Neonatal Herpes Simplex Infection

Abstract

Tremendous advances have occurred over the past 30 years in the diagnosis and management of neonatal herpes simplex virus (HSV) disease. Mortality in patients with disseminated disease has decreased from 85 to 29%, and that in patients with central nervous system (CNS) disease has decreased from 50 to 4%. Morbidity has been improved more modestly: the proportion of patients with disseminated disease who are developing normally at 1 year has increased from 50 to 83%. While the proportion of patients with neurologic morbidity following CNS disease has remained essentially unchanged over the past three decades, the total number of patients who are developing normally following HSV CNS disease has increased due to the improved survival. Although additional therapeutic advances in the future are possible, more immediate methods for further improvements in outcome for patients with this potentially devastating disease lie in an enhanced awareness of neonatal HSV infection and disease. A thorough understanding of the biology and natural history of HSV in the gravid woman and the neonate provides the basis for such an index of suspicion and is provided in this article

Encefalitis herpética neonatal: valor de la clínica versusla biología molecular

“…La encefalitis por VHS es un tópico ampliamente difundido tanto en la literatura científi ca nacional 9-11 como internacional 1,3,5,6 . El objetivo de dar a conocer este caso, www.sochinf.cl es recalcar la necesidad de una adecuada interpretación de los resultados de los exámenes de biología molecular en base a las características clínicas de los pacientes y la importancia del contacto entre el médico tratante y el laboratorio de biología molecular.…”

“…En consecuencia, la RPC-TR negativa para VHS no permite descartar la etiología herpética en un paciente con manifestaciones clínicas, electroencefalograma o estudios de neuro-imágenes altamente sugerentes de esta entidad. La interpretación de una RPC positiva o negativa debe ser siempre realizada en el contexto clínico del paciente y el tratamiento antiviral debe ser iniciado frente a la sospecha diagnóstica de encefalitis herpética, cuya mayor precocidad ha demostrado disminuir la mortalidad 1,2 .…”

Encefalitis herpética neonatal: dos gemelas, dos casos

“…Lo anterior ocurre en la primoinfección y el riesgo es algo menor en las recurrencias 1 . Sesenta a 80% de las madres que tienen hijos con infección neonatal por VHS no tienen historia previa de herpes genital y las recurrencias en 85% son asintomáticas 5 .…”

Evaluation of AD472, a live attenuated recombinant herpes simplex virus type 2 vaccine in guinea pigs

“…Prophylaxis with antiviral drugs, such as valacyclovir and famciclovir are effective in reducing the recurrence of genital herpes infections [19]; however, virus shedding and transmission to sexual partners can still occur during therapy, albeit at a reduced rate [8]. Although these drugs are useful in the treatment of primary disease and prevention of recurrent infections [25], they are not well suited to reduce the incidence of severe neonatal herpes infections that occur in approximately 1500 infants per year [14]. Precautionary cesarean section has been shown to reduce the transmission of the virus to neonates [2], but it is estimated that 1580 excess cesarean births are performed for every poor neonatal outcome and the procedure carries the risk of increased maternal mortality [14].…”

“…Although these drugs are useful in the treatment of primary disease and prevention of recurrent infections [25], they are not well suited to reduce the incidence of severe neonatal herpes infections that occur in approximately 1500 infants per year [14]. Precautionary cesarean section has been shown to reduce the transmission of the virus to neonates [2], but it is estimated that 1580 excess cesarean births are performed for every poor neonatal outcome and the procedure carries the risk of increased maternal mortality [14].…”