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    K28 B Congenital HSV KBK

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    La Lydia Tampubolon
    This document discusses congenital and neonatal herpes simplex virus infections. It begins by describing the different types of herpes viruses and neonatal HSV infection, which can present as skin/eye/mouth disease, CNS disease, or disseminated disease. The document then covers the routes of transmission from mother to infant, which is primarily during birth through an infected maternal genital tract. It also discusses diagnostic testing and treatment with acyclovir for the different presentations of neonatal HSV infection. Key points are that most infections occur from mothers who are asymptomatic at delivery, no single test confirms HSV, and keeping it in mind clinically is important.

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    © All Rights Reserved
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    K28 B Congenital HSV KBK

    Uploaded by

    La Lydia Tampubolon
    36 views25 pages
    This document discusses congenital and neonatal herpes simplex virus infections. It begins by describing the different types of herpes viruses and neonatal HSV infection, which can present as skin/eye/mouth disease, CNS disease, or disseminated disease. The document then covers the routes of transmission from mother to infant, which is primarily during birth through an infected maternal genital tract. It also discusses diagnostic testing and treatment with acyclovir for the different presentations of neonatal HSV infection. Key points are that most infections occur from mothers who are asymptomatic at delivery, no single test confirms HSV, and keeping it in mind clinically is important.

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    K28 b Congenital HSV kbk.ppt

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    This document discusses congenital and neonatal herpes simplex virus infections. It begins by describing the different types of herpes viruses and neonatal HSV infection, which can present as skin/eye/mouth disease, CNS disease, or disseminated disease. The document then covers the routes of transmission from mother to infant, which is primarily during birth through an infected maternal genital tract. It also discusses diagnostic testing and treatment with acyclovir for the different presentations of neonatal HSV infection. Key points are that most infections occur from mothers who are asymptomatic at delivery, no single test confirms HSV, and keeping it in mind clinically is important.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    36 views25 pages

    K28 B Congenital HSV KBK

    Uploaded by

    La Lydia Tampubolon
    This document discusses congenital and neonatal herpes simplex virus infections. It begins by describing the different types of herpes viruses and neonatal HSV infection, which can present as skin/eye/mouth disease, CNS disease, or disseminated disease. The document then covers the routes of transmission from mother to infant, which is primarily during birth through an infected maternal genital tract. It also discusses diagnostic testing and treatment with acyclovir for the different presentations of neonatal HSV infection. Key points are that most infections occur from mothers who are asymptomatic at delivery, no single test confirms HSV, and keeping it in mind clinically is important.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 25

    Congenital/Neonatal

    Herpes Simplex Infections


    Infectious and Tropical Pediatric
    Division
    Department of Child Health
    Medical Faculty
    University of Sumatera Utara

    Herpes Infections
    Herpes from the
    Greek to creep,
    crawl
    Herpetic
    eruptions
    described as early
    as 100 AD
    1960s HSV1 and
    HSV2 differentiated

    HHV1
    HHV2
    HHV3
    HHV4
    HHV5
    HHV6
    HHV7
    HHV8

    HSV1
    HSV2
    VZV
    EBV
    CMV
    Causes?

    Neonatal HSV
    1 in 2,500-5,000 deliveries / 500-1500 per yr.
    Birth to 7 weeks of life
    HSV2 = 70-75%, HSV1 = 25-30%
    3 Main Types
    Skin, Eye, Mouth (SEM)
    CNS
    Disseminated Disease (DISSEM)

    At Risk: Premature, ROM >6hr, Fetal scalp


    monitoring
    Can be acquired congenitally, during the
    birth process, and in the post-partum period

    Routes of Transmission
    85% via infected
    maternal genital
    tract
    Ascending
    infection?
    En route

    10% postpartum
    5% (or less)
    intrauterine/conge
    nital infection

    Congenital HSV
    Rare, most
    devastating
    Only 50 cases
    described
    Skin vesicles
    Chorioretinitis
    Microcephaly
    Micro-ophthalmia
    IUGR

    Archival Photo:
    HSV In Utero
    Healed by Time
    Of Birth With
    Microcephally

    Skin, Eye, Mouth (SEM)


    Approximately of
    all HSV infections
    1st-2nd week
    presentation
    Limited to skin, eye,
    mouth/mucous
    membranes
    60-70% of untreated
    patients progress to
    CNS/disseminated
    disease

    Groin Vesicles
    16 Days of Life
    HSV-1, This Infant
    Had a Cardiac Cath
    (Groin Line)
    At 3 Days of Life

    SEM (cont)
    Long term
    neurologic
    sequelae seen in
    30% of cases
    even if treated
    Ophthalmology
    involvement

    Presenting Part (SEM)

    HSV 2 Arm Lesions


    9 Days of Life
    Presenting Limb in a 34 Week
    Premature Infant

    HSV - CNS Disease


    Encephalitis without
    visceral involvement,
    mainly involving the
    temporal lobes
    Early to 3rd week of
    life presentation
    Skin lesions may
    appear late, if at all
    35% of all cases,
    only 2-5% untreated
    survive normally

    HSV 2, Necrotic Brain

    Radiographic Findings

    Disseminated Disease
    Approximately 20%
    of all infections
    Hepatitis
    Pneumonitis
    DIC

    Infant may be ill on


    first day of life
    Skin lesions appear
    late, or not at all

    Signs

    Postnatal acquisition
    Most commonly
    HSV1
    Moms with HSV
    Mask
    Breastfeeding
    O.K. if without
    lesions

    Contacts
    Personnel with
    an active herpetic
    whitlow should
    not have direct
    patient care of
    neonates.
    Family
    transmission has
    been described

    Morbidity and Mortality

    Take Home Message


    Infection is most common when a
    mother develops a genital infection
    late in pregnancy ( her primary
    HSV1 or HSV2 infection) then
    delivers before the development of
    protective maternal antibodies

    Herpes Simplex
    Approximately 5% of the general
    population has been diagnosed
    with genital herpes but
    approximately 20-30% of women
    may be infected with HSV-2
    Viral shedding occurs without
    identifiable lesions on 1-3% of days

    Herpes during Pregnancy


    As many as 2% of pregnant women are
    infected with HSV2 during pregnancy
    25% of women with a history of genital
    herpes have an outbreak at some time
    during their pregnancy, 11-14% at time
    of delivery
    36% at delivery for those with first infection!
    Virus is recovered from 1% of asymptomatic
    women at delivery

    What is the risk?


    Vaginal delivery when mom has presence
    of first symptomatic lesions 50%
    Vaginal delivery when mom is
    asymptomatic, but is newly infected 33%
    Vaginal delivery when mom has recurrent
    lesions 4%
    Vaginal delivery when mom has a history
    of herpes lesions in past, none presently
    0.04%

    OB Management
    70s-80s weekly HSV cultures
    1988 patient examined at delivery,
    Cesarean delivery if: (no data)
    Identifiable genital lesions
    Patient describes prodromal symptoms

    Vaginal delivery for those with hx only


    Primary infection diagnosed - treat
    Estimated $2-4 million to prevent each case
    20-30% of infants who are diagnosed with
    neonatal herpes are delivered by Cesarean
    delivery

    Diagnostics
    HSV Cx positive
    in 1-2 days
    (cytopathic effect)
    DFA
    sensitivity/specific
    ity in the 75%85% range

    PCR Testing
    Detects minute
    amounts of DNA,
    RNA
    DISSEM 93%
    CNS 76%
    SEM 24%

    False negative may


    occur if CSF is
    obtained too early
    Order through IVF!

    Diagnostics (cont)
    Surface cultures
    Mouth (40-50%)
    Eyes (25%)
    Rectum
    Skin

    Cultures
    Stool
    Urine
    CSF >100 WBC/Inc. Pro

    Tzanck neither
    sensitive nor specific

    Treatment - Acyclovir
    SEM infections
    60mg/kg/day divided q8h for 14 days
    May be lengthened to 21 days in the near
    future
    Oral Acyclovir needed later in life?

    DISSEM and CNS HSV infections


    60mg/kg/day divided q8h for 21 days
    Re-tap if CNS disease exists prior to d/c

    Watch for neutropenia 2x week ANCs

    Take Home Messages


    Most neonates with
    HSV infection are
    born to mothers with
    asymptomatic
    genital shedding at
    delivery, with no
    history of genital
    herpetic lesions
    No one test is 100%
    sensitive / specific
    Keep HSV in mind

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