pediatrics
Neonatal Herpes Simplex Virus (HSV) Infection
Symptoms and Signs of Neonatal HSV Infection
Manifestations generally occur between the 1st and 3rd weeks of life but rarely may not appear until as late as the 4th week. Neonates may present with local or disseminated disease. Skin vesicles are common with either type, occurring in about 70% overall. Neonates with no skin vesicles usually present with localized central nervous system (CNS) disease. In neonates with isolated skin or mucosal disease, progressive or more serious forms of disease frequently follow within 7 to 10 days if left untreated. This close-up of a neonate's mouth shows a large red ulcer under the upper lip caused by HSV-1. DR P. MARAZZI/SCIENCE PHOTO LIBRARY This neonate with AIDS also has disseminated HSV-2 infection with lesions covering the entire body. DR M.A. ANSARY/SCIENCE PHOTO LIBRARY Clusters of vesicles on an erythematous base are characteristic and may be present on almost any part of the body. By permission of the publisher. From Demmler G: Congenital and perinatal infections. InAtlas of Infectious Diseases: Pediatric Infectious Diseases. Edited by CM Wilfert. Philadelphia, Current Medicine, 1998. Neonates with localized disease can be divided into 2 groups. One group has encephalitis manifested by neurologic findings, cerebrospinal fluid pleocytosis, and elevated protein concentration, with or without concomitant involvement of the skin, eyes, and mouth. The other group has only skin, eye, and mouth involvement and no evidence of CNS or organ disease. Neonates with disseminated disease and visceral organ involvement have hepatitis, pneumonitis, disseminated intravascular coagulation, or a combination, with or without encephalitis or skin disease. Other signs, which can occur singly or in combination, include temperature instability, lethargy, hypotonia, respiratory distress, apnea, and seizures. 