Ascending in Utero Herpes Simplex Virus Infection in an Initially Healthy-Appearing Premature Infant

Abstract

The usual route of acquisition for intrauterine herpes simplex virus (HSV) infection is transplacental. We evaluated a premature infant with in utero acquisition of HSV resulting from ascending infection. Histopathologic evidence of chronic chorioamnionitis and positive staining with immunohistochemistry for HSV in the placenta and umbilical cord established the diagnosis. The clinical presentation was also of interest in that the infant was initially healthy appearing.

Zika Virus Infection during Pregnancy in Mice Causes Placental Damage and Fetal Demise

“…Viruses from the urogenital tract can disseminate into intrauterine space and colonize the fetal membrane or the placenta in an ascending manner (Edwards et al, 2015). In contrast, viruses from the maternal blood circulation can be transported to the feto-maternal space and infect trophoblasts lining the maternal-fetal interface.…”

Prevalence of herpes simplex virus types 1 and 2 at maternal and fetal sides of the placenta in asymptomatic pregnant women

“…This observation suggests that most HSV‐1 infections at the placental tissue ascend from the vagina due to genital herpes infection and reach first the fetal side. It is known that HSV may ascend from the lower genital tract during pregnancy increasing the risk of vertical transmission. This can explain the higher positivity of HSV‐1 at the fetal side.…”

Placental Immune Responses to Viruses: Molecular and Histo-Pathologic Perspectives

“…Histological manifestations of a placental HSV infection can include subacute necrotizing inflammation with stromal cell necrosis involving the umbilical cord and fetal surface/chorionic plate (Figure 5D) [140]. Additional investigation has described chronic chorioamnionitis with degradation of the amniotic lining, chorionic villi that are appropriate for gestational age, delayed villous maturation, and a HSV Cowdry type B intranuclear inclusion within subamniotic tissue [141]. Another study evaluating 64 cases of latent neonatal infection endorsed that although no HSV cytologic changes were found, the HSV-specific antigen was identified in individual cells of the subamnionic chorion, and/or individual cells of the subamniotic tissue, and/or perivascular tissue [135].…”