HSV Case Review by Type of HSV Disease

Case No.
SEMDisseminatedCNSPotential HSVa
CNS UnknownbCNS-NegativeCNS-Positive
Age, d
 At symptom onset2165103561231039121616129318
 At presentation288511106712511418182016139318
Symptoms or PE
 HSV high riskeRashRash, scalp site<36°C, ill<36°C, ill, AMS, excessive bleeding<36°C, ill, AMS, abnormal neurologic examination, excessive bleedingAMSIll, likely maternal primary genital HSVfIll, rash, grandmother oral HSVIll, AMSAMS, ill, likely primary genital HSVfIllSeizure, abnormal neurologic examination, rash<36°C, rash, likely maternal cutaneous HSVfApnea, seizure, maternal primary genital HSVSeizureIll, apnea, AMS, abnormal neurologic examinationIll, apnea, abnormal neurologic examination, maternal oral HSVRash, maternal oral HSVNone
 OtherNoneNoneDifficulty breathing, poor feedingPoor feeding, vomitingPoor feedingDifficulty breathingFeverPoor feedingJaundiceFever, poor feedingFever, difficulty breathing, poor feedingEye drainagePoor feedingFeverFever, vomitingDifficulty breathing, poor feedingFever, difficulty breathingNoneFever, poor feeding
  WBCs per mL11429137867121284321933
  RBCs per mL762709191613131 778633180011042125
  % segs8NR4002403740851213
  Glucose, mg/dL494848406554259333032813839
  Protein, mg/dL6087926610977772081957214758104133
 Other, U/L
  AST3763284111 63114 18390858311952136912 0003953713362292346
Hours to acyclovir541771459434428614343155
 LOS, d3.813.81.6g7.01.86.322.
  • ALT, alanine aminotransferase; AMS, altered mental status; AST, aspartate aminotransferase; BAL, bronchoalveolar lavage; NR, not reported; PE, physical examination; RBC, red blood cell; seg, segmented neutrophil; WBC, white blood cell; —, not applicable.

  • a Potential patients with HSV are those without positive HSV testing results but who received a full 21-d course of acyclovir for possible HSV.

  • b All of the patients with disseminated HSV and CNS unknown status were too ill at presentation for lumbar punctures.

  • c CSF PCR results were negative but were treated as CNS-positive on the basis of abnormal CSF cell counts.

  • d No CSF cell counts were available because of low CSF volume and traumatic lumbar puncture.

  • e HSV high-risk symptoms and PE findings are based on common HSV symptoms in published case series of HSV-positive infants.

  • f Probable maternal HSV based on signs and symptoms, but no access to maternal medical record to verify.

  • g For each patient who died, the LOS is days in the hospital before death.

  • h Neonatal AKI definitions were adapted from Selewski DT, Charlton JR, Jetton JG, et al. Neonatal acute kidney injury. Pediatrics. 2015;136(2). Available at: