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Evaluation for Neonatal HSV in Infants Undergoing Workup for Serious Bacterial Infection: A 5-Year Retrospective
Laura H Brower1, Paria M Wilson2, Eileen Murtagh-Kurowski2,3
1Divisions of Hospital Medicine, laura.brower@cchmc.org.
Insights
Herpes simplex virus (HSV) in infants often presents without fever and with nonspecific symptoms. Early diagnosis and treatment are crucial, even without fever, to improve outcomes in neonates.
Area of Science:
- Neonatal Medicine
- Pediatric Infectious Diseases
- Virology
Background:
- Serious bacterial infections are a common concern in infants presenting to emergency departments.
- Herpes simplex virus (HSV) infection in neonates can lead to severe morbidity and mortality.
- Empirical testing and treatment for HSV are critical in infants evaluated for serious infections.
Purpose of the Study:
- To characterize infants evaluated for serious bacterial infection.
- To focus on empirical testing and treatment strategies for herpes simplex virus (HSV).
- To describe the clinical features of HSV-positive infants.
Main Methods:
- Descriptive study of 1633 infants aged 0-60 days evaluated for serious bacterial infection.
- Comparison of clinical characteristics and laboratory workup between HSV-positive and HSV-negative infants.
- Statistical analysis using 2-sample t test or Wilcoxon rank test.
Main Results:
- HSV was diagnosed in 19 infants (1.2%), with 11 having disseminated disease.
- HSV-positive infants were younger, less likely to be febrile, and more likely to have mothers with HSV symptoms.
- Incomplete testing (22%) and longer hospital stays for tested/treated infants were observed.
Conclusions:
- Fever is not a reliable indicator for ruling out HSV in neonates.
- Comprehensive specimen collection (serum, CSF, surface) is vital when initiating HSV workup.
- Development of clinical guidelines for HSV evaluation in high-risk infants is recommended.
Objectives:
To describe the characteristics of infants evaluated for serious bacterial infection, focusing on empirical testing and treatment of herpes simplex virus (HSV) and describe the characteristics of HSV-positive patients.
Methods:
We included infants aged 0 to 60 days undergoing evaluation for serious bacterial infection in the emergency department. This descriptive study was conducted between July 2010 and June 2014 at a tertiary-care children's hospital. Eligible patients were identified on the basis of age at presentation to the hospital and laboratory specimens. Infant characteristics, symptoms on presentation, and laboratory workup were compared between HSV-positive and HSV-negative patients by using the 2-sample t test or the Wilcoxon rank test.
Results:
A total of 1633 infants were eligible for inclusion, and 934 (57.2%) were 0 to 28 days of age. HSV was diagnosed in 19 infants, 11 of whom had disseminated disease. Compared with those without HSV, HSV-positive infants were younger, less likely to be febrile and to present with nonspecific symptoms, and more likely to have a mother with HSV symptoms (P < .05). Testing from all recommended locations was only performed in 22% of infants. Infants tested or empirically treated with acyclovir had a longer median length of stay compared with children who were not tested or treated (P < .01).
Conclusions:
The absence of fever should not preclude a workup for HSV in neonates, and when a workup is initiated, emphasis should be placed on obtaining samples from serum, cerebrospinal fluid, and surface specimens. Physicians may benefit from a guideline for evaluation of HSV with specific guidance on high-risk features of presentation and recommended testing.
