Neonatal herpes simplex virus infection: Clinical features and diagnosis
- Gail J Demmler-Harrison, MD
Gail J Demmler-Harrison, MD
- Professor of Pediatrics
- Baylor College of Medicine
- Section Editors
- Sheldon L Kaplan, MD
Sheldon L Kaplan, MD
- Editor-in-Chief — Pediatrics
- Section Editor — Pediatric Infectious Diseases
- Professor and Vice Chairman for Clinical Affairs
- Baylor College of Medicine
- Leonard E Weisman, MD
Leonard E Weisman, MD
- Section Editor — Neonatology
- Professor of Pediatrics
- Baylor College of Medicine
Neonatal infection with herpes simplex virus (HSV) occurs in 1 out of every 3200 to 10,000 live births, causes serious morbidity and mortality, and leaves many survivors with permanent sequelae [1-4]. Despite this seemingly low prevalence, neonatal HSV accounts for 0.2 percent of neonatal hospitalizations and 0.6 percent of in-hospital neonatal deaths in the United States, and is associated with substantial healthcare resource utilization [5-8].
Since the discovery of neonatal HSV disease in the 1930s, important breakthroughs in understanding how HSV is transmitted to the fetus and neonate, molecular methods to diagnose HSV, and antiviral treatment strategies have improved diagnosis and treatment . However, despite these advances, neonatal HSV remains a clinical challenge.
The clinical features and diagnosis of neonatal HSV infection will be reviewed below. The management, outcome, and prevention of neonatal HSV infection and non-neonatal HSV infections are discussed separately. (See "Neonatal herpes simplex virus infection: Management and prevention" and "Genital herpes simplex virus infection and pregnancy" and "Herpetic gingivostomatitis in young children" and "Clinical manifestations and diagnosis of herpes simplex virus type 1 infection".)
HSV is a member of the Herpesviridae family of viruses. It contains a double-stranded linear deoxyribonucleic acid (DNA) genome that consists of 150,000 base pairs that encode for more than 80 polypeptides, a capsid consisting of 162 capsomeres arranged in icosahedral symmetry that is covered by a tightly adherent membranous tegument, and an envelope consisting of 11 glycoproteins (gB, gC, gD, gE, gG, gH, gI, gJ, gK, gL, and gM), lipids, and polyamines that surrounds the viral nucleocapsid (picture 1) . Like all Herpesviridae viruses, HSV shares the biological properties of latency and reactivation, which causes recurrent infections in the host.
HSV enters the human host through inoculation of oral, genital, or conjunctival mucosa or breaks in skin, infects the sensory nerve endings, and then transports via retrograde axonal flow to the dorsal root ganglia, where it remains for the life of the host. The fetus may be infected transplacentally or through retrograde spread through ruptured or seemingly intact membranes . Latent virus is not susceptible to antiviral drugs, and infection (even after antiviral therapy) is lifelong. (See "Neonatal herpes simplex virus infection: Management and prevention", section on 'Outcome'.)
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- EPIDEMIOLOGY AND TRANSMISSION
- CLINICAL MANIFESTATIONS
- Intrauterine HSV
- Neonatal HSV
- - Skin, eye, mouth (SEM)
- - Central nervous system (CNS) disease
- - Disseminated disease
- EVALUATION AND DIAGNOSIS
- Clinical suspicion
- Detection of HSV
- - Specimens to collect
- - Viral culture
- - PCR testing
- Other sites
- - DFA and EIA
- - Serology
- - Interpretation/diagnosis
- Additional studies
- - Laboratory evaluation
- - Eye examination
- - Electroencephalogram
- - Diagnostic imaging
- Brain imaging
- Chest radiograph
- Abdominal ultrasonography
- DIFFERENTIAL DIAGNOSIS
- SOCIETY GUIDELINE LINKS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS