Persistence of Herpes Simplex Virus DNA in Cerebrospinal Fluid of Neonates With Herpes Simplex Virus Encephalitis

J Perinatol. 2009 Apr;29(4):290-6. doi: 10.1038/jp.2008.235. Epub 2009 Feb 5.


Objective: The significance of detecting herpes simplex virus (HSV) DNA in the cerebrospinal fluid (CSF) of infants with HSV encephalitis after receipt of prolonged therapy with high-dose (60 mg kg(-1) day(-1)) acyclovir is unknown. We report the clinical and laboratory characteristics, neuroimaging studies and outcomes of four neonates with HSV encephalitis who had persistence of CSF HSV DNA, by polymerase chain reaction (PCR) after 15 to 21 days of high-dose acyclovir therapy.

Study design: Retrospective chart review.

Results: All four infants had abnormal neuroimaging studies and subsequently experienced severe developmental delay or death.

Conclusion: A persistently positive CSF HSV PCR in neonates may be another risk factor for worse neurodevelopmental outcome. Prospective studies are needed to document how often HSV DNA persists in CSF, elucidate whether it represents an initially high CSF viral load, ongoing viral replication or viral resistance, and determine its possible association with neurodevelopmental impairment.

Publication types

  • Case Reports

MeSH terms

  • Acyclovir / administration & dosage*
  • Adult
  • Antiviral Agents / administration & dosage*
  • Atrophy
  • Brain / pathology
  • Brain Damage, Chronic / cerebrospinal fluid
  • Brain Damage, Chronic / diagnosis
  • Brain Damage, Chronic / drug therapy
  • Brain Damage, Chronic / virology
  • DNA, Viral / cerebrospinal fluid*
  • Dose-Response Relationship, Drug
  • Drug Administration Schedule
  • Encephalitis, Herpes Simplex / cerebrospinal fluid*
  • Encephalitis, Herpes Simplex / drug therapy
  • Encephalitis, Herpes Simplex / virology*
  • Encephalomalacia / cerebrospinal fluid
  • Encephalomalacia / diagnosis
  • Encephalomalacia / drug therapy
  • Encephalomalacia / virology
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Magnetic Resonance Imaging
  • Male
  • Polymerase Chain Reaction*
  • Pregnancy
  • Prognosis
  • Retrospective Studies
  • Simplexvirus / drug effects
  • Simplexvirus / genetics*
  • Tomography, X-Ray Computed
  • Viral Load


  • Antiviral Agents
  • DNA, Viral
  • Acyclovir