Prolonged fever and hyperferritinaemia: a puzzling diagnosis of neonatal herpes simplex virus infection during COVID-19 pandemic

Abstract

Neonatal herpes simplex virus (HSV) infection is rare, with an estimated incidence of 3.58 per 100 000 live births in the UK and should be suspected in any newborn with fever and bacterial culture-negative sepsis. We describe a case of a previously well full-term male neonate who presented with persistent fever and elevated ferritin level that was carried out during the era of the COVID-19 pandemic as part of SARS-CoV-2 panel investigations. Despite the initial negative HSV serology, HSV-1 PCR from a scalp lesion returned positive. He made a full recovery after acyclovir therapy. This case highlights the importance of maintaining a high clinical index of suspicion of HSV infection in any febrile neonate even with absence of maternal history and negative serology, particularly if associated with hyperferritinaemia. We also address the challenge of interpreting inflammatory biomarkers’ results for SARS-CoV-2 infection in neonates.

Epidemiology of herpes simplex virus type 2 in Europe: systematic review, meta-analyses, and meta-regressions

“…44 Tens of studies have documented occurrence of neonatal herpes for over 4 decades in Europe in countries such as Denmark, 45 France, 43 Germany, 46,47 Ireland, 48 Israel, [49][50][51] the Netherlands, [52][53][54][55][56][57][58] Poland, 59,60 Russia, 61 Spain, 62 Sweden, [63][64][65] Switzerland, 66 Turkey, 67 and the United Kingdom (UK). 48,[68][69][70][71][72][73][74][75][76][77][78] However, surveillance for this condition remains overall limited with no data being reported for the majority of countries in Europe. Reporting quality also varies widely from reports indicating sporadic cases to well-conducted epidemiologic studies based on surveillance systems and reporting estimates for incidence at a national level, such as in the Netherlands [52][53][54][55][56][57] and the UK.…”

Neonatal herpes simplex virus infection: From the maternal infection to the child outcome

“…36 In the presence of a sepsis-like picture with negative bacterial cultures, HSV should be ruled out and empiric antiviral therapy considered, even with the absence of maternal history and negative serology. 37 7 | DIAGNOSIS…”