Diagnostic and therapeutic management for suspected neonatal herpes simplex virus infection

• Published in: Journal of clinical virology Vol. 51; no. 1; pp. 8 - 11
• Main Authors: Wolfert, S.I.M, de Jong, E.P, Vossen, A.C.T.M, Zwaveling, J, Te Pas, A.B, Walther, F.J, Lopriore, E
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier B.V 01-05-2011; Elsevier
• Subjects: Acyclovir - administration & dosage; Acyclovir - therapeutic use; Allergy and Immunology; Antiviral Agents - administration & dosage; Antiviral Agents - therapeutic use; Biological and medical sciences; Echoencephalography; Female; Fundamental and applied biological sciences. Psychology; Herpes Simplex - diagnosis; Herpes Simplex - drug therapy; Herpes Simplex - virology; Herpes simplex virus; Human viral diseases; Humans; Infant, Newborn; Infectious Disease; Infectious diseases; Male; Management; Medical sciences; Microbiology; Miscellaneous; Neonate; Polymerase Chain Reaction; Pregnancy Complications, Infectious - diagnosis; Pregnancy Complications, Infectious - drug therapy; Pregnancy Complications, Infectious - virology; Retrospective Studies; Simplexvirus - genetics; Simplexvirus - isolation & purification; Viral diseases; Viral diseases with cutaneous or mucosal lesions and viral diseases of the eye; Virology; Herpes simplex virus; Neonate; Management; Infection; Virus; Herpesviridae; Viral disease; Alphaherpesvirinae; Herpes; Herpesvirus hominis
• ISSN: 1386-6532; 1873-5967
• DOI: 10.1016/j.jcv.2011.02.008

Abstract Background Neonatal herpes simplex virus (HSV) is a rare disease associated with high mortality and morbidity rates. HSV infection can be subdivided into 3 clinical manifestations: isolated skin, eye and mouth (SEM) disease, central nervous system (CNS) disease and disseminated disease. Consensus guidelines for diagnostic and therapeutic management are not available. Objectives To evaluate the diagnostic work-up and therapeutic management in neonates with suspected or proven HSV infection. Study design Retrospective study of diagnostic and therapeutic management in all neonates with suspected HSV infection admitted to our neonatal nursery between January 2005 and July 2010. Results A total 53 neonates with suspected HSV infection were included in the study and classified as SEM disease ( n = 2), CNS disease ( n = 41) or disseminated disease ( n = 10). None of the included infants tested positive for HSV infection. Correct and complete diagnostic work-up was performed in only 11% (6/53) of the cases. All neonates were treated with intravenous acyclovir. Conclusions None of the neonates with suspected HSV tested positive. Diagnostic management in neonates with suspected HSV infection was often improper and incomplete. Consensus guidelines to identify low-risk infants in whom HSV testing and acyclovir treatment is not warranted, are urgently needed.