Initial Presentation of Neonatal Herpes Simplex Virus Infection

Area of Science:

• Pediatric infectious diseases
• Neonatal neurology
• Virology

Background:

• Neonatal herpes simplex virus (HSV) infection poses a significant threat to infants.
• Early diagnosis and management are critical for improving outcomes.
• Understanding the varied clinical presentations is essential for timely intervention.

Purpose of the Study:

• To describe the initial clinical presentation and laboratory findings of infants diagnosed with neonatal HSV.
• To inform decisions regarding testing and empirical treatment for neonatal HSV.

Main Methods:

• Retrospective case series conducted at two pediatric tertiary care centers.
• Included infants with laboratory-confirmed HSV symptoms before 42 days of age (2002-2012).
• Excluded preterm infants (<34 weeks gestation), those with illness before hospital discharge, or symptoms after 42 days.

Main Results:

• 49 infants met the inclusion criteria; 88% presented by 28 days of age.
• Disease distribution: 45% disseminated, 33% central nervous system, 20% skin/eye/mouth.
• 16% had nonspecific presentations lacking classic signs (seizure, rash, critical illness); these infants were younger (<14 days) or had cerebrospinal fluid pleocytosis.

Conclusions:

• Most infants (84%) with neonatal HSV presented with classic signs.
• A notable subset (16%) lacked typical signs, but often developed suggestive symptoms within 24 hours.
• Age <14 days and CSF pleocytosis may indicate risk in nonspecific presentations, warranting further study.