新生儿单纯疱疹病毒感染的研究进展

新生儿单纯疱疹病毒(HSV)感染病死率高，预后差，对新生儿有极大危害性。本篇综述主要介绍新生儿HSV感染的流行病学及影响因素，特别是母亲HSV感染对新生儿的影响及新生儿HSV感染的患病率、临床表现、干预措施等方面的研究进展。     

新生儿中枢神经系统单纯疱疹病毒感染的临床横断面研究

目的通过分子生物学方法了解新生儿中枢神经系统单纯疱疹病毒(HSV)感染情况,并对其临床特点进行分析。方法收集考虑中枢神经系统病毒感染新生儿40例的脑脊液(CSF)标本,通过套式PCR检测CSF中HSV-DNA及酶联免疫吸附法检测CSF中特异性HSV-IgM抗体。结果2例患儿检测CSF中HSV-1 DNA( ),其母亲妊娠期均体健,无生殖器疱疹史,无皮损;1例提示为播散性感染,另1例局限为中枢神经系统感染。40例CSF检测HSV-2 DNA均阴性。结论HSV感染占新生儿中枢神经系统病毒感染的5%,不是常见病原;1型可能为新生儿HSV中枢感染的常见类型,可能与我国孕母HSV-2血清感染率较低有关。     

新生儿单纯疱疹病毒感染1例

患儿男,２天,Ｇ１Ｐ１,足月剖宫产,无窒息史,无早破膜史,其母妊娠晚期心律不齐,出现频发的室性早搏。患儿出生后１５ｈ出现咽及上腭充血、发热,诊断上“上感”用青霉素,潘生丁治疗２天无效。体温３８℃一３９Ｃ,口吐白沫,气促,双肺呼吸音粗,胸片示：间质性肺炎,改用先锋需素Ⅵ、干扰素治疗,于发病第七日开始出现出血倾向,面部、上唇、牙龈有２ｍｍ大小的数个疱疹,无脓液。肝脏进行性增大,肋下３．５ｃｍ,剑下３．５ｃｍ,质中等。脾未扪及。血培养为腐生葡萄球菌生长,ＷＢＣ１２．８×１０~９／Ｌ,中性分叶１０％、杆…     

单纯疱疹病毒感染新生儿血液微量元素的变化

目的 探讨单纯疱疹病毒感染的新生儿血液中微量元素含量的变化.方法 采用电感耦合等离子体原子发射光谱ICP-AES法测定单纯疱疹病毒感染的新生儿与健康新生儿血液中微量元素的含量.结果 单纯疱疹病毒感染组血清锌、镁、铁、钙均低于正常,全血铅、血清铜均高于正常.结论 单纯疱疹病毒感染时,新生儿血液微量元素存在一定的失衡,与感染所造成的机体伤害有一定的关系,因此需要及时补充和调理微量元素,对疾病的治疗和恢复有重要意义.     

新生儿单纯疱疹病毒感染2例报告

新生儿单纯疱疹病毒感染的脑炎型及播散型预后差,病死率高,临床少见,目前国内报道较少。 临床资料 例1.患儿男,12天,因拒乳、吐沫11天,胸部及双上肢出现水疱样皮疹2天而入院,母孕38周正常分娩,无早破膜史,生后轻度     

新生儿全身播散型单纯疱疹病毒感染1例报告

新生儿单纯疱疹病毒(HSV)感染可以分为眼皮肤口腔型、脑型和全身播散型；新生儿单纯疱疹病毒感染的病死率很高，其中以全身播散型最高。现将我院收治的1例全身播散型病例报告如下。     

小儿中枢神经系统单纯疱疹病毒感染的临床横断面研究

目的了解小儿中枢神经系统单纯疱疹病毒(HSV)感染的患病情况,并对其临床特点进行分析。方法收集2001年6月~2002年6月住院的中枢神经系统病毒感染患儿150例的脑脊液(cerebrospinal fluid,CSF)标本,应用套式PCR检测脑脊液中HSV-DNA及酶联免疫吸附法检测脑脊液中特异性HSV-IgM抗体。结果6例患儿脑脊液中HSV1-DNA( ),另1例HSV1-IgM( ),单纯疱疹病毒占中枢神经系统病毒感染的4.67%;呈散发性起病,无明显季节、年龄、性别分布特点,与其他病毒感染相比,惊厥持续状态、精神症状发生率高(P<0.01),意识障碍、病死率差异无显著性。结论①单纯疱疹病毒感染占儿童中枢神经系统感染的4.67%,不是儿童病毒性脑炎的常见病原,呈散发性起病,无明显季节、性别、年龄分布特点;②儿童中枢神经系统单纯疱疹病毒感染多为HSV1的原发感染,可导致脑炎、脑干脑炎、急性播散性脊髓膜炎;③单纯疱疹病毒脑炎(herpes si mplexvirus encephalitis,HSE)起病较危重,出现精神症状较多,及时有效的抗病毒治疗能明显改善病情,降低病死率。     

先天性无症状Ⅱ型单纯疱疹病毒感染患儿近期预后观察

为观察先天性无症状Ⅱ型单纯疱疹病感染患儿近期生长发育情况，对12例感染婴儿及12例对照婴儿为期1年的跟踪随访，检查内容包括体格测量，Bayley婴幼儿发育量表，头颅B超和脑干听觉诱发电位（BAEP）等，结果显示感染组婴儿体格发育与对照组相比，差异无显著性意义，但智能发育的差异有显著性意义（P＜0．05），感染组3个月时的头颅B超异常率高于对照组，差异有显著性意义（P＝0．034），12个月时的头颅B超异常率虽高于对照组，但差异无显著性意义，感染组BAEP的异常率高于对照组，差异有显著性意义（P＝0．023），提示先天性II期单弛疱疹病毒感染对新生儿及婴儿的神经系统发育可能造成一定的不良影响，应普及孕妇HSV－II感染的筛查，对感染者及早予抗病毒治疗。     

儿童单纯疱疹病毒感染血清学检查分析

目的：单纯疱疹病毒(HSV)感染是小儿时期常见的病毒感染,也是病毒性脑炎的常见病因,血清学检查是诊断HSV感染常用的检测方法。该文探讨儿童HSV感染的血清抗体检查的意义。方法：采用ELISA方法检测2436例儿童血清中HSV-1和HSV-2的IgG和IgM抗体,并作回顾性分析。结果：儿童单纯疱疹病毒血清抗体阳性率为44.6%(143/321),其中HSV-1抗体阳性率38.9%(117/301),HSV-2抗体阳性率15.9%(43/271);IgM阳性率为41.1%(132/321),IgG阳性率为25.5%(73/286);HSV-1血清阳性率随年龄而增加(P<0.01)。TORCH检测组HSV-2抗体血清阳性率1.9%,均为HSV-2IgG阳性。结论：HSV血清学检查对儿童HSV感染具有重要的诊断意义。     

Relapse of neonatal herpes simplex virus infection

BACKGROUND: Neonatal herpes simplex virus (HSV) infection is a severe disease with high mortality and morbidity. Recurrence of skin vesicles is common. OBJECTIVE: To determine the features of relapse and identify the factors related to relapse. DESIGN: Thirty two surviving patients with neonatal herpes virus infections were enrolled. All patients received acyclovir treatment. Clinical and virological data were analysed and compared between relapsed and non-relapsed cases. RESULTS: Thirteen (41%) had either local skin or central nervous system relapse between 4 and 63 days after completing the initial antiviral treatment. Nine patients exhibited local skin relapses, and four developed central nervous system relapses. In one skin and two central nervous system relapse cases, neurological impairment later developed. Type 2 virus infection was significantly related to relapse (odds ratio 10.4, 95% confidence interval 1.1 to 99.0). Patients with relapse had worse outcomes than those without relapse. CONCLUSION: Neonates with HSV type 2 infections have a greater risk of relapse. Relapsed patients have poorer prognoses.     

Disseminated neonatal herpes simplex virus infection acquired from the father

A disseminated herpes virus type 1 infection in a baby was acquired from the father, who had herpes labialis. This was shown by virus strain typing using restriction endo-nuclease DNA analysis. Labial herpes, a common infection in adults, must be recognised as a potential threat to newborn babies.Abbreviations HSV herpes simplex virus - CSF cerebrospinal fluid - IFA immunofluorescent assay     

Intrauterine herpes simplex virus infection

BACKGROUND: Early fetal herpes simplex virus (HSV) infection is rarely documented. Only the minority of affected fetuses survive this condition. PATIENT AND METHODS: At 19 weeks of gestation the first episode of a genital HSV-infection of a pregnant woman was treated with local interferon beta. At 34 weeks of gestation hydrocephalus with secondary microcephaly and microphthalmia of both eyes was detected by ultrasonography. In the amniotic fluid HSV type 2 (HSV-2) was isolated and HSV-2-DNA was detected by PCR. The serum of the mother proved positive for HSV-2 (glycoprotein G2)-specific IgG-antibodies. No other infectious causes were apparent on further testing. At 35 + 4 weeks gestation a small-for-gestational-age neonate (2130 g) with microcephaly (29 cm head circumference) was born by spontaneous vaginal delivery. Scarce ulcerative skin lesions and vesicles, hepatosplenomegaly and microphthalmia were diagnosed. Furthermore, encephalomalacia with parenchymal destruction, cataract of both eyes and aplasia of the maculae and papillae were found. HSV-2-PCR was tested positive in chorionic cells and an umbilical segment of the placenta as well as in swabs from both eyes, throat, and a herpetic skin lesion collected during the first 5 days of life. HSV-IgM-antibodies were found in the umbilical cord blood. Local and intravenous treatment with aciclovir was started. The infant exhibited signs of a severely malfunctioning central nervous system. At the age of 4 months the boy suffered from generalised cerebral seizures. He died at the age of 9 months as a consequence of respiratory insufficiency with consecutive circulation failure. RESULTS: The case of an intrauterine HSV-2-infection is presented. The time of onset of fetal infection was most probably at the time of the maternal disease (19 weeks of gestation). Inspite of the very early infection the fetus did not die in utero. CONCLUSIONS: Especially, if a primary genital HSV-2-infection of a pregnant woman is suspected, which can be proven by serological means only several weeks after infection, systemic therapy of the mother with aciclovir should be considered since materno-fetal transmission may occur due to the risk of maternal viraemia.     

Neonatal herpes simplex virus infection

Herpes simplex virus (HSV) infection in the neonate is a rare event with severe consequences for the child even if adequately treated with antiviral drugs. Mothers with primary genital herpes infections late in pregnancy or at delivery have a high risk of transferring the infection to the child, while the risk of transfer in mothers with recurrent genital infections is only a few percent. Neonatal herpes localized in skin-eye-mouth has no mortality and morbidity after antiviral treatment. In neonatal disseminated and central nervous system disease, early treatment is a predictor for better outcome. The morbidity in survivors is high; after herpes encephalitis, only one-third of children have normal development. While awaiting vaccines or reliable predictors for prevention of neonatal herpes, clinical awareness of primary maternal herpes during pregnancy and recommendations for prophylactic treatment are important tools. For pediatricians the differential diagnosis of a child aged two to four weeks with seizures, neonatal herpes encephalitis must be considered and either excluded or treated. Neurological follow-up and training programs to minimize the consequences of a disability are important clinical aspects.     

Progressive calcifications of lung and liver in neonatal herpes simplex virus infection

We report a female neonate who developed severe septicemia presenting with pneumonia and hepatitis due to an infection with herpes simplex virus type II. In spite of antiviral as well as intensive care therapy, three weeks after admission, extensive hepatic calcification was demonstrable on abdominal radiograph, a sign of severe cellular necrosis. In contrast the pulmonary infiltration recovered completely. The clinical follow up was completed by ultrasound and radiography. The infant died at the age of two months secondary to severe postnecrotic hepatic failure. At autopsy, histological evaluation confirmed the former diagnostic and technical findings; in addition, pulmonary calcifications were detected morphologically which had not been seen on the chest radiograph. The significance of progressive organ calcifications for the prognosis of recovery has been discussed.     

Three cases of neonatal herpes simplex virus infection presenting as fulminant hepatitis

We report three cases of neonatal herpes simplex virus (HSV) infection presenting as fulminant hepatitis. None of the patients had clear risk factors for HSV infection and they all died. Antiviral treatment for HSV is currently available but must be administered early in the course of the disease before irreversible liver tissue damage is present. Since the diagnosis may be difficult to establish, we wish to draw the attention of clinicians to the presentation of neonatal HSV infection and suggest that in such cases viral cultures, including culture of liver tissue, should be obtained early and antiviral treatment administered while awaiting the culture results.