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Generalized Herpes Simplex Infection of the Newborn

Herpes Simplex Infection of Newborn Generalized


Presentation

  • Disseminated herpes simplex virus infection presenting as fever in the newborn - A lethal outcome.[scholars.northwestern.edu]
  • […] fever, lethargy, or apnea are present.[hosppeds.aappublications.org]
  • Clinical presentation Clinical presentations of HSV include: Neonatal HSV usually presents within two weeks of birth.[www2.health.vic.gov.au]
  • ). [3], [4] Disseminated disease is the most severe form of neonatal HSV infection. [4], [5] Infants with disseminated disease usually present between 10 and 12 days of life. [5] The clinical presentation is often characterized by sepsis syndrome, with[jcnonweb.com]
  • 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]
Fever
  • […] with fever and tachypnea on day 6 of life is described.[scholars.northwestern.edu]
  • Symptoms and fevers in both the mother and neonate responded to antiviral therapy.[journals.lww.com]
  • TABLE 1 Historical and Examination Characteristics The most common neonatal complaint was fever (11 patients). Two patients presented with fever alone with no other complaints.[hosppeds.aappublications.org]
  • There is often a systemic prodrome of fever, malaise and myalgias one to two days before the appearance of lesions.[aafp.org]
  • […] 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 and fever[radiopaedia.org]
Recurrent Infection
  • The topics covered include the historical background of the two viruses; description and clinical manifestations of infection in man of herpes simplex (HSV) and varicella-zoster (V-Z); definition of B virus (herpesvirus simiae); recurrent infection zoster[books.google.com]
  • . • The risk of transmission of HSV to neonate is higher with primary infection acquired closer to the time of delivery and less risk with recurrant infections. • This is explained possibly by:- (1).decreased transplacentally acquired antibody levels[slideshare.net]
  • Thus, neonatal HSV infection is most often caused by primary maternal HSV infection, rather than recurrent infection.[openanesthesia.org]
  • Viral reactivation from latency and subsequent antegrade translocation of virus back to skin and mucosal surfaces produces a recurrent infection.[pediatrics.aappublications.org]
Disability
  • […] vasogenic edema GE/SWI: may demonstrate blooming if hemorrhagic T1 C (Gd): enhancement usually presents in a gyriform pattern Treatment and prognosis Neonatal herpes simplex encephalitis is highly lethal (in about 50% of cases) and can cause permanent disability[radiopaedia.org]
  • Affected children may have developmental delay and learning disabilities. If your baby has any symptoms of birth-acquired herpes, including skin blisters with no other symptoms, have the baby seen by the provider right away.[medlineplus.gov]
  • . • It is associated with a good outcome without any disabilities after 1 year of treatment. 23. CUTANEOUS LESIONS 24. VESICULAR LESIONS HSV 25.[slideshare.net]
  • Sx: lethargy, poor feeding, seizures, temperature instability, bulging fontanelle, cutaneous lesions CSF: pleocytosis, HSV DNA will confirm diagnosis (may be neg early in disease) Morbidity HSV2 HSV1 Developmental delay Epilepsy Blindness Cognitive disability[pedclerk.bsd.uchicago.edu]
  • Death TABLE 2 Complications of Neonatal Herpes Simplex Virus Infections Seizures Psychomotor retardation Spasticity Blindness Learning disabilities Death Illustrative Case A male infant was born vaginally at 39 weeks of gestation with a birth weight[aafp.org]
Anemia
  • Werner Cambridge University Press, 18 Aug 2005 - Medical - 452 pages Neonatal hematology : a historical overview -- Disorders of the fetomaternal unit -- Erythropoiesis, red cells, and the approach to anemia -- Anemia of prematurity and indications for[books.google.com]
Pneumonia
  • Keywords: Disseminated disease, neonatal herpes, pneumonia How to cite this article: Shetty AK, Givner LB. Disseminated neonatal herpes simplex virus infection presenting with pneumonia and progressive respiratory failure.[jcnonweb.com]
  • Systemic treatment is important in cases of chlamydial conjunctivitis since topical therapy is ineffective in eradicating the bacteria in the nasopharynx of the infant, which could cause a life-threatening pneumonia if left untreated.[es.slideshare.net]
  • All 11 also had abnormalities on chest radiograph consistent with HSV pneumonia.[hosppeds.aappublications.org]
  • Sometimes a baby with herpes gets pneumonia, has difficulty breathing, or has apnea - spells with no breathing at all. These are serious problems that require intensive investigation in hospital.[medbroadcast.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]
Hepatomegaly
  • On admission to our hospital, several vesicles were found on the left upper arm, and moderate hepatomegaly was also present. Herpes simplex virus (HSV) type II genome was detected from serum, spinal fluid, and bone marrow.[ci.nii.ac.jp]
  • Disseminated disease Features of disseminated disease include: poor prognosis, with over 70 per cent mortality if untreated non-specific presentation with: lethargy poor feeding fever seizures apnoea respiratory distress hepatomegaly jaundice DIC.[www2.health.vic.gov.au]
  • Clinical findings include a sepsis-like presentation with respiratory distress, haemodynamic instability, jaundice, hepatomegaly, elevated liver enzymes, bleeding with associated coagulopathy, and seizures with signs of meningitis, encephalitis or respiratory[herpes.org.nz]
Hepatosplenomegaly
  • Eleven days later, his condition suddenly deteriorated with jaundice, abdominal collateral circulation, hepatosplenomegaly, and diarrhea in a febrile context(39.5 C) suggesting splenic hypertension; he was transferred to the neonatal intensive care unit[benthamopen.com]
  • There was no rash, adenopathy or hepatosplenomegaly. An arterial blood gas revealed a pH of 7.33, a partial pressure of oxygen of 45 mm Hg, and a partial pressure of carbon dioxide of 52 mm Hg.[jcnonweb.com]
Red Eye
  • Other conditions causing red eye. Orbital cellulitis. Investigations [ 1 ] Most cases will be confirmed clinically and do not require further investigation following ophthalmological review.[patient.info]
Seizure
  • Sequelae are mostly seen in neurodevelopment, including deafness, vision loss, cerebral palsy, and seizure.[radiopaedia.org]
  • Treatment may also be needed for the effects of herpes infection, such as shock or seizures. Because these babies are very ill, treatment is often done in the hospital intensive care unit.[medlineplus.gov]
  • Other signs, which can occur singly or in combination, include temperature instability, lethargy, hypotonia, respiratory distress, apnea, and seizures.[merckmanuals.com]
  • A trial to reduce the dose of levamisole resulted in a new episode of seizures and skin lesions. A similar relapse was observed at the age of 7 months, which resulted in control of symptoms by increasing the dose of levamisole.[karger.com]
  • . 79 Mortality is highest in those with an altered conscious state, seizures, disseminated intravascular coagulation, and prematurity.[herpes.org.nz]

Workup

  • […] método más eficaz, pero no se suele usar por costo y disponibilidad Newborns with conjunctivitis are at risk for secondary infections, such as pneumonia, meningitis, and septicemia, which can lead to sepsis and death and thus should be admitted for full workup[es.slideshare.net]
  • A full septic workup was undertaken and ampicillin and gentamicin were commenced. The initial white blood cell count (WBC) was 12.4 10 9 /L, platelet count 184 10 9 /L and hemoglobin 147 g/L. The C-reactive protein (CRP) was 31 mg/L.[academic.oup.com]
Hyperviscosity
  • […] and the approach to anemia -- Anemia of prematurity and indications for erythropoietin therapy -- Hypoplastic anemia -- Hemolytic disease of the fetus and newborn -- Neonatal hemolysis -- Neonatal screening for hemoglobinopathies -- Polycythemia and hyperviscosity[books.google.com]
Herpes Simplex Virus 2 Infection
  • Herpes simplex virus 2 infection in women attending an antenatal clinic in Fuzhou, China. Sex Transm Infect. 2007; 83 (5): 369-70[ DOI ][ PubMed ] 7. Biswas D, Borkakoty B, Mahanta J, Walia K, Saikia L, Akoijam BS, et al.[ircmj.com]
Intranuclear Inclusion Bodies
  • The diagnosis of generalized viral infection was established from virologic studies of liver and brain tissue and from the demonstration of intranuclear inclusion bodies in the esophagus, myocardium, liver, spleen, adrenal glands and brain.[onlinelibrary.wiley.com]
  • Hepato-adrenal necrosis with intranuclear inclusion bodies: report of a case. Am J Pathol 1935; 11 :127–147. 2 Kimberlin DW, Lin CY, Jacobs RF, et al. The National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group.[nature.com]

Treatment

  • This text not only outlines the various disease patterns but gives guidance to rational treatment with antiviral agents.[books.google.com]
  • IV acyclovir (20 mg/kg/dose Q8 hrs) Side Effect: neutropenia but without adverse clinical outcomes Treatment at end of pregnancy to prevent recurrences SEM: Systemic treatment to avoid progression High dose IV acyclovir Q8hr for 14 days CNS disease:[pedclerk.bsd.uchicago.edu]
  • For localized disease (skin, mouth, or conjunctivae), treatment is acyclovir 20 mg/kg IV q 8 h for 14 days.[merckmanuals.com]
  • The most commonly used treatments for neonatal herpes simplex are called ganciclovir and valganciclovir.[childrenshospital.org]
  • The efficacy of newer antiviral agents with better bioavailability (e.g. valaciclovir, valganciclovir) for the treatment of neonatal disease needs to be evaluated in randomised trials.[cochrane.org]

Prognosis

  • , 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]
  • […] 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]
  • Prognosis Mortality and morbidity rates for disseminated and CNS disease are very high, even with early and aggressive treatment.[www2.health.vic.gov.au]
  • Last Revised: 9/18/01. 8pp. www.neonatal.peds.washington.edu/NICU-WEB/HSV/hsv.stm The Prognosis for Many Infants with Neonatal Herpes Simplex Virus Infection Remains Poor.[rarediseases.org]
  • SEM herpes has the best prognosis of the three, however, if left untreated it may progress to disseminated or CNS herpes with its attendant increases in mortality and morbidity.[en.wikipedia.org]

Etiology

  • Etiology of DNA virus infections in liver transplant recipients with neonatal hepatitis. Transplant Proc. 2010; 42 (3): 837-8[ DOI ][ PubMed ] 11. Gupta A, Rani PK, Bagga B, Dore P, Mittal A, Jalali S.[ircmj.com]
  • Because, the etiological quest of severe sepsis in newborn is difficult and that delayed therapy jeopardizes the outcome, it is recommended to start empiric acyclovir treatment when cytolytic hepatitis is diagnosed [ 8 Light IJ.[benthamopen.com]
  • Noninfectious etiologies include cardiac disease and inborn errors of metabolism.[jcnonweb.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

  • Epidemiology of herpes simplex virus type 2 infection in rural and urban Burkina Faso. Sex Transm Dis. 2011; 38 (2): 117-23[ DOI ][ PubMed ] 10. Yaghobi R, Zamani S, Gramizadeh B, Rahsaz M.[ircmj.com]
  • […] 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]
  • Epidemiology [ edit ] Neonatal HSV rates in the U.S. are estimated to be between 1 in 3,000 and 1 in 20,000 live births.[en.wikipedia.org]
  • […] encephalomalacia, hydranencephaly, intracranial calcification Intrapartum (85%) Mother must be shedding virus at time of delivery Postnatal (10%) Almost always HSV-1 3 types of infection from intrapartum (and postnatal) exposure SEM CNS Disseminated Epidemiology[pedclerk.bsd.uchicago.edu]
  • Tesini, MD, Assistant Professor of Medicine and Pediatrics, Division of Infectious Diseases, University of Rochester School of Medicine and Dentistry; Associate Hospital Epidemiology, Strong Memorial Hospital and Golisano Children's Hospital, University[merckmanuals.com]
Sex distribution
Age distribution

Prevention

  • STD Prevention. 3. Preventing Neonatal Herpes. Last reviewed; December 14, 2002. 2pp. www.cdc.gov/nchstp/dstd/Reports_Piblications/part3.htm FOR NON-CLINICIANS Ebel C, Wald A. Managing Herpes: How to Live and Love with a Chronic STD. 3rd Ed.[rarediseases.org]
  • Neonatal herpes is exceedingly unlikely to occur and is highly preventable. Furthermore, if it happens in spite of efforts at prevention, it is treatable.[medbroadcast.com]
  • Prevention of perinatal herpes: Prophylactic antiviral therapy. Clin Obstet Gynecol 1999;42:134-48. Stray-Pedersen B. Acyclovir in late pregnancy to prevent neonatal Herpes simplex. Lancet 1990;336:756.[pulsus.com]
  • Prevention Efforts to prevent neonatal transmission have not been very effective. Universal screening has not been recommended or shown to be effective, and most maternal infections with risk of transmission are asymptomatic.[merckmanuals.com]
  • […] recurrence Prognosis, 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[medbullets.com]

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