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Factors Associated With HSV PCR CSF Testing and Empiric Acyclovir Therapy in Young Febrile Infants

Sheila Swartz1, Jennifer Hadjiev1, Julie Kolinski1

  • 1Medical College of Wisconsin, Milwaukee, WI, USA.

Clinical Pediatrics
|August 15, 2019
PubMed

Insights

Many febrile infants with potential herpes simplex virus (HSV) infection are not tested or treated. Guidelines are needed to ensure timely diagnosis and acyclovir therapy for high-risk infants.

Area of Science:

  • Pediatrics
  • Infectious Diseases
  • Neonatology

Background:

  • Herpes simplex virus (HSV) infection in infants presents subtly but can be devastating.
  • Early diagnosis and treatment are crucial for improving infant outcomes.

Purpose of the Study:

  • To examine the rates of cerebrospinal fluid (CSF) HSV PCR testing and empiric acyclovir therapy in young febrile infants.
  • To identify factors associated with HSV testing and treatment.
  • To evaluate the adherence to guidelines for high-risk infants.

Main Methods:

  • Retrospective chart review of hospitalized infants aged ≤60 days with fever (≥38°C) who underwent lumbar puncture.
  • Utilized previously published criteria to define high-risk infants for HSV.
  • Assessed primary outcomes of CSF HSV PCR testing and empiric acyclovir administration.

Main Results:

  • Of 536 infants, 23% received HSV testing and 15% received empiric acyclovir.
  • Testing and therapy were linked to younger age, seizures, maternal lesions, and infant clinical signs.
  • Critically, 62% of high-risk infants were not tested, and 75% did not receive acyclovir.

Conclusions:

  • High-risk infants are frequently not tested or treated for HSV, indicating a gap in care.
  • There is a significant need for evidence-based criteria to guide HSV testing and treatment in febrile infants.
  • Improved diagnostic and therapeutic strategies are essential to reduce the morbidity and mortality associated with infant HSV infections.

Keywords:
HSV testingfebrile neonateneonatal herpes infection

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