Herpes Simplex Virus Infection in Young Infants During 2 Decades of Empiric Acyclovir Therapy

Abstract

Early manifestations of perinatally acquired HSV are frequently nonspecific, yet CNS infection is common. Empiric acyclovir strategy narrowly restricted to infants with onset of illness at ≤ 21 days of age, who would receive antibiotics empirically, captured 90% of HSV cases and anticipated a rate of HSV CNS infection similar to that of bacterial meningitis.

Neonatal Herpes Simplex Viral Infections and Acyclovir: An Update

“…1,2,9 Neonates with CNS disease often present with nondescript symptoms of decreased or inadequate enteral intake, irritability, lethargy, and temperature instability that mirror neonatal bacterial infections. 2,10 Analysis of cerebrospinal fluid (CSF) may show pleocytosis.…”

“…1,2,9 Neonates with disseminated disease often present with fevers and respiratory distress or pneumonia. 9,10,13 Neonates may also appear septic and experience disseminated intravascular coagulopathy. 1,2,13 Typically patients have positive HSV blood polymerase chain reactions (PCRs), although this alone is not diagnostic for type of disease.…”

“…However, lesions may not be present at disease onset. 1,2,[9][10][11][12] Skin lesion cultures are often positive for HSV if present. 10 …”

Challenges in the Care of Young Infants With Suspected Neonatal Herpes Simplex Virus

“…Empiric treatment with high-dose intravenous acyclovir is also not controversial because high-dose acyclovir has been the standard treatment for more than a decade and has a low side-effect profi le relative to the risk of untreated HSV infection. 3,4 However, for infants without clinical signs of HSV, the decision to include empiric testing and treatment is less clear. Although a maternal history of fever and primary HSV infection are associated with neonatal HSV, 5 the absence of maternal history of known HSV is not helpful in predicting which infants should be evaluated for HSV infection.…”

“…Of these 16 patients who presented with nonspecifi c complaints, 15 (94%) developed symptoms ≤21 days of age. 3 In another study by Kotzbauer et al, the authors focused on the presentation of neonates with disseminated HSV. They found that all patients presented at ≤14 days of age, with 2 of these patients presenting with fever alone.…”