Viremia in neonatal herpes simplex virus infections.

BACKGROUND: Polymerase chain reaction assays of the peripheral blood mononuclear cells (PBMC) and plasma may facilitate the diagnosis of neonatal herpes simplex virus (HSV). METHODS: Assays for HSV DNA were submitted from at least 1 specimen site (PBMC, plasma or cerebrospinal fluid) in 11 consecutive cases of neonatal HSV infection. RESULTS: HSV DNA was detected by PCR in the PBMC of 6 of 10 infants tested (60%), the plasma of 4 of 6 tested (67%) and the cerebrospinal fluid of 4 of 11 tested (36%). CONCLUSIONS: HSV viremia is more frequent than previously appreciated, and detection of HSV DNA in PBMC and plasma is a useful diagnostic tool, particularly in infants without skin lesions.     

Prevention and management of neonatal herpes simplex virus infections

Human herpes simplex virus (HSV) infection in neonates can result in devastating outcomes, including mortality and significant morbidity. All infants are potentially at risk for neonatal HSV infection. This position statement reviews epidemiology, transmission and risk factors, with a focus on intrapartum infection. It considers diagnosis and prognosis according to infection category, along with testing modalities and limitations. Recommendations for managing newborns known to have been exposed intrapartum to HSV are based on expert opinion because a randomized trial to compare management options is not feasible. Guidance is provided for the empirical management of infants with suspected clinical sepsis, including those who do not respond to antibacterial therapy. The present statement replaces a 2006 position statement by the Canadian Paediatric Society.     

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.     

Management of Neonatal herpes simplex virus infections

As many as 2,500 infants develop neonatal herpes each year, most of whom are born to women with no history or physical findings suggestive of genital herpes. Infection usually takes one of three forms: 1) disease localized to skin, eyes, and mucous membranes, 2) localized central nervous system infection, or 3) disseminated infection. Exposure to the virus occurs during passage through an infected birth canal, but 5% of infants acquire the infectionin utero. The mortality rate is 31% for disseminated infection and 6% for localized central nervous system disease; long-term neurologic sequelae are seen in 17% and 70% of survivors, respectively. Diagnosis is made by isolating of the virus from skin lesions or other involved sites. The polymerase chain reaction for the detection of viral DNA in cerebrospinal fluid or serum is now the diagnostic test of choice for central nervous system or disseminated neonatal herpes because it has higher sensitivity than traditional culture methods. Treatment is with high-dose intravenous acyclovir (60 mg/kg per day in three divided doses), with adjustments made for infants with renal or hepatic insufficiency. Supportive measures and neuroimaging studies are often required. Acyclovir is administered for three weeks, but infants with disease localized to the skin, eyes, and mucous membranes can be treated for two weeks if the cerebrospinal fluid polymerase chain reaction assay is negative for herpes simplex virus DNA. Prevention of infection in infants can be accomplished by cesarean delivery when women have active lesions at the onset of labor. Neonates delivered through an infected birth canal should be screened between 24 and 48 hours of age with viral cultures of eyes, nasopharynx, mouth, and rectum. If positive, they should be treated with acyclovir even if asymptomatic. Suppressive acyclovir therapy beginning at 36 weeks gestation is often prescribed for women with frequent recurrences of genital herpes.     

Multicystic cerebral degeneration in neonatal herpes simplex virus encephalitis.

Typical herpetic papulovesicular skin lesions developed in an apparently normal infant at 12 days of age and were followed within 48 hours by signs and symptoms of acute encephalitis. Herpes simplex virus type 2 was cultured from the intact skin vesicles, and a fourfold increase in complement fixation titer to herpes simplex virus type 2 was found over the ensuing 24 days. The infant survived her acute illness, but was left with severe neurologic sequelae manifested as microcephaly with multicystic cerebral degeneration. The short-term and convalescent course is documented by serial, clinical, and EEG examinations, and the nature of the cerebral damage is demonstrated by computerized transaxial tomography.     

Use of aciclovir in herpes simplex virus infections

Herpes simplex virus type 1 and type 2 cause a wide range of illnesses ranging from minor cold sores to severe necrotising encephalitis or disseminated systemic infections seen in immunocompromised patients including neonates. Following primary infection, the virus is not eradicated from the body but is latent in sensory nerve ganglia where it can reactivate and cause recurrent disease. Aciclovir is the most studied and used antiviral agent with activity against herpes simplex virus infections. In most situations the use of aciclovir shortens the duration of clinical illness and viral shedding and reduces morbidity and mortality. All life- or sight-threatening infections should be managed in an inpatient hospital setting with intravenous therapy. The use of oral aciclovir is recommended in patients with non-life-threatening illness who may still have significant symptoms.     

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。     

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     

Computed tomography in young children with herpes simplex virus encephalitis

Computed tomographic (CT) scans were obtained from eight infants and young children with herpes simplex virus encephalitis. In two cases the initial scan showed diffuse edematous changes as a mass effect without laterality. Unilateral localized low attenuation in the initial scan was evident 4 days after the onset in one patient, and high attenuation in the initial scan appeared on the 6th day in another patient, but in general, it was not possible to establish an early diagnosis of herpes simplex virus encephalitis from CT scan. In the longitudinal study the calcification with ventriculomegaly appeared in 3 of 5 survivors, and gyriform calcification in 2 of 3 patients, respectively. The appearance of multicystic encephalomalacia was evident in one patient 6 months after the onset of neonatal herpes simplex encephalitis. It is shown that the CT findings of neonates and young children with herpes simplex encephalitis are different from those of older children and adults, and the importance of longitudinal CT studies was stressed in clarifying the pathophysiology of the central nervous system involvement in survivors.     

Herpes simplex virus infections of the central nervous system

Herpes simplex virus (HSV) infections of the central nervous system (CNS) can occur within weeks after birth (neonatal HSV disease) or in childhood or adulthood [herpes simplex encephalitis (HSE)]. Most cases of neonatal HSV disease are caused by HSV type 2, whereas virtually all cases of HSE are caused by HSV type 1. Diagnostic advances made during the past decade include the application of polymerase chain reaction (PCR) technology to cerebrospinal fluid from patients with suspected HSV CNS disease to evaluate for the presence of HSV DNA. Although not foolproof, PCR is a powerful diagnostic tool that has supplanted brain biopsy as the modality of choice for diagnosing HSV CNS disease, in no small part because of the invasiveness of brain biopsy. PCR also can provide information regarding the therapeutic response to antiviral therapy. Efforts made during the past decade to improve the outcome of HSV CNS disease have focused on increased doses of intravenous acyclovir administered for longer durations of time. Although advances have been achieved, morbidity and mortality rates from neonatal HSV disease and HSE remain unacceptably high.     

儿童单纯疱疹病毒性脑炎22例临床特征和随访研究

目的 分析儿童单纯疱疹病毒性脑炎（HSE）的临床特征,探讨其诊断依据及影响预后的因素。方法 对22例经脑脊液病毒病原学确诊的HSE患儿的临床特征进行分析,并对治疗效果进行观察和随访。结果 发热22例（100％）,意识障碍18例（81％）,其中昏迷12例[采用Glasgow Coma Scale(GCS)评分、GCS≤4分3例、5－7分5例、8－9分4例],嗜睡6例。惊厥16例（72％）,呕吐13例（59％）,头痛10例（45％）,精神症状8例（36％）。合并颅神经麻痹10例（45％）,肢体瘫痪7例（31％）。应用酶联免疫吸附方法测定脑脊液（CSF）HSV－IgM阳性者13例、特异性IgG抗体局部产生指数：血清／CSF比值≤20者7例、双份CSF标本恢复期特异性HSV－IgG4倍以上升高者4例;或采用聚合酶链反应（PCR)技术测定脑脊液HSV－DNA阳性者3例。头颅CT和（或）MRI提示异常者19例,病变部位以额、颞叶为主12例,7例伴颅内出血。对15例患儿进行6个月－6年的随访,完全恢复5例,轻度残疾3例,中度残疾2例,合并癫Xian者7例。结论 HSE临床可分轻重两型,早期意识障碍及精神症状是本病特征。脑脊液病毒学检测阳性为确诊依据。起始治疗时的病程、意识状态、及脑内病变程度是影响预后的重要因素。     

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目的分析儿童单纯疱疹病毒性脑炎(HSE)临床特征和预后,探讨HSE早期诊断的重要性。方法分析2005年1月至2010年5月复旦大学附属儿科医院神经科住院的20例HSE患儿,均经脑脊液(CSF)病毒病原学确诊,观察治疗效果及预后。结果 20例患儿中发热20例(100%)、意识障碍16例(80%)、抽搐19例(95%)、精神行为异常4例(20%)、肢体偏瘫7例(35%)。CSF常规或生化异常14例(70%),其中红细胞增多9例(64%)、CSF糖<2.2mmol/L3例(21%)。头颅影像学检查19例异常(95%),颅内出血11例(58%),其中合并丘脑出血5例(45%);中脑梗塞1例(5%)。对12例进行6个月至5年的随访,完全康复1例、智力运动发育迟缓生活不能自理5例、智力发育迟缓3例、肢体运动障碍3例、合并癫痫7例。结论 HSE起病急,多为重症病情,但儿童患者临床特征可不典型。应进行细致临床观察,尽早行神经影像学检查,积极查找病原学,早期正规给予抗病毒治疗是早期诊断、改善预后的关键。     

Clinical and laboratory features of neonatal herpes simplex virus infection: a case-control study

BACKGROUND: Neonatal herpes simplex virus (HSV) infection can cause significant morbidity and mortality but can be difficult to identify, particularly in neonates without vesicular rash. OBJECTIVE: To determine the unique clinical and laboratory features of neonates with and without HSV infection admitted to Texas Children's Hospital during a 14-year period. METHODS: An historic case-control study of all hospitalized neonates with laboratory-confirmed HSV infection and a restricted sample (ratio 1:4) of HSV test-negative hospitalized neonates. Univariate and multivariate analyses were performed to identify clinical and laboratory factors associated with neonatal HSV infection. RESULTS: Forty cases and 160 comparison subjects were identified. The following factors were associated with neonatal HSV infection by univariate analysis: maternal primary HSV infection, maternal fever, vaginal delivery, prematurity, postnatal HSV contact, vesicular rash, hypothermia, lethargy, seizures, severe respiratory distress, hepatosplenomegaly, thrombocytopenia, elevated hepatic enzymes, and cerebrospinal fluid (CSF) pleocyosis and proteinosis. Factors not associated with neonatal HSV infection were fever, total peripheral white blood cell count, and red blood cells in the CSF. For neonates presenting without vesicular rash, maternal fever, respiratory distress requiring mechanical ventilation, and CSF pleocytosis were independently associated with HSV infection. CONCLUSIONS: Inclusion of the newly appreciated features of maternal fever, respiratory distress, and thrombocytopenia might improve the detection of neonatal HSV infection. Clinical and laboratory factors typically associated with neonatal HSV infection were confirmed to be maternal primary HSV infection, vaginal delivery, prematurity, neonatal seizures, vesicular rash, elevated hepatic enzymes, and CSF pleocytosis.     

新生儿播散型单纯疱疹病毒感染继发暂时性免疫功能下降一例

患儿男,出生后29 d,面、颈、四肢皮疹5 d.2007年10月6日,以"多形红斑?病毒疹?"收住院.家长诉患儿于入院前5 d出现面部红疹、水疱,皮疹进行性增多,发至四肢并以肢端部位为重,无嗜睡、惊厥发作,无呼吸急促、呕吐及腹泻等症状.曾于外院诊断"水痘?手足口病?脓疱疮?",百多邦外擦局部治疗无好转.