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Congenital Herpes Virus Infection

Antenatal Herpes Virus Infection


Presentation

  • Neonatal CNS HSV disease often presents in the second to third week of life, although earlier presentations can occur.[med.cmu.ac.th]
  • CT may be negative in the early course of the disease in advanced stages may present with extensive areas of parenchymal hypoattenuation, predominantly in the white matter, as a result of edema or necrosis 3 enhancement usually presents in a gyriform[radiopaedia.org]
  • Symptoms mother presents with multiple, very painful, vesicular, genital ulcers infected infant presents with vesicles seizures respiratory distress meningitis encephalitis impaired neurologic development Physical exam primary herpes infection generally[medbullets.com]
  • The poorest outcome is for the 25% of neonates who present with widespread (disseminated) disease, involving the lungs, liver, adrenal glands, skin, eye and mouth.[herpesguide.ca]
  • Up to 15% of women presenting for the first time will have serological evidence of prior infection.[patient.info]
Fever
  • Factors not associated with neonatal HSV infection were fever, total peripheral white blood cell count, and red blood cells in the CSF.[journals.lww.com]
  • The affected person may feel well or suffer from fever, pain and have enlarged local lymph nodes.[dermnetnz.org]
  • Generalized symptoms such as fever and malaise may develop, and lymph nodes in the groin may enlarge. Lesions may persist in this stage for a week or more, and complete healing may take four to six weeks.[britannica.com]
  • Less Common Symptoms In general, herpes simplex infections cause sporadic recurrences of sores, often with a preceding trigger, such as a cold or a fever—and sometimes without any trigger at all.[verywell.com]
Respiratory Distress
  • Inclusion of the newly appreciated features of maternal fever, respiratory distress, and thrombocytopenia might improve the detection of neonatal HSV infection.[journals.lww.com]
  • 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 ( 3, 4 ).[wwwnc.cdc.gov]
  • The infant had mild respiratory distress at the time of birth but otherwise appeared normal. On day 3 of birth, the child presented with classical symptoms of HSV.[jcnonweb.com]
  • distress meningitis encephalitis impaired neurologic development Physical exam primary herpes infection generally symptoms last longer and are more severe HSV-1 in infancy widespread, severe herpetic gingivostomatitis with oral erosions eczema herpeticum[medbullets.com]
  • Other signs, which can occur singly or in combination, include temperature instability, lethargy, hypotonia, respiratory distress, apnea, and seizures.[merckmanuals.com]
Constipation
  • Autonomic dysfunction exhibited by urinary retention, constipation, and anesthesia or hyperesthesia of the perineum, lower back and sacrum have all been described.[clinicaladvisor.com]
Purpura
  • […] transmission represents only 4-5% of neonatal HSV disease but leads to catastrophic events such as death, developmental anomalies, and disabilities. [6] CNS manifestations are responsible for mortality and morbidity. [7] Other clinical manifestations include purpura[jcnonweb.com]
Irritability
  • For example, HSV type 1 can occur on the tongue near the teeth, which can cause extra irritation.[verywell.com]
  • Symptoms of CNS herpes include irritability, seizures, tremors (uncontrollable shaking), and lethargy or tiredness. A swelling in the skull is also common.[diseaseinfosearch.org]
  • ., or more, rectally), poor feeding, irritability, and skin rash in the form of pimples or blisters, seizures or other similar symptoms that may develop within six weeks following birth.[health.ny.gov]
  • Call a GP or your health visitor straight away if your baby: is lethargic or irritable isn't feeding has a high temperature (fever) – find out how to take your baby's temperature has a rash or sores on the skin, eye and inside the mouth These are early[nhs.uk]
Lethargy
  • The examination was significant for mild lethargy, mild jaundice and a few scattered petechiae on the chest.[aafp.org]
  • Symptoms of CNS herpes include irritability, seizures, tremors (uncontrollable shaking), and lethargy or tiredness. A swelling in the skull is also common.[diseaseinfosearch.org]
  • The following factors were associated with neonatal HSV infection by univariate analysis: maternal primary HSV infection, maternal fever, vaginal delivery, prematurity, postnatal HSV contact, vesicular rash, hypothermia, lethargy, seizures, severe respiratory[journals.lww.com]
  • CNS) involvement, also known as skin, eye and mouth disease CNS disease (with or without skin lesions, but without involvement of visceral organs); usually this presentation has non-specific signs including decreased level of consciousness, seizures, lethargy[radiopaedia.org]
  • Parents should be warned to report any early signs of infection such as poor feeding, lethargy, fever or any suspicious lesions.[patient.info]
Cognitive Deficit
  • Herpes infections can be transmitted to the foetus and to the newborn infant, and give rise to severe clinical conditions with long-term sensory and cognitive deficits.[ncbi.nlm.nih.gov]
Encephalopathy
  • […] for Rational Use of Antimicrobials in Chinese Children Symposiast: YANG Yonghong Symposium4 Central Nervous System Infections in Asia 11月11日(日) 15:00 16:30 4F C会場 Infectious causes of encephalitis Chair/Symposiast: Tawee Chotpitayasunondh Influenza encephalopathy[c-linkage.co.jp]
Personality Change
  • The prodromal phase lasts 4 - 10 days during which the patient experiences non-specific symptoms (fever, malaise etc.) as well as headaches and personality changes.[virology-online.com]

Workup

  • […] evaluation via a Tzanck preparation Serologic testing (only for determining past HSV exposure) Lumbar puncture and cerebrospinal fluid analysis Immunofluorescent microscopy Brain biopsy Imaging studies: Computed tomography, magnetic resonance imaging See Workup[emedicine.medscape.com]
Human Herpesvirus 6
  • Multiplex real-time PCR for the simultaneous detection of herpes simplex virus, human herpesvirus 6, and human herpesvirus 7. Microbiol Immunol 2009;53(1):22-9. Kimura H, Ito Y, Futamura M, et al.[cps.ca]

Treatment

  • Fortunately, the better knowledge about these infections gained in recent years together with the development of effective antiviral treatments have improved the patients' prognosis.[ncbi.nlm.nih.gov]
  • Treatment of Recurrent Genital HSV Infection in Pregnancy 5,6 The same treatment regimens for primary infection can be used to reduce viral shedding, although treatment duration can be limited to 5 days. Topical treatment is not effective.[dermquest.com]
  • See “Diagnostics” and "Treatment" below.[amboss.com]
  • Treatment with acyclovir can reduce the need for Cesarean delivery. If a woman with herpes delivers vaginally, there are several precautions that should be taken.[abclawcenters.com]
  • No swabs or treatment are required unless the baby becomes unwell.[patient.info]

Prognosis

  • Fortunately, the better knowledge about these infections gained in recent years together with the development of effective antiviral treatments have improved the patients' prognosis.[ncbi.nlm.nih.gov]
  • , Prevention, and Complications Prognosis very good to excellent in healthy adults outcomes in infants born with herpes vary widely according to symptoms Prevention avoid skin-to-skin contact with active, shedding lesions practice safe sex cesarian delivery[medbullets.com]
  • Another way of classifying this disorder depends on probable outcomes (prognosis).[rarediseases.org]
  • Following active infection, HSV establishes latent infection that can be reactivated Neonates Better prognosis with herpes simplex virus type 1 (HSV-1) ocular, oral, cutaneous disease Less neurologic morbidity with HSV-1 encephalitis More sequelae from[arupconsult.com]
  • […] cytotoxic edema restricted diffusion is less intense compared to infarction beware of T2 shine through due to vasogenic edema GE/SWI: may demonstrate blooming if hemorrhagic T1 C (Gd): enhancement usually presents in a gyriform pattern Treatment and prognosis[radiopaedia.org]

Etiology

  • Herpetic whitlow Pathogen : HSV-1 in 60% of cases; HSV-2 in 40% of cases (in the adult population) Etiology Direct contact with infected secretions through a break in the skin, e.g., torn cuticle Main groups: Children ; (via sucking of thumb/fingers ([amboss.com]
  • Novel Dengue Virus Vaccine Symposiast: Wataru Akahata Dengue Virus-Blocking Mosquito Trial in Vietnam Symposiast: Dan Duc Anh Symposium8 Pneumonia in Asian Children 11月12日(月) 10:30 12:00 4F C会場 Chair: LayMyint Yoshida Molecular diagnosis of pneumonia etiology[c-linkage.co.jp]
  • Section 5 - Management and Treatment of Specific Infections Genital Herpes simplex virus (HSV) Infections Etiology Herpes simplex virus (HSV) types 1 and 2.[canada.ca]
  • Differential diagnosis Because the presentation of herpes simplex virus can vary considerably, many individuals will confuse infection with a variety of other etiologies including: Other ulcerative STIs (syphilis, chancroid) Non-infectious ulcerations[clinicaladvisor.com]
  • Infants admitted with pneumonia of uncertain etiology who do not improve after 24 h on antibiotics, especially if the radiographic picture is consistent with viral pneumonia.[cps.ca]

Epidemiology

  • Herpes simplex virus infection in pregnancy and in neonate: status of art of epidemiology, diagnosis, therapy and prevention. Virol J 2009 Occurrence of cytomegalovirus and herpes simplex virus infections in pregnancy.[perinatology.com]
  • .), and Epidemiology (A.W.), University of Washington — both in Seattle. Address reprint requests to Dr. Corey at the Vaccine and Infectious Disease Institute, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave.[nejm.org]
  • Congenital cytomegalovirus infection: review of the epidemiology and outcome. Obstet Gynecol Surv. 2002; 57 :245–256. [ PubMed ] [ Google Scholar ] 8. Fowler KB, Stagno S, Pass RF.[ncbi.nlm.nih.gov]
  • […] transmitted by direct contact Spreads via epidermal cells that fuse forming " multinucleated giant cells " Virus remains dormant in local nerves reactivation occurs in unilaterally in areas innervated by these nerves mechanism for reoccurrence is unclear Epidemiology[medbullets.com]
  • Herpes simplex virus infection in pregnancy and in neonate: Status of art of epidemiology, diagnosis, therapy and prevention. Virol J 2009;6:40. [ PUBMED ] [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5][jcnonweb.com]
Sex distribution
Age distribution

Pathophysiology

  • General information Pathophysiology Inoculation : The virus enters the body through mucosal surfaces or small dermal lesions. Neurovirulence : The virus invades, spreads, and replicates in nerve cells.[amboss.com]
  • […] settings where the test may be helpful An aid in the diagnosis of congenital herpes simplex virus (HSV) infection in patients younger than 35 days old through the recovery of HSV using viral culture (shell-vial) Clinical Information Discusses physiology, pathophysiology[mayomedicallaboratories.com]
  • Approximately 22% of pregnant women have had a previous exposure HSV-2, and a further 2% or more women acquire the virus during pregnancy. [1] Particularly among young adults, genital herpes infections are increasing caused by HSV-1. [2] Pathophysiology[wikidoc.org]
  • Pathophysiology Herpes simplex virus is a double stranded DNA virus capable of causing herpes labialis, gingivostomatitis, keratoconjunctivitis and genital herpes, depending on the subtype implicated.[clinicaladvisor.com]

Prevention

  • Valganciclovir (32 mg/kg/day in two doses for six months) prevents the development of hypoacusis and improves the neurological prognosis in symptomatic congenital infection due to cytomegalovirus.[ncbi.nlm.nih.gov]
  • A vaccine that could reduce the spread of herpes would result in many positive outcomes – including preventing infants from dying of neonatal herpes".[who.int]
  • Preventing neonatal herpes: reducing transmission of HSV infection Identification of pregnant women who have (or are at risk of having) HSV is a critical component of preventing transmission to a baby.[abclawcenters.com]
  • Centers for Disease Control and Prevention. Genital Herpes - CDC Fact Sheet. Available online at . Page last reviewed September 6, 2012. Accessed January 2013. Centers for Disease Control and Prevention.[labtestsonline.it]
  • Both HSV-1 and HSV-2 can be detected in oral and genital lesions. 1 Managing HSV in pregnancy is of high interest, and the main goal is to prevent neonatal HSV infection. Table 1.[dermquest.com]

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