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Published on: February 9, 2011
A Rare Case of Neonatal Disseminated Herpes Simplex Virus (HSV) With Concomitant Methicillin-Sensitive Staphylococcus
Stephanie R Sykes1, Elizabeth L Sharpe
1The Ohio State University, Columbus, OH.
Background:
Neonatal herpes simplex virus (HSV) infections can be challenging to diagnose and often occur without maternal history of infection. Routine initial pharmacologic management when a neonate presents with signs of sepsis in the first weeks of life typically targets antibiotic therapies. This case illustrates the importance of the addition of antiviral coverage, especially when a neonate demonstrates temperature instability and neurologic changes.
Clinical Findings:
This case report describes the unique presentation of a 9-day old neonate with clinical findings significant for sepsis. This neonate was diagnosed with methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia with concomitant disseminated HSV-2 infection after presenting with temperature instability, lethargy, and signs of multisystem organ impairment.
Primary Diagnosis:
This neonate was diagnosed with disseminated HSV infection, which occurs in 25% of neonatal HSV disease.
Interventions:
Treatment was initiated with high-dose intravenous acyclovir at 20 mg/kg/dose every 8 hours along with broad-spectrum antibiotics. Management should include anticipating and monitoring for progressive multisystem organ failure in bacterial or viral infection.
Outcomes:
This patient did not survive despite maximal intervention from the neonatal intensive care unit team. Disseminated HSV neonatal infections are associated with high mortality rates when they are present alone, and mortality is higher with concurrent bacteremia.
Practice Recommendations:
Providers should have a high index of suspicion for HSV infection in neonates presenting in the first 1 to 3 weeks of life with signs of sepsis. Prophylactic treatment with high-dose acyclovir as an adjunct to broad-spectrum antibiotics while awaiting laboratory confirmation can be lifesaving.
Insights
Neonatal herpes simplex virus (HSV) infection, often without maternal history, requires prompt antiviral treatment alongside antibiotics. Early acyclovir may be lifesaving for neonates with sepsis signs like temperature instability and lethargy.
Area of Science:
- Neonatal Medicine
- Infectious Diseases
- Virology
Background:
- Neonatal herpes simplex virus (HSV) infections pose diagnostic challenges and often lack maternal history.
- Standard sepsis management in neonates typically involves antibiotics, potentially delaying crucial antiviral treatment.
- This case highlights the critical need for early consideration of antiviral therapy in neonates with sepsis symptoms.
Observation:
- A 9-day-old neonate presented with sepsis, temperature instability, lethargy, and multisystem organ impairment.
- The neonate was diagnosed with methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia and concurrent disseminated HSV-2 infection.
- Disseminated HSV infection occurred in 25% of this neonatal HSV disease case.
Findings:
- Treatment involved high-dose intravenous acyclovir and broad-spectrum antibiotics.
- Despite maximal interventions, the neonate did not survive.
- Disseminated neonatal HSV infections have high mortality, increased by concurrent bacteremia.
Implications:
- Healthcare providers must maintain a high suspicion for HSV in neonates with sepsis symptoms.
- Prophylactic high-dose acyclovir, as an adjunct to antibiotics, can be life-saving while awaiting confirmation.
- Prompt diagnosis and treatment are crucial for improving outcomes in neonatal HSV infections.
