The Indian Journal of Pediatrics

, Volume 71, Issue 10, pp 921–926

Management of Neonatal herpes simplex virus infections

Symposium on Protocols for Managing Severe Infections-II

Abstract

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 infectionin 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.

Key words

Herpes simplex virus Pregnancy complications infectious Herpes encephalitis Acyclovir Cesarean section 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Armstrong GL, Schillinger J, Markowitz Let al. Incidence of herpes simplex virus type 2 infection in the United States.Am J Epidemiol 2001; 153: 912–920.PubMedCrossRefGoogle Scholar
  2. 2.
    Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines 2002.MMWR 2002; 51(RR-6): 1–78.Google Scholar
  3. 3.
    Brown ZA, Selke S, Zeh Jet al. The acquisition of herpes simplex virus during pregnancy.N Engl J Med 1997; 337: 509–515.PubMedCrossRefGoogle Scholar
  4. 4.
    Fleming DT, McQuillan GM, Johnson REet al. Herpes simplex virus type 2 in the United States, 1976 to 1994.N Engl J Med 1997; 337: 1105–1111.PubMedCrossRefGoogle Scholar
  5. 5.
    Kaur R, Gupta N, Nair D, Kakkar M, Mathur MD. Screening for TORCH infections in pregnant women: a report from Delhi.Southeast Asian J Trop Med Public Health 1999; 30: 284–286.PubMedGoogle Scholar
  6. 6.
    Cowan FM, French RS, Mayaud Pet al. Seroepidemiological study of herpes simplex virus types 1 and 2 in Brazil, Estonia, India, Morocco, and Sri Lanka.Sex Transm Infect 2003; 79: 286–290.PubMedCrossRefGoogle Scholar
  7. 7.
    Jonsson MK, Wahren B. Sexually transmitted herpes simplex viruses.Scand f Infect Dis 2004; 36: 93–101.CrossRefGoogle Scholar
  8. 8.
    Koelle DM, Wald A. Herpes simplex virus: the importance of asymptomatic shedding.J Antimicrob Chemother 2000; 45: 1–8.PubMedCrossRefGoogle Scholar
  9. 9.
    Kimberlin DW, Rouse DJ. Genital herpes.N Engl J Med 2004; 350: 1970–1977.PubMedCrossRefGoogle Scholar
  10. 10.
    Wald A, Zeh J, Selke Set al. Reactivation of genital herpes simplex virus type 2 infection in asymptomatic seropositive persons.N Engl J Med 2000; 342: 844–850.PubMedCrossRefGoogle Scholar
  11. 11.
    Kimberlin DW, Lin C-Y, Jacobs RFet al. Natural history of neonatal herpes simplex virus infections in the acyclovir era.Pediatrics 2001; 108: 223–229.PubMedCrossRefGoogle Scholar
  12. 12.
    Freij BJ, Sever JL. Fetal herpes simplex virus infection. In Buyse ML, ed.Birth Defects Encyclopedia. Boston; Blackwell Scientific Publications, 1990; 713–714.Google Scholar
  13. 13.
    Kimberlin DW. Neonatal herpes simplex infection.Clin Microbiol Rev 2004; 17: 1–13.PubMedCrossRefGoogle Scholar
  14. 14.
    Filippine MM, Katz BZ. Neonatal herpes simplex virus infection presenting with fever alone.J Hum Virol 2001; 4: 223–225.PubMedGoogle Scholar
  15. 15.
    Toth C, Harder S, Yager J. Neonatal herpes encephalitis: a case series and review of clinical presentation.Can J Neurol Sci 2003; 30: 36–40.PubMedGoogle Scholar
  16. 16.
    Kimura H, Futamura M, Ito Yet al. Relapse of neonatal herpes simplex virus infection.Arch Dis Child Fetal Neonatal Ed 2003; 88: F483-F486.PubMedCrossRefGoogle Scholar
  17. 17.
    Whitley R, Arvin A, Prober Cet al. Predictors of morbidity and mortality in neonates with herpes simplex virus infections.N Engl J Med 1991; 324: 450–454.PubMedCrossRefGoogle Scholar
  18. 18.
    Jerome KR, Ashley RL. Herpes simplex viruses and herpes B virus. In Murray PR, Baron EJ, Jorgensen JH, Pfaller MA, Yolken RH, eds.Manual of Clinical Microbiology, 8th ed. Washington, DC; ASM Press, 2003; 1291–1303.Google Scholar
  19. 19.
    Kimura H, Ito Y, Futamura Met al. Quantitation of viral load in neonatal herpes simplex virus infection and comparison between type 1 and type 2.J Med Virol 2002; 67: 349–353.PubMedCrossRefGoogle Scholar
  20. 20.
    Whitley R, Arvin A, Prober Cet al. A controlled trial comparing vidarabine with acyclovir in neonatal herpes simplex virus infection.N Engl J Med 1991; 324: 444–449.PubMedCrossRefGoogle Scholar
  21. 21.
    Kimberlin DW, Lin C-Y, Jacobs RFet al. Safety and efficacy of high-dose intravenous acyclovir in the management of neonatal herpes simplex virus infections.Pediatrics 2001; 108: 230–238.PubMedCrossRefGoogle Scholar
  22. 22.
    Pramod NP, Thyagarajan SP, Mohan KVK, Anandakannan K. Acyclovir resistance in herpes simplex virus isolates from keratitis cases: an analysis from a developing country.Microbiol Immunol 2000; 44: 241–247.PubMedGoogle Scholar
  23. 23.
    Nyquist A-C, Rotbart HA, Cotton Met al. Acyclovir-resistant neonatal herpes simplex virus infection of the larynx.J Pediatr 1994; 124: 967–971.PubMedCrossRefGoogle Scholar
  24. 24.
    Kesson AM. Management of neonatal herpes simplex virus infection.Pediatr Drugs 2001; 3: 81–90.CrossRefGoogle Scholar
  25. 25.
    Reynolds SJ, Risbud AR, Shepherd MEet al. Recent herpes simplex virus type 2 infection and the risk of human immunodeficiency virus type 1 acquisition in India.J Inject Dis 2003; 187: 1513–1521.CrossRefGoogle Scholar
  26. 26.
    Leonard JR, Moran CJ, Cross DT III, Wippold FJ II, Schlesinger Y, Storch GA. MR imaging of herpes simplex type 1 encephalitis in infants and young children: a separate pattern of findings.AJR Am J Roentgenol 2000; 174: 1651–1655.PubMedGoogle Scholar
  27. 27.
    Kimberlin D, Powell D, Gruber Wet al. Administration of oral acyclovir suppressive therapy after neonatal herpes simplex virus disease limited to the skin, eyes and mouth: results of a phase I/II trial.Pediatr Infect Dis J 1996; 15: 247–254.Google Scholar
  28. 28.
    American College of Obstetricians and Gynecologists. ACOG practice bulletin. Management of herpes in pregnancy. Number 8 October 1999. Clinical management guidelines for obstetrician-gynecologists.Int J Gynaecol Obstet 2000; 68: 165–173.CrossRefGoogle Scholar
  29. 29.
    Brown ZA, Wald A, Morrow RA, Selke S, Zeh J, Corey L. Effect of serologic status and cesarean delivery on transmission rates of herpes simplex virus from mother to infant.JAMA 2003; 289: 203–209.PubMedCrossRefGoogle Scholar
  30. 30.
    Garland SM, Lee TN, Sacks S. Do antepartum herpes simplex virus cultures predict intrapartum shedding for pregnant women with recurrent disease?Infect Dis Obstet Gynecol 1999; 7: 230–236.PubMedCrossRefGoogle Scholar
  31. 31.
    Sheffield JS, Hollier LM, Hill JB, Stuart GS, Wendel GD Jr. Acyclovir prophylaxis to prevent herpes simplex virus recurrence at delivery: a systematic review.Obstet Gynecol 2003; 102: 1396–1403.PubMedCrossRefGoogle Scholar
  32. 32.
    Centers for Disease Control and Prevention. Pregnancy outcomes following systemic prenatal acyclovir exposure — June 1, 1984-June 30, 1993.MMWR 1993; 42: 806–809.Google Scholar

Copyright information

© Dr. K C Chaudhuri Foundation 2004

Authors and Affiliations

  1. 1.Division of Infectious Diseases, Department of PediatricsWilliam Beaumont HospitalRoyal OakUSA

Personalised recommendations