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

• 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
• ISSN: 1421-9964
• DOI: 10.1159/000342756

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.