Herpes Simplex Virus Infection ✅ Flashcards
How common is HSV infection in neonates?
2-30/100,000 live births
Why is HSV infection in neonates in important?
It is one of the most serious infections in newborns
What is the risk of HSV infection if the mother has primary infection at delivery?
25-60%
Why is the risk of infection high if the mother has primary infection during delivery?
As the infant is exposed during passage through the infected birth canal, and the infant will not have passively acquired maternal antibody
What is the risk of HSV infection in the neonate in mothers with recurrent HSV infection, or where primary infection has happened well below delivery?
2%
Is there a risk of infection to the neonate when a parent or caregiver has cold sores?
Small risk
What reduces the risk of HSV transmission to the neonate when the parent/caregiver has cold sores?
Careful hand hygiene
What is the problem with prevention of HSV infection in neonates?
In the majority of cases, the mother is a symptomatic or becomes unwell, but the condition is not diagnosed
How can risk of HSV transmission to the neonate be reduced if the maternal infection is known about?
- C-section delivery
- Maternal aciclovir
- Avoidance of invasive obstetric procedures
What invasive obstetric procedures should be avoided when the mother is known to be infected with HSV?
- Mechnically-assisted deliveries
- Fetal scalp electrodes
What can act as a portal of entry for HSV in neonates?
- Skin
- Eyes
- Mouth
What can happen once HSV has entered the body in a neonate?
Can disseminate to the brain and other organs
What are the modes of presentation of HSV infection in the neonate?
- Localised
- Encephalitis
- Systemic
How does localised neonatal HSV present?
Skin manifestations with rash, conjunctivitis, or mouth
When does localised neonatal HSV usually present?
Second week of life
How does localised neonatal HSV present?
With vesicles
What is the prognosis of localised neonatal HSV?
The prognosis is generally good, but neurodevelopmental complications may arise
What is the mortality of HSV encephalitis?
10-15%
When does systemic neonatal HSV present?
10-12 days
How does systemic neonatal HSV present?
- Respiratory failure
- Circulatory collapse
- Shock
- Deranged clotting
What might systemic neonatal HSV be accompanied by?
Encephalitis
What is the prognosis of neonatal systemic HSV?
50% mortality, with high rate of neurodisability amongst survivors
What is the most important thing in the management of neonatal HSV?
Early suspicion and antiviral treatment with IV aciclovir and supportive care
In what % of neonates with systemic HSV or encephalitis are vesicles present?
2/3
What is the problem with vesicles not always being present with systemic HSV or encephalitis?
Often delays diagnosis
How is a diagnosis of neonatal HSV made?
PCR of blood, CSF, or local lesions
Who is at the greatest risk of neonatal HSV?
Infants born by vaginal delivery in mothers with primary HSV infection at the time of delivery
What is required for infants at the highest risk of neonatal HSV?
IV aciclovir
How long do infants at high risk of neonatal HSV need IV antibiotics for?
Until active infection is ruled out
What treatment is required for infants who were born by C-section to mothers with active HSV?
Observation, but no active treatment
What treatment is required for infants born to mothers with recurrent HSV, with or without active lesions?
No active treatment unless infant becomes symptomatic
