Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Neonatal herpes simplex virus infection


Key points

  • Herpes simplex virus (HSV) is a virus that can cause severe infection in a neonate but also has treatment options that can improve disease outcomes.

  • There are three periods of acquisition of HSV: in utero, perinatal, and postnatal.

  • HSV can be diagnosed via polymerase chain reaction (PCR) of blood and cerebrospinal fluid (CSF), as well as surface cultures and PCR.

  • It is important to assess for disseminated HSV.

  • HSV can be treated with intravenous acyclovir for management of acute disease, followed by oral acyclovir suppressive therapy.

Introduction

Of the viruses capable of infecting neonates, herpes simplex virus (HSV) is among the most severe, causing significant mortality and morbidity. Unlike many other viral pathogens, HSV is treatable using a commercially available antiviral drug: acyclovir. Neonatal HSV infection is primarily acquired in the peripartum period, which improves the likelihood that antiviral therapy can be beneficial, because viral damage is of a relatively short duration compared with injury to the developing fetal brain from viruses such as rubella, cytomegalovirus, and Zika virus, which are primarily acquired in utero. Studies conducted by the National Institute of Allergy and Infectious Diseases (NIAID) Collaborative Antiviral Study Group (CASG) over the course of four decades have advanced our knowledge of the favorable impact that antiviral therapy has on neonatal HSV disease outcomes, and many neonates now are effectively treated and experience no long-term sequelae of this potentially devastating infection.

Timing of infection

Neonatal HSV is acquired in one of three distinct periods: in utero, perinatal, or postnatal. In most cases (∼85%), neonates acquire the infection perinatally. In approximately 10% of cases, neonates are infected postnatally, and in 5% the infection is acquired in utero.

You're Reading a Preview

Become a Clinical Tree membership for Full access and enjoy Unlimited articles

Become membership

If you are a member. Log in here