Intrauterine Herpes Simplex Virus Infection: Insights Into a Silent Threat

Area of Science:

• Neonatal infections
• Virology
• Maternal-fetal medicine

Background:

• Congenital herpes simplex virus (HSV) infection is rare, particularly when the mother shows no symptoms.
• Prenatal screening and routine ultrasounds can miss early signs of intrauterine HSV infection.

Observation:

• A neonate presented with severe fetal malformations, including brain abnormalities and organomegaly, following premature rupture of membranes (PROM) at 24 weeks.
• The infant exhibited profound physical abnormalities, skin erosions, and neurological impairment post-delivery.
• Grouped vesicles appeared on the fourth day of life, confirming HSV-2 infection via PCR, despite intravenous acyclovir treatment.

Findings:

• The neonate succumbed to the infection on the fifth day of life, underscoring the aggressive nature of congenital HSV-2.
• Diagnosis was challenging due to the absence of maternal HSV symptoms during pregnancy.

Implications:

• This case highlights the critical need to consider HSV infection in the differential diagnosis of fetal malformations associated with PROM.
• Early recognition and prompt management are crucial, though often challenging, in preventing severe neonatal outcomes from congenital HSV.
• Further research into improved diagnostic methods for asymptomatic maternal HSV carriage during pregnancy is warranted.