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Acyclovir use in sick infants.

John Thomas Meadows1, Lori Shook, Hubert Otho Ballard

  • 1Division of Neonatology, Department of Pediatrics, Kentucky Children's Hospital, Lexington, KY 40536-0298, USA. jmead2@email.uky.edu

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Summary
This summary is machine-generated.

Infantile herpes simplex virus encephalitis (HSVE) is rare in infants. A lack of cerebrospinal fluid (CSF) leukocytosis strongly predicts against HSVE, guiding acyclovir treatment decisions.

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Area of Science:

  • Pediatric Neurology
  • Infectious Diseases
  • Neonatal Care

Background:

  • Infantile herpes simplex virus encephalitis (HSVE) presents diagnostic challenges in infants.
  • Empirical acyclovir treatment is common but often unnecessary due to low HSVE prevalence.
  • Identifying specific clinical and laboratory indicators for HSVE is crucial.

Purpose of the Study:

  • To evaluate the use of empirical acyclovir in infants under one year of age.
  • To identify clinical and laboratory findings suggestive of HSVE.
  • To correlate findings with confirmed HSVE cases.

Main Methods:

  • Retrospective review of medical records for infants treated with acyclovir.
  • Analysis of serum and cerebrospinal fluid (CSF) white blood cell counts, red blood cell counts, glucose, and protein.
  • Evaluation of clinical neurological findings upon admission.

Main Results:

  • Out of 218 infants, 3 tested positive for HSVE via PCR.
  • CSF leukocytosis was the only consistent laboratory finding in HSVE-positive infants.
  • Generalized neurological findings were present in all HSVE cases; focal findings and hemorrhagic CSF were not indicative of HSVE.

Conclusions:

  • HSVE has a low prevalence in the studied infant population.
  • Clinically significant neurological findings and specific risk factors are necessary to consider empirical acyclovir.
  • Absence of CSF leukocytosis is a strong negative predictor for HSVE; hemorrhagic CSF is not specific.