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Related Experiment Videos

Herpes simplex virus, meningitis and encephalitis in neonates.

David Kimberlin1

  • 1Division of Pediatric Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama 35233, USA. dkimberlin@peds.uab.edu

Herpes : the Journal of the IHMF
|August 21, 2004
PubMed
Summary

Neonatal herpes simplex virus (HSV) infection is severe, with high mortality and neurological sequelae. Early diagnosis via swabs and PCR, followed by intravenous aciclovir treatment, is crucial for improving infant outcomes.

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Area of Science:

  • Neonatal Medicine
  • Infectious Diseases
  • Virology

Background:

  • Neonatal herpes simplex virus (HSV) infection presents severe consequences, including localized (skin, eye, mouth), central nervous system (CNS), or disseminated disease.
  • High mortality rates (80% without therapy) and neurological sequelae in survivors of CNS or disseminated HSV underscore the need for effective management.
  • The International Herpes Management Forum (IHMF) has developed guidelines for diagnosing, preventing, and treating neonatal herpes.

Purpose of the Study:

  • To outline diagnostic and management strategies for neonatal herpes simplex virus (HSV) infection based on IHMF guidelines.
  • To emphasize prompt diagnostic testing and appropriate antiviral therapy to improve infant outcomes.
  • To provide guidance on monitoring treatment and adjusting therapy based on diagnostic assessments.

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Main Methods:

  • Suspected neonatal herpes requires prompt sample collection including oropharyngeal, conjunctival, rectal, skin/mucosal lesion swabs, and urine for virus culture.
  • Cerebrospinal fluid (CSF) analysis for HSV DNA via polymerase chain reaction (PCR) is essential for CNS involvement.
  • Diagnostic workup includes liver function tests, complete blood count, CSF analysis, and chest X-ray if indicated to assess for disseminated or CNS disease.

Main Results:

  • Intravenous aciclovir at 20 mg/kg every 8 h for 21 days is recommended for neonates with suspected HSV infection.
  • Treatment duration is 14 days for localized skin, eye, and mouth (SEM) disease.
  • Monitoring neutrophil counts and considering dose reduction or G-CSF if absolute neutrophil count falls below 500/mm3 is advised.

Conclusions:

  • Neonatal herpes requires prompt diagnosis, even without skin lesions, using viral cultures and PCR on various sample types.
  • Intravenous aciclovir therapy for 14-21 days, depending on disease extent, is the standard of care.
  • Post-treatment CSF PCR assessment is recommended for CNS and disseminated disease to guide continued therapy if positive.