Neonatal HSV: Difference between revisions

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(Updated Pathophysiology and added Management)
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== Background ==
==Background==
* See also [[Herpes simplex virus]]


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


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


*Generally acquired at time of delivery, though 5-8% may be [[Congenital HSV|congenital]]
=== Disseminated disease ===
*Localized CNS infection is thought to occur by retrograde axonal transmission
* 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


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


*Incubation period 7 to 21 days post-partum, with range from birth to 6 weeks
=== Skin, eye, and mouth disease ===
*Spectrum of disease from cutaneous to disseminated
* 45% of cases

* Localized to skin, eyes, and/or mouth
===Disseminated disease===
* Usually presents in the first or second week of life

*25% of cases
*Sepsis syndrome that predominantly affects the liver, lungs, and CNS
**May not have skin findings (25%)
**CNS involved in 60-75%, causing meningoencephalitis
**Can also affect larynx, trachea, esophagus, stomach, lower gastrointestinal tract, spleen, kidneys, pancreas, and heart
*Later in the course of the disease, may develop elevated ALT/AST and direct bilirubin, as well as coagulopathy and thrombocytopenia
*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

== Management ==

* '''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
* '''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
** For eye involvement, consult and ophthalmologist to add topical trifluridine, idoxuridine, or vidarabine

==Prognosis==

*Disseminated disease has 65% mortality if untreated, improves to 30% with treatment
*With CNS disease, 80% have developmental problems
*Prognosis much better with isolated cutaneous disease


== 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]]

Revision as of 01:34, 21 July 2020

Background

Pathophysiology

  • Generally acquired at time of delivery, though 5-8% may be congenital
  • Localized CNS infection is thought to occur by retrograde axonal transmission

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%)
    • CNS involved in 60-75%, causing meningoencephalitis
    • Can also affect larynx, trachea, esophagus, stomach, lower gastrointestinal tract, spleen, kidneys, pancreas, and heart
  • Later in the course of the disease, may develop elevated ALT/AST and direct bilirubin, as well as coagulopathy and thrombocytopenia
  • 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

Management

  • Disseminated disease: high-dose 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
  • Localized CNS disease: same as for disseminated
  • Localized skin, eye, and mouth disease: high-dose 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

Prognosis

  • Disseminated disease has 65% mortality if untreated, improves to 30% with treatment
  • With CNS disease, 80% have developmental problems
  • Prognosis much better with isolated cutaneous disease