Document Detail


Management of neonatal herpes simplex virus infections.
MedLine Citation:
PMID:  15531836     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
As many as 2,500 infants develop neonatal herpes each year, most of whom are born to women with no history or physical findings suggestive of genital herpes. Infection usually takes one of three forms: 1) disease localized to skin, eyes, and mucous membranes, 2) localized central nervous system infection, or 3) disseminated infection. Exposure to the virus occurs during passage through an infected birth canal, but 5% of infants acquire the infection in utero. The mortality rate is 31% for disseminated infection and 6% for localized central nervous system disease; long-term neurologic sequelae are seen in 17% and 70% of survivors, respectively. Diagnosis is made by isolating of the virus from skin lesions or other involved sites. The polymerase chain reaction for the detection of viral DNA in cerebrospinal fluid or serum is now the diagnostic test of choice for central nervous system or disseminated neonatal herpes because it has higher sensitivity than traditional culture methods. Treatment is with high-dose intravenous acyclovir (60 mg/kg per day in three divided doses), with adjustments made for infants with renal or hepatic insufficiency. Supportive measures and neuroimaging studies are often required. Acyclovir is administered for three weeks, but infants with disease localized to the skin, eyes, and mucous membranes can be treated for two weeks if the cerebrospinal fluid polymerase chain reaction assay is negative for herpes simplex virus DNA. Prevention of infection in infants can be accomplished by cesarean delivery when women have active lesions at the onset of labor. Neonates delivered through an infected birth canal should be screened between 24 and 48 hours of age with viral cultures of eyes, nasopharynx, mouth, and rectum. If positive, they should be treated with acyclovir even if asymptomatic. Suppressive acyclovir therapy beginning at 36 weeks gestation is often prescribed for women with frequent recurrences of genital herpes.
Authors:
Bishara J Freij
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Indian journal of pediatrics     Volume:  71     ISSN:  0019-5456     ISO Abbreviation:  Indian J Pediatr     Publication Date:  2004 Oct 
Date Detail:
Created Date:  2004-11-08     Completed Date:  2005-02-15     Revised Date:  2008-11-21    
Medline Journal Info:
Nlm Unique ID:  0417442     Medline TA:  Indian J Pediatr     Country:  India    
Other Details:
Languages:  eng     Pagination:  921-6     Citation Subset:  IM    
Affiliation:
Division of Infectious Diseases, Department of Pediatrics, William Beaumont Hospital, 3535 West Thirteen Mile Road, Royal Oak, MI 48073, USA. bfreij@beaumont.edu
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MeSH Terms
Descriptor/Qualifier:
Antiviral Agents / therapeutic use
Drug Resistance, Viral
Herpes Simplex / diagnosis*,  epidemiology,  therapy*,  transmission
Humans
Infant, Newborn
Infectious Disease Transmission, Vertical / prevention & control
Chemical
Reg. No./Substance:
0/Antiviral Agents

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