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The initiation of cell-mediated immunity can be observed as early as the third month of fetal growth, with active antibody-mediated immunity following approximately one month later.
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Predictors of Invasive Herpes Simplex Virus Infection in Young Infants.

Andrea T Cruz1, Lise E Nigrovic2, Jianling Xie3

  • 1Baylor College of Medicine, Houston, Texas acruz@bcm.edu.

Pediatrics
|August 27, 2021
PubMed
Summary

A new risk score helps identify infants with a very low risk of invasive herpes simplex virus (HSV) infection, potentially reducing the need for routine testing and treatment.

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Area of Science:

  • Neonatal infectious diseases
  • Virology
  • Pediatric emergency medicine

Background:

  • Invasive herpes simplex virus (HSV) infection in infants can lead to severe complications.
  • Accurate risk stratification is crucial for appropriate management of suspected HSV cases in neonates.

Purpose of the Study:

  • To identify independent predictors of invasive HSV infection in infants.
  • To develop and validate a risk score for invasive HSV in infants.

Main Methods:

  • A nested case-control study involving 149 infants with HSV and 1340 controls (≤60 days old).
  • Cerebrospinal fluid (CSF) analysis and clinical data were collected within 24 hours of presentation.
  • Logistic regression was used to identify independent predictors, which were then used to derive a risk score.

Main Results:

  • Key predictors of invasive HSV included younger age, prematurity, seizure at home, ill appearance, abnormal temperature, vesicular rash, thrombocytopenia, and CSF pleocytosis.
  • The derived HSV risk score ranged from 0-17, with higher scores associated with invasive disease (median 6 vs. 3).
  • The risk score demonstrated good discriminatory ability (AUC 0.85) and high sensitivity (95.6%) at a cut-point of ≥3 for identifying invasive HSV.

Conclusions:

  • A novel HSV risk score effectively identifies infants at extremely low risk for invasive HSV.
  • This score may help clinicians avoid routine testing and empirical treatment in low-risk infants.
  • The validated risk score aids in optimizing the management of neonatal HSV infections.