Congenital Herpes Simplex

Excerpt

Herpes simplex virus (HSV) infection in newborn infants can present with the following manifestations:

1. Disseminated disease involving multiple organs, most prominently liver and lungs (25%)

2. Localized central nervous system (CNS) disease, with or without skin involvement (30%)

3. Disease limited to the skin, eyes, and/or mouth (SEM disease) (45%)

More than 80% of neonates with SEM disease have skin vesicles. Those patients without skin vesicles have infection limited to the eyes and/or oral mucosa. Approximately two-thirds of neonates with disseminated or CNS disease have skin lesions, but other symptoms may be present before these lesions can be seen. When skin lesions are not present, it can be challenging to diagnose neonatal HSV infection. Disseminated infection is a consideration when neonates present with sepsis syndrome, negative bacteriologic culture results, severe liver dysfunction, or consumptive coagulopathy in the first 30 days. HSV may be the causative agent in neonates who present with a fever, a vesicular rash, or abnormal cerebrospinal fluid (CSF) findings. This probability increases when the infant also has a history of seizures or presents at times when enteroviruses are not reported in the community. Asymptomatic HSV infection is common in older children but rare in neonates.

Initial signs of HSV infection can occur anytime between birth and approximately 6 weeks of age, although almost all infected infants develop clinical disease within the first month of life. Infants with disseminated disease and SEM disease have an earlier age of onset, typically presenting between the first and second weeks of life. Infants with CNS disease usually present with illness between the second and third weeks of life.