Abstract and Introduction
Abstract
Disseminated neonatal herpes simplex virus (HSV) infection is characterized by progressive multiple organ failure and high mortality rates. It can result from infection with either HSV-1 or HSV-2. We report a case of disseminated neonatal herpes that was caused by HSV-1 and HSV-2.
Introduction
Neonatal herpes simplex virus (HSV) infection is among the most severe perinatal infections. Most (85%) neonatal HSV infections are acquired during delivery, although in utero (5%) and postnatal (10%) infections do occur. The risk for transmission to the newborn is much higher in women with primary HSV infections. Neonatal herpes can be localized to skin, eyes, and mouth (~45% of cases), involve the central nervous system (~30% of cases), or can cause disseminated infection involving multiple organs such as liver, lungs, adrenal glands, and brain (~25% of cases).
Disseminated infection is the most severe form of neonatal herpes, with a mortality rate of 85% for untreated neonates. It is usually observed when the infant is 5-9 days old; signs include irritability, seizures, respiratory distress, jaundice, bleeding diatheses, shock, and often vesicular exanthema. Early treatment with high-dose acyclovir reduces the mortality rate. Early recognition of disseminated infection is difficult because of nonspecific symptoms and signs of sepsis and because initiation of antiviral therapy is often delayed. The high risk for death requires prompt diagnostic evaluation that includes testing by HSV DNA PCR as the preferred method or virus culture.
Neonatal herpes can result from infection with either HSV-1 or HSV-2; the latter is associated with a poorer prognosis. We report a case of disseminated neonatal herpes infection with HSV-1 and HSV-2.