Neonatal herpes simplex virus infection presenting with fever alone

Unlike bacterial infections, herpes simplex virus (HSV) infections are rarely considered as the diagnosis in neonates less than 1 month of age who present with fever alone. We wanted to determine the proportion of neonates with HSV who presented with fever alone and to compare that with the proportion of neonates with bacterial infection who presented with fever alone over the same period of time at our institution.

We retrospectively reviewed all neonatal medical records from March 1995 to February 1997 with a discharge diagnosis of HSV infection and all laboratory reports of a positive assay for HSV. We reviewed the medical records of neonates with a discharge diagnosis of bacterial infection over the same period of time. We excluded neonates who were afebrile, whose fever source was evident on physical examination, or who were immunocompromised.

Eighteen neonates were diagnosed with an HSV infection over the 2-year period. One presented with fever alone. Twenty-seven of 113 neonates who presented with fever alone had a bacterial infection; 2 of these babies had meningitis.

The proportion of neonates with HSV infection who presented with fever alone was comparable to that of neonates with bacterial meningitis who presented with fever alone at our institution. Testing and empirically treating for HSV infection might be warranted in febrile neonates with negative bacterial cultures.