1、THE FIRST AFFLIATED HOSPITAL OF GUANGXI MEDICAL UNIVERSITYDEPARTMENT OF PEDIATRICS NICUDiscovery of neonatal Herpes Simplex virus (HSV) in the 1930sNeonatal infection with HSV occurs in 1/3200 to 1/10,000 live birthsIn China，2/10,000 to 5/10,000VIROLOGY HSV is a DNA virus HSV-I, HSV-II HSV-II associ
2、ated with poorer outcomeTRANSMISSIONHSV enters human host through inoculation of oral, genital, or conjunctival mucosa or break in skin1.Intrauterine2. Perinatal3. Postnatal-Maternal viremia-Ascending infection-Usually after prolonged rupture of membranesIntrauterine 2. Perinatal-HSV infection is pr
3、esent in the genital tract of pregnant woman at time of delivery-Most common mode (85%) of neonatal HSV infection3. Postnatal-When active HSV infection has close contact with the newbornintrauterine CLINICAL MANIFESTATIONS-Skin, Eye, Mouth-Central Nervous System-Disseminated Disease 90% present betw
4、een 5-19 days of age 20% NEVER have skin lesionsInitial symptoms vague in 30%LethargyPoor feedingFeverIrritabilityskin-Usually presents in the first two weeks of life-clustering vesicular lesions with an erythematous base Eyes-1.Excessive watering of the eye2.Crying from apparent eye pain3.Conjuncti
5、val erythema4.Periorbital skin vesicles5.Can progress to cataracts and chorioretinitis permanent vision lossMouth-Localized ulcerative lesions of the mouth, palate, and tongueCNS Disease1/3 of neonatal HSV disease involves the CNSPresents in second-third week of life IrritabilityTremorsPoor feeding
6、of HSV disease is in the disseminated formPresent in the first week of lifeAffects: liver, lungs, adrenals, CNS, skin, eyes, and mouth,DICDisseminated DiseaseDiagnosis of Neonatal HSV InfectionGold standard = Positive culture of: lesion, nasopharynx, conjunctiva, rectum, or CSF Rapid diagnostic meth
7、odsPolymerase chain reaction on CSF and bloodFluorescent antibody stain on vesicle scrapingEEGBrain ImagingChest RadiographMay demonstrate bilateral, diffuse pneumoniaAbdominal USMay demonstrate ascites and/or enlarged liver in neonates with HSV hepatitis and acute liver failure60mg/kg/day divided q
8、8h for 14 daysMay be lengthened to 21 days in the near futureDissiminated and CNS HSV infections60mg/kg/day divided q8h for 21 days referencesNeonatal Herpes Simplex Virus Infection: Clinical Features and Diagnosis. UptoDate. Demmier-Harrison, Gail MDNeonatal Herpes Simplex Virus Infection: Management and Prevention. UptoDate. Demmier-Harrison, Gail MDNeonatal Herpes Simplex Virus Infections. American Family Physician. Rudnick, Caroline MD, Hoekzema, Grant MD. 03/15/2002, 1138-1142
