added Epidemiology

2020-07-21T01:43:24Z

Background: added Epidemiology

← Older revision		Revision as of 01:43, 21 July 2020
Line 2:		Line 2:

	*See also [[Herpes simplex virus]]		*See also [[Herpes simplex virus]]

			=== Epidemiology ===

			*Risk of transmission is determined by maternal serostatus at time of maternal genital infection
			**Newly acquired
			***First-episode primary infection (mother has no serum antibodies to HSV-1 or -2 at onset): risk of transmission is about 60%
			***First-episode nonprimary infection (mother has a new infection with one HSV type in the presence of antibodies to the other type): risk of transmission is less than 40%
			**Recurrent (mother has pre-existing antibodies to the HSV type that is isolated from the genital tract): risk of transmission is less than 2%

	===Pathophysiology===		===Pathophysiology===
Line 37:		Line 45:
	*Usually presents in the first or second week of life		*Usually presents in the first or second week of life

	== Management ==		==Management==

	* '''Disseminated disease:''' high-dose [[Is treated with::acyclovir]] 60 mg/kg/day IV divided q8h for at least 21 days		*'''Disseminated disease:''' high-dose [[Is treated with::acyclovir]] 60 mg/kg/day IV divided q8h for at least 21 days
	** If CNS disease, repeat lumbar puncture at the end of therapy to document resolution of CSF parameters and ensure that PCR is negative		**If CNS disease, repeat lumbar puncture at the end of therapy to document resolution of CSF parameters and ensure that PCR is negative
	* '''Localized CNS disease:''' same as for disseminated		*'''Localized CNS disease:''' same as for disseminated
	* '''Localized skin, eye, and mouth disease:''' high-dose [[Is treated with::acyclovir]] 60 mg/kg/day IV divided q8h for at least 14 days		*'''Localized skin, eye, and mouth disease:''' high-dose [[Is treated with::acyclovir]] 60 mg/kg/day IV divided q8h for at least 14 days
	** For eye involvement, consult and ophthalmologist to add topical trifluridine, idoxuridine, or vidarabine		**For eye involvement, consult and ophthalmologist to add topical trifluridine, idoxuridine, or vidarabine

	==Prognosis==		==Prognosis==

Aidan: Updated Pathophysiology and added Management

2020-07-21T01:34:55Z

Updated Pathophysiology and added Management

@@ Line 1: / Line 1: @@
-== Background ==
+==Background==
 [[Category:Pediatrics]]
 [[Category:Viruses]]

Aidan: added prognosis

2020-02-08T02:08:45Z

added prognosis

← Older revision		Revision as of 02:08, 8 February 2020
Line 27:		Line 27:
	* Usually presents in the first or second week of life		* Usually presents in the first or second week of life

			== Prognosis ==
			* 65% mortality if untreated
			* With CNS disease, 80% have developmental problems
			* Prognosis much better with isolated cutaneous disease
	[[Category:Pediatrics]]		[[Category:Pediatrics]]
	[[Category:Viruses]]		[[Category:Viruses]]

Aidan: added category

2020-02-08T02:07:15Z

added category

← Older revision		Revision as of 02:07, 8 February 2020
Line 28:		Line 28:

	[[Category:Pediatrics]]		[[Category:Pediatrics]]
			[[Category:Viruses]]

Aidan: Created page with "== Background == * See also Herpes simplex virus === Pathophysiology === * Generally acquired at time of delivery, though 5-8% may be congenital == Cl..."

2020-02-08T02:05:21Z

Created page with "== Background == * See also Herpes simplex virus === Pathophysiology === * Generally acquired at time of delivery, though 5-8% may be congenital == Cl..."

New page

== Background ==
* See also [[Herpes simplex virus]]

=== Pathophysiology ===
* Generally acquired at time of delivery, though 5-8% may be [[Congenital HSV|congenital]]

== Clinical Presentation ==
* Incubation period 7 to 21 days post-partum, with range from birth to 6 weeks
* Spectrum of disease from cutaneous to disseminated

=== Disseminated disease ===
* 25% of cases
* Sepsis syndrome that predominantly affects the liver, lungs, and CNS
* May not have skin findings (25%)
* Usually presents in the first or second week of life
* Should be considered in sepsis without bacterial cause and with liver dysfunction or coagulopathy

=== Localized CNS disease ===
* 30% of cases
* Usually presents in the second or third week of life
* May not have cutaneous manifestations
* Can cause seizures

=== Skin, eye, and mouth disease ===
* 45% of cases
* Localized to skin, eyes, and/or mouth
* Usually presents in the first or second week of life

[[Category:Pediatrics]]