Neonatal HSV
From IDWiki
Background
- See also Herpes simplex virus
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
