Neonatal herpes simplex virus infection: a report of 43 patients

M Koskiniemi1, J M Happonen, A L Järvenpää

  • 1Children's Hospital, University of Helsinki, Finland.

We present a series of 43 infants with neonatal herpes simplex virus infection treated at the Children's Hospital, University of Helsinki, during a 16-year period from 1970 to 1985. Twelve mothers (28%) had a history of genital herpes during pregnancy, and two had had labial herpes infection. Eight infants (19%) were delivered by cesarean section. In 14 (33%) infants symptoms appeared within 24 hours and in 26 (61%) they appeared within 7 days. The presenting symptoms were neurologic in 79%, cutaneous in 30%, respiratory in 19%, cyanosis/pallor/grayish skin in 16%, irritability in 12% and fever in 7%. Herpes simplex virus was detected most early and frequently in pharyngeal swabs, in one-third on Postnatal Days 2 to 5. Cerebrospinal fluid contained an increased amount of protein and/or pleocytosis in 72%. Abnormal electroencephalographic background activity appeared in 56% and electrical paroxysms in 41%. Six infants (14%) died, 9 (21%) were damaged severely and 6 (14%) were moderately or mildly damaged. Poor prognosis was associated with acute maternal illness at delivery, prematurity, visceral involvement and/or electrical paroxysms in the electroencephalograms. This study underlines the occurrence of intrauterine transmission of herpes virus, infections with neurologic manifestations, early symptomatology and the need for prompt diagnosis, brain biopsy in selected patients and antiviral therapy in neonates with herpes virus infection.

Related Concept Videos

Herpes01:28

Herpes

Herpes simplex type 1 (HSV‑1) is a widespread pathogen responsible for orolabial lesions. It is an enveloped, double-stranded DNA (dsDNA) virus belonging to the family Herpesviridae. Once the virus infects a host cell, its double‑stranded DNA genome is delivered into the nucleus, where a coordinated cascade of immediate‑early, early, and late gene expression directs viral DNA replication, structural protein synthesis, and virion assembly. After primary infection of epithelial cells, HSV-1...
Chickenpox01:20

Chickenpox

Chickenpox is an acute, highly contagious disease caused by the varicella-zoster virus (VZV), a double-stranded DNA virus belonging to the Herpesviridae family. Its transmission occurs primarily through the inhalation of respiratory droplets or direct contact with vesicular fluid from skin lesions. The incubation period typically ranges from 10 to 21 days, during which the virus replicates and disseminates through sequential phases within the host. Although generally self-limiting in children,...
Viral Meningitis01:18

Viral Meningitis

Viral meningitis is the most common form of meningitis and is often referred to as aseptic meningitis to indicate the absence of bacterial involvement. It is generally milder than bacterial meningitis, with symptoms including fever, headache, stiff neck, drowsiness, nausea, photophobia, and vomiting. Rarely, more severe manifestations or death may occur. Common causative agents include enteroviruses, particularly coxsackie A and B viruses and echoviruses, all members of the Enterovirus genus...
Cytomegalovirus Disease01:27

Cytomegalovirus Disease

Cytomegalovirus (CMV) disease is caused by human cytomegalovirus, a double-stranded DNA virus of the Herpesviridae family. While primary CMV infection is often asymptomatic in immunocompetent individuals, the virus can cause severe disease in neonates and immunocompromised patients. CMV is the most common cause of congenital viral infection in the United States, and a major pathogen in solid organ and hematopoietic stem cell transplant recipients.CMV is transmitted via bodily fluids, sexual...
Genital Herpes01:23

Genital Herpes

Genital herpes is a sexually transmitted infection primarily caused by herpes simplex virus type 2 (HSV-2), though herpes simplex virus type 1 (HSV-1) is increasingly implicated in genital infections, particularly among younger populations. Transmission occurs mainly through sexual contact, with asymptomatic viral shedding serving as a major route of spread. This characteristic makes HSV-2 difficult to control at a population level, as individuals may unknowingly transmit the virus even in the...
Encephalitis l: Introduction01:19

Encephalitis l: Introduction

Encephalitis is inflammation of the brain parenchyma, most often due to infections or autoimmune processes. It presents with neuropsychiatric features such as fever, altered mental status, behavioral changes, cognitive dysfunction, seizures, focal deficits, and sometimes autonomic instability. In some cases, the meninges are also involved, resulting in meningoencephalitis.Infectious CausesInfectious encephalitis is most commonly viral but can also result from bacterial, fungal, or parasitic...