What is Herpes Simplex Neonatorum (Neonatal Herpes Simplex Virus Infection)?
Since the introduction of acyclovir in the 1980s, there has been a significant increase in the survival rate of babies infected with serious diseases. Now, the death rate for infants with widespread disease has dropped from 85% to 29%. Similarly, for patients with diseases affecting the central nervous system (CNS), the rate has gone down from 50% to about 4% in developed countries. However, the rate is still high in developing countries.
What Causes Herpes Simplex Neonatorum (Neonatal Herpes Simplex Virus Infection)?
There are eight types of herpes viruses. These include Herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2), Cytomegalovirus (CMV), Epstein-Barr virus (EBV), Varicella-zoster, Human herpesvirus 6 (HHV-6), Human herpesvirus 7 (HHV-7), and human herpesvirus 8 (HHV-8).
A condition known as ‘Herpes simplex neonatorum’ is the passage of either HSV-1 or HSV-2 from the mother to the baby during pregnancy, childbirth, or shortly after birth. This can happen through the placenta while the baby is still in the womb, through vaginal secretions during birth, or through direct contact with active herpes sores after the baby is born.
Risk Factors and Frequency for Herpes Simplex Neonatorum (Neonatal Herpes Simplex Virus Infection)
The frequency of HSV-1 and HSV-2, two types of herpes, has shifted in recent years. Currently, over one third of the global population has recurring herpes infections. An interesting fact is that by the age of 5, 35% of black children have HSV-1, alongside 18% of white children. When looking at genital herpes specifically, it’s mostly caused by HSV-2 in the United States, but in Japan, HSV-1 is the leading cause.
Signs and Symptoms of Herpes Simplex Neonatorum (Neonatal Herpes Simplex Virus Infection)
This illness can show up in a variety of ways. Among them are skin conditions such as scarring, lesions, skin discoloration, cutis aplasia, and macular rashes. It can also impact the eyes, causing conditions such as small eyes (referred to as microphthalmia), abnormal retinal development, optic nerve damage, and inflammation of the retina and choroid. Neurologically, it can lead to a smaller than normal head size (microcephaly), softening of the brain tissue, absence of cerebral hemispheres, and buildup of calcium in the brain. Infants with this illness also often show signs of sepsis within the first three weeks of life.
Multiple organs can be affected, leading to problems like jaundice, irregular liver function, low blood sugar, low blood pressure, coagulation problems, pneumonia, and even respiratory failure. Brain inflammation is common in severe cases of the disease, which can in turn cause seizures. Blisters are not usually present in infants with this illness. In severe cases, the illness can lead to potentially fatal health issues like shock, progressive liver failure, severe coagulation problems, respiratory failure, and steady neurological decline.
Usually, these infants start showing symptoms around the second or third week of life. Initially, they may have a fever, trouble feeding, or suddenly experience seizures or periods of stopped breathing. Skin, eye, and mouth issues also usually show up around the second or third week of life. A large portion of infants with this illness develop skin lesions during its course. Typical signs include blister-like lesions on a red base. Lesions in the mouth are rare. However, the illness often involves eye infections and, if left untreated, can develop into herpes of the cornea or even result in blindness from damage to the cornea. The illness frequently results in multiple recurrences in many patients.
- Scarring, lesions, skin discoloration, cutis aplasia, and macular rashes
- Microphthalmia, abnormal retinal development, optic nerve damage, inflammation of the retina and choroid
- Microcephaly, softening of brain tissue, absence of cerebral hemispheres, buildup of calcium in the brain
- Jaundice
- Irregular liver function
- Low blood sugar
- Low blood pressure
- Coagulation problems
- Pneumonia
- Respiratory failure
- Brain inflammation
- Blisters on the skin
Testing for Herpes Simplex Neonatorum (Neonatal Herpes Simplex Virus Infection)
The best method for confirming an HSV (Herpes Simplex Virus) infection is known as viral culture. This involves taking samples from sores or from fluids like blood, urine, or from the spinal fluid. These samples are immediately cooled on ice for transport to a viral laboratory. Once in the lab, if the virus grows in a cell culture system, it can be identified as either HSV-1 or HSV-2. The best samples usually come from fresh skin sores or from the conjunctiva of the eye.
A faster method for diagnosing HSV is the Polymerase chain reaction (PCR) test, which can quickly identify the virus with an accuracy rate of 80%. An alternative method is a Tzank smear, where doctors look for multiple large cells in a sore that can indicate HSV.
Other test results like low white blood cell counts, low platelets, abnormal liver enzymes, low blood sugars, or higher-than-normal protein in spinal fluid might suggest HSV, but none of these is definitive.
Treatment Options for Herpes Simplex Neonatorum (Neonatal Herpes Simplex Virus Infection)
Patients can sometimes be in a severe enough condition from HSV (Herpes Simplex Virus) that they need assistance with breathing via a tube and ventilator, or require treatments to stabilize their blood pressure. Once they are stable in terms of breathing, brain function, and blood pressure, it’s important to start the right medication, which is often given intravenously (through an IV). Anti-viral medication such as acyclovir is typically used.
Even newborn infants who are infected with HSV need this treatment. Doctors often recommend a 21-day course of intravenous acyclovir. The purpose of this treatment is to stop the virus from multiplying and reduce the chances of future outbreaks.
Doctors also generally recommend a CT scan or MRI of the infant’s brain to look for any abnormalities. An eye specialist should also check the infant for eye problems like inflammation or damage to the optic nerve.
If the disease has spread throughout the body (disseminated) or to the central nervous system (CNS), infants should be treated with intravenous acyclovir three times a day for 21 days. If it’s impossible to obtain spinal fluid for testing, it’s safer to treat the child for 21 days. At the end of the treatment, a blood test should be done to make sure the virus has been eliminated.
Improved outcomes have been reported for infants with widespread HSV disease thanks to the use of acyclovir. This treatment usually lasts for 14 days. If a blood test after the treatment still shows the presence of the virus, treatment should continue for another week or until the test shows no virus.
For premature infants, the frequency of acyclovir doses may need to be adjusted due to their lower kidney function. Also, it’s important to check all patients twice a week for signs of a low count of a certain type of white blood cell (neutrophil); this can happen in about one-fifth of patients receiving acyclovir.
After the initial IV treatment phase, a lower dose of oral acyclovir is typically given three times a day for six months to suppress the virus.
What else can Herpes Simplex Neonatorum (Neonatal Herpes Simplex Virus Infection) be?
Neonatal sepsis and Pediatric sepsis are conditions where an infant or child has a severe infection that spreads throughout their body.
Pediatric aphthous ulcers, more commonly known as canker sores, can show up in the mouth of children.
Pediatric chickenpox is a highly contagious illness that children often get, causing an itchy rash and flu-like symptoms.
Pediatric cytomegalovirus infection is an illness caused by a common virus that can infect people of all ages; it can cause fever, sore throat, fatigue and swollen glands in children.
Pediatric enteroviral infections are a group of viral infections that are common in children and can cause rashes, cold-like symptoms, or more severe issues like meningitis.
Pediatric erythema toxicum, also called newborn rash, is a harmless condition that can cause red spots to appear on a baby’s skin.
Zoster, also known as shingles, is usually an adult disease; however, children can get it too. It causes a painful rash on one side of the body.
