Current Treatment Options in Neurology

, Volume 7, Issue 2, pp 151–156 | Cite as

Herpes simplex virus infections of the newborn

  • James F. Bale
  • Lonnie J. Miner

Opinion statement

Herpes simplex virus (HSV) infection in newborns is an important cause of death and permanent neurodevelopmental disability among young children. Neonatal HSV infections can be categorized as 1) mucocutaneous (skin-eyes-mouth), 2) disseminated, or 3) encephalitic. In addition, congenital HSV infection, a distinct clinical syndrome, accounts for approximately 5% of HSV infections identified in the neonatal period. Polymerase chain reaction greatly enhances the clinician’s ability to diagnosis HSV infections, but as many as 25% of infants with neonatal HSV encephalitis have negative polymerase chain reaction studies of cerebrospinal fluid. Infants with proven or suspected HSV infections should receive acyclovir 60 mg/kg/day divided every 8 hours for 14 days if disease is restricted to the skin, eyes, or mucous membranes and for 21 days if the infant has disseminated infection or encephalitis. The benefit of long-term suppression therapy after completion of the initial treatment regimen has not been established definitively. Despite therapy with acyclovir, the best available anti-HSV drug, a substantial number of HSV-infected infants with disseminated infections or encephalitis die or have long-term neurodevelopmental sequelae.


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References and Recommended Reading

  1. 1.
    Stone K, Brooks C, Guinan M, et al.: National surveillance for neonatal herpes simplex virus infections. Sex Transm Dis 1989, 16:152–156.PubMedCrossRefGoogle Scholar
  2. 2.
    Kimberlin DW: Neonatal herpes simplex infection. Microbiol Rev 2004, 17:1–13. A well-written, contemporary summary of the clinical features, diagnosis, and management of HSV infections of the neonate.CrossRefGoogle Scholar
  3. 3.
    Buchacz K, McFarland W, Hernandez M, et al.: Prevalence and correlates of herpes simplex virus type 2 infection in a population-based survey of young women in low-income neighborhoods of Northern California. The Young Women’s Survey Team. Sex Transm Dis 2000, 27:393–400.PubMedCrossRefGoogle Scholar
  4. 4.
    Armstrong GL, Schillinger J, Markowitz L, et al.: Incidence of herpes simplex virus type 2 infection in the United States. Am J Epidemiol 2001, 153:912–920.PubMedCrossRefGoogle Scholar
  5. 5.
    Fleming AL, McQuillan GM, Johnson RE, et al.: Herpes simplex virus type 1 in the United States, 1976 to 1994. N Engl J Med 1997, 337:1105–1111.PubMedCrossRefGoogle Scholar
  6. 6.
    Sucato G, Celum C, Dithmer D, et al.: Demographic rather than behavioral risk factors predict herpes simplex virus type 2 infection in sexually active adolescents. Pediatr Infect Dis J 2001, 20:422–426.PubMedCrossRefGoogle Scholar
  7. 7.
    Brown ZA, Selke S, Zeh J, et al.: The acquisition of herpes simplex virus during pregnancy. N Engl J Med 1997, 337:509–515.PubMedCrossRefGoogle Scholar
  8. 8.
    Kimberlin DW, Lin C-Y, Jacobs RF, et al.: Natural history of neonatal herpes simplex virus infections in the acyclovir era. Pediatrics 2001, 108:223–229. This article provides a useful clinical perspective regarding the natural history of neonatal infections after the widespread use of acyclovir. The conclusions emphasize that “no progress” was made in shortening the interval between the onset of symptoms suggesting HSV and the initiation of antiviral therapy.PubMedCrossRefGoogle Scholar
  9. 9.
    Hutto C, Arvin A, Jacobs R, et al.: Intrauterine herpes simplex virus infections. J Pediatr 1987, 110:97–101. This article remains the most comprehensive description of congenital HSV infection.PubMedCrossRefGoogle Scholar
  10. 10.
    Chalhub EG, Baenziger J, Feigen RD, et al.: Congenital herpes simplex type II infection with extensive hepatic calcification, bone lesions, and cataracts: complete post-mortem examination. Develop Med Child Neurol 1977, 19:527–534.PubMedCrossRefGoogle Scholar
  11. 11.
    Grose C: Congenital infections caused by varicella zoster virus and herpes simplex virus. Sem Pediatr Neurol 1994, 1:43–49.Google Scholar
  12. 12.
    Whitley RJ, Nahmias AJ, Visintine AM, et al.: The natural history of herpes simplex virus infection of mother and newborn. Pediatrics 1980, 66:489–494.PubMedGoogle Scholar
  13. 13.
    Koskiniemi M, Happonen JM, Jarvenpaa AL, et al.: Neonatal herpes simplex virus infection: A report of 43 patients. Pediatr Infect Dis J 1989, 8:30–35.PubMedCrossRefGoogle Scholar
  14. 14.
    Kimberlin DW: Herpes simplex virus, meningitis encephalitis in the neonate. Herpes 2004, 11(suppl 2):65–76. This review summarizes in detail the current status of diagnosis, therapy, and prevention of neonatal HSV infections.Google Scholar
  15. 15.
    Kimberlin DW, Lakeman FD, Arvin AM, et al.: Application of the polymerase chain reaction to the diagnosis and management of neonatal herpes simplex virus disease. J Infect Dis 1996, 174:1162–1167.PubMedGoogle Scholar
  16. 16.
    Romero JR, Kimberlin DW: Molecular diagnosis of viral infections of the central nervous system. Clin Lab Med 2003, 23:843–865.PubMedCrossRefGoogle Scholar
  17. 17.
    Kimberlin DW, Lin C-Y, Jacobs RF, et al.: Safety and efficacy of high-dose intravenous acyclovir in the management of neonatal herpes simplex virus infections. Pediatrics 2001, 108:230–238. This comprehensive manuscript confirms the value of high dose acyclovir in the management of neonatal HSV infections. High dose therapy (60 mg/kg/day) was associated with reduced morbidity and mortality when compared with the previous regimen of 30 mg/kg/day.PubMedCrossRefGoogle Scholar
  18. 18.
    Brown ZA, Wald A, Morrow RA, et al.: Effect of serologic status and cesarean delivery on transmission rates of herpes simplex virus from mother to infant. JAMA 2003, 289:203–209. This prospective study confirmed that cesarean section reduces the risk of HSV transmission from infected mother to newborn infant. Risk factors for neonatal HSV infection in this study included first episode of infection, HSV isolation from the cervix, HSV isolation at the time of labor, invasive monitoring of the infant, delivery before 38 weeks, and maternal age less than 21 years.PubMedCrossRefGoogle Scholar
  19. 19.
    Whitley RJ, Nahmias AJ, Soong SJ, et al.: Vidarabine therapy of neonatal herpes simplex virus infection. Pediatrics 1980, 66:495–501.PubMedGoogle Scholar
  20. 20.
    Whitley R, Arvin A, Prober C, et al.: A controlled trial comparing vidarabine with acyclovir in neonatal herpes simplex virus infection. N Engl J Med 1991, 324:444–449. The landmark study showing efficacy for acyclovir in infants with neonatal HSV infections.PubMedCrossRefGoogle Scholar
  21. 21.
    Kimberlin DW: Advances in the treatment of neonatal herpes simplex virus infections. Rev Med Virol 2001, 11:157–163.PubMedCrossRefGoogle Scholar
  22. 22.
    Kimberlin DW, Powell D, Gruber W, et al.: Administration of oral acyclovir suppressive therapy after neonatal herpes simplex disease limited to skin, eyes, and mouth: results of a phase I/II trial. Pediatr Infect Dis J 1996, 15:247–254. This NIAID-CASG study reported the effects of oral acyclovir suppressive therapy (300 mg/m2/dose twice or three times daily) for six months in infants with virologically confirmed HSV-2 SEM infections. Nineteen percent of the treated infants had recurrences of skin lesions compared with historical controls in which 46% of untreated infants had skin recurrences. Nearly 50% of the treated infants experienced neutropenia (ANC <1000/μL). One child shed an HSV isolate that was highly resistant to acyclovir after six months of therapy.PubMedCrossRefGoogle Scholar
  23. 23.
    Leung DT, Sacks SL: Current treatment options to prevent perinatal transmission of herpes simplex virus. Expert Opin Pharmacother 2003, 10:1809–1019.CrossRefGoogle Scholar
  24. 24.
    Scott LL, Hollier LM, McIntire D, et al.: Acyclovir suppression to prevent recurrent genital herpes at delivery. Infect Dis Obstet Gynecol 2002, 10:71–77.PubMedCrossRefGoogle Scholar
  25. 25.
    Brown Z: Preventing herpes simplex virus transmission to the neonate. Herpes 2004, 11 (Suppl 3):175A-186A.PubMedGoogle Scholar

Copyright information

© Current Science Inc 2005

Authors and Affiliations

  • James F. Bale
    • 1
  • Lonnie J. Miner
  1. 1.Primary Children’s Medical CenterSalt Lake CityUSA

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