Neonatal Herpes Simplex Infections

Posted by e-Medical PPT Monday, July 26, 2010
Herpes simplex virus infections are ubiquitous and cause a wide range of infections from isolated mucocutaneous lesions to disseminated infection in all age groups. Neonatal herpes simplex virus disease is associated with high morbidity and mortality.The herpes viruses are characterized by their propensity for latency in sensory neural ganglia. The site of latency is the trigeminal ganglion in HSV-1 infection1 and the sacral ganglion in HSV-2 infection.Herpes simplex virus type 1 (HSV-1) typically causes infection above the waist and the infections are localized to mouth and oropharynx, whereas herpes simplex virus type 2 (HSV-2) usually causes genital infections and can also cause CNS or disseminated disease in neonates.
Most neonatal herpes simplex virus infections result from exposure of the neonate to infected maternal genital secretions. The risk of the infection is largely influenced by the antibody status of the mother. About 50% of neonates exposed to maternal primary herpes simplex virus infection contract the virus as opposed to less than 5% of those exposed to recurrent herpes simplex virus disease.Neonates with herpes simplex virus infection manifest disease in 3 different ways as follows:
Skin, eye, and mucous membrane (SEM) disease: Infection with herpes simplex virus limited to SEM historically accounts for about 20% of all neonatal herpes simplex virus infections
Disseminated infection: Disseminated infection now accounts for approximately 25% of herpes simplex virus infections in newborns
CNS infection: Nearly one third of infants with neonatal herpes simplex virus infection have encephalitis as the sole manifestation of disease. Patients usually present with symptoms and signs of illness at 2-3 weeks of age. Initial manifestations include lethargy, irritability, and focal seizures

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