Midtrimester fetal herpes simplex-2 diagnosis by serology, culture and quantitative polymerase chain reaction

Midtrimester fetal herpes simplex-2 diagnosis by serology, culture and quantitative polymerase chain reaction

The acquisition of herpes simplex virus (HSV) in utero comprises a minority of neonatal herpes infections. Prenatal diagnosis is rare. We describe a midtrimester diagnosis of fetal HSV-2 infection. Ultrasound at 20 weeks for elevated maternal serum α-fetoprotein (MSAFP) showed lagging fetal growth,...

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Bibliographic Details
Published in:Fetal diagnosis and therapy Vol. 33; no. 2; p. 133
Main Authors: Curtin, William M, Menegus, Marilyn A, Patru, Maria-Magdalena, Peterson, C Jeanne, Metlay, Leon A, Mooney, Robert A, Stanwood, Nancy L, Scheible, Amy L, Dorgan, Angela
Format: Journal Article
Language:English
Published: Switzerland 01-03-2013
Subjects:
Abortion, Eugenic
Adult
alpha-Fetoproteins - analysis
Amniotic Fluid - virology
Antibodies, Viral - analysis
Female
Herpes Simplex - diagnosis
Herpes Simplex - embryology
Herpes Simplex - immunology
Herpes Simplex - virology
Herpesvirus 2, Human - classification
Herpesvirus 2, Human - immunology
Herpesvirus 2, Human - isolation & purification
Humans
Molecular Typing
Patient Education as Topic
Pregnancy
Pregnancy Trimester, Second
Prenatal Diagnosis
Young Adult
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Summary:The acquisition of herpes simplex virus (HSV) in utero comprises a minority of neonatal herpes infections. Prenatal diagnosis is rare. We describe a midtrimester diagnosis of fetal HSV-2 infection. Ultrasound at 20 weeks for elevated maternal serum α-fetoprotein (MSAFP) showed lagging fetal growth, echogenic bowel, echogenic myocardium, and liver with a mottled pattern of echogenicity. Amniocentesis demonstrated normal karyotype, elevated AFP and positive acetylcholinesterase. Culture isolated HSV-2 with an aberrant growth pattern. Maternal serology was positive for HSV-2. Quantitative DNA polymerase chain reaction (PCR) showed 59 million copies/ml. Fetal autopsy demonstrated widespread tissue necrosis but only sparse HSV-2 inclusions. Fetal HSV-2 infection can be suspected when an elevated MSAFP accompanies ultrasound findings suggesting perinatal infection. Maternal HSV serology, amniotic fluid culture and quantitative PCR are recommended for diagnostic certainty and counseling.
ISSN:1421-9964
DOI:10.1159/000342756