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American Academy of Pediatrics
Research Articles

Clinical and Laboratory Characteristics of Disseminated Herpes Simplex Virus Infection in Neonates

David Kotzbauer, Gary Frank, Wei Dong and Steve Shore
Hospital Pediatrics May 2014, 4 (3) 167-171; DOI: https://doi.org/10.1542/hpeds.2013-0086
David Kotzbauer
Children’s Healthcare of Atlanta, Atlanta, Georgia
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Gary Frank
Children’s Healthcare of Atlanta, Atlanta, Georgia
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Wei Dong
Children’s Healthcare of Atlanta, Atlanta, Georgia
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Steve Shore
Children’s Healthcare of Atlanta, Atlanta, Georgia
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Abstract

Background And Objectives: Disseminated herpes simplex virus (HSV) infection is the most fulminant type of neonatal HSV infection and has the highest mortality. Early diagnosis and treatment are essential for patient survival. We describe the clinical presentation, laboratory characteristics, and outcomes of neonates with disseminated HSV infection at our institution.

Methods: A retrospective review of electronic medical records from 2006 to 2013 was performed. Only neonates with disseminated HSV infection, confirmed by using polymerase chain reaction or viral culture results, were included.

Results: Twenty-two cases were identified; the age range was 1 to 14 days. The majority of patients did not have a maternal history of HSV or a history of maternal fever at delivery. Eleven of the patients were delivered by cesarean delivery, and 3 of these patients did not have prolonged rupture of membranes. Neonatal fever, the most common historical characteristic, was present in only one-half of the patients. Pneumonia and respiratory distress were present in one-half of the patients. Serum aspartate aminotransferase and alanine aminotransferase levels were elevated in most, but not all, patients. The blood HSV polymerase chain reaction was positive in all patients tested. Of the 22 study patients, 16 survived and 6 died. The majority of the patients who died had respiratory disease and a delay in the initiation of acyclovir therapy.

Conclusions: Disseminated HSV infection in neonates can be challenging to diagnose and is associated with high mortality. Clinicians must strongly consider this diagnosis, test the blood for HSV polymerase chain reaction, and initiate early treatment in the appropriate clinical scenarios.

  • acyclovir
  • clinical characteristics
  • disseminated herpes simplex infection in neonates
  • herpes simplex infection
  • laboratory characteristics
  • retrospective case series
  • Abbreviations:
    ALT
    alanine aminotransferase
    AST
    aspartate aminotransferase
    CNS
    central nervous system
    CRP
    C-reactive protein
    CSF
    cerebrospinal fluid
    DIC
    disseminated intravascular coagulation
    HSV
    herpes simplex virus
    PCR
    polymerase chain reaction
    ROM
    rupture of membranes
    SEM
    skin/eye/mouth
    • Copyright © 2014 by the American Academy of Pediatrics
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    Hospital Pediatrics: 4 (3)
    Hospital Pediatrics
    Vol. 4, Issue 3
    1 May 2014
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    Clinical and Laboratory Characteristics of Disseminated Herpes Simplex Virus Infection in Neonates
    David Kotzbauer, Gary Frank, Wei Dong, Steve Shore
    Hospital Pediatrics May 2014, 4 (3) 167-171; DOI: 10.1542/hpeds.2013-0086

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    Clinical and Laboratory Characteristics of Disseminated Herpes Simplex Virus Infection in Neonates
    David Kotzbauer, Gary Frank, Wei Dong, Steve Shore
    Hospital Pediatrics May 2014, 4 (3) 167-171; DOI: 10.1542/hpeds.2013-0086
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    • Testing and Empiric Treatment for Neonatal Herpes Simplex Virus: Challenges and Opportunities for Improving the Value of Care
    • Challenges in the Care of Young Infants With Suspected Neonatal Herpes Simplex Virus
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    Subjects

    • Fetus/Newborn Infant
      • Neonatology
    • Infectious Disease
      • Infectious Disease

    Keywords

    • acyclovir
    • clinical characteristics
    • disseminated herpes simplex infection in neonates
    • herpes simplex infection
    • laboratory characteristics
    • retrospective case series
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