Herpes Simplex Virus Infection in Infants Undergoing Meningitis Evaluation

Area of Science:

• Pediatrics
• Infectious Diseases
• Neonatology

Background:

• Neonatal herpes simplex virus (HSV) infection poses a significant risk to infants, necessitating prompt diagnosis and treatment.
• Large-scale data on the incidence of HSV in potentially infected infants are limited.

Purpose of the Study:

• To assess the frequency of HSV infection in infants up to 60 days old presenting to North American emergency departments.
• To determine the incidence of central nervous system (CNS) and disseminated HSV infections.
• To examine patterns in HSV testing and treatment with acyclovir across different sites.

Main Methods:

• A retrospective cross-sectional study was conducted involving 26,533 infants ≤60 days old across 23 North American emergency departments.
• Infants with positive cerebrospinal fluid (CSF) HSV polymerase chain reaction (PCR) or viral culture were identified.
• Data on CNS/disseminated HSV, testing rates, and acyclovir administration were analyzed.

Main Results:

• HSV infection was identified in 112 infants (0.42%), with most cases (80.4%) occurring within the first four weeks of life.
• The incidence of CNS or disseminated HSV was 0.26%.
• Significant variability was observed in HSV testing rates (35%) and acyclovir administration (23%) across participating sites.

Conclusions:

• HSV infection is relatively uncommon in young infants evaluated for CNS infections, especially those older than 28 days.
• The study highlights the need for evidence-based guidelines to standardize the evaluation and management of HSV in infants.
• Variations in diagnostic and treatment practices underscore the need for improved protocols.