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]

[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]

Clinical presentation Clinical presentations of HSV include: Neonatal HSV usually presents within two weeks of birth. [www2.health.vic.gov.au]

Neonatal CNS HSV disease often presents in the second to third week of life, although earlier presentations can occur. [med.cmu.ac.th]

• 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]

  Patients usually present with fever, malaise, odynophagia, and headache with vesiculoulcerative lesions on the tonsils. [emedicine.medscape.com]

  About 20% present with nonspecific symptoms that resemble dengue fever, including fever, headache, myalgia, arthralgia, and maculopapular rash. Rare infections cause the Guillain-Barre syndrome. [neuropathology-web.org]

• Splenomegaly

  Splenomegaly is usual and there may be jaundice with liver failure. If the adrenals are involved, Waterhouse-Friderichsen syndrome ensues. Septicaemia and neonatal herpes share many clinical features. [virology-online.com]

• 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]

• Conjunctival Injection

  Involvement here is less common in secondary infection although conjunctival injection (red eye) is almost universal. There may be erosions around the lid margin with the presence of small vesicles or pustules. [patient.info]

  Keratoconjunctivitis manifests with acute onset of pain, watery discharge, itching, blurred vision, lid swelling, and conjunctival injection. [62] Acute retinal necrosis can result in blindness. [emedicine.medscape.com]

[…] 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]

• 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]

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]

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]

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]

Where dissemination occurs, infection carries a grave prognosis. Infection is particularly dangerous in premature infants. In mature infants, infection 10 days or more after birth carries a much improved prognosis. [virology-online.com]

(Etiology) Birth-Acquired Herpes is caused by the herpes simplex virus (HSV). [dovemed.com]

Only by specific virologie and serologic laboratory procedures and a high index of suspicion may the viral etiology be proved. [healio.com]

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]

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]

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]

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]

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]

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]

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]

Preventing acquisition of a new genital herpes infection is particularly important for women in late pregnancy, as this is when the risk for neonatal herpes is greatest. [who.int]

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]