Herpes Simplex Virus Infections

Herpes Simplex Virus Infections 

Background: Many previous studies have shown the efficacy of early antiviral therapy for neonatal herpes simplex virus (HSV) disease. An update of neonatal HSV disease has been provided to identify ways to further improve the management of this disorder.

Methods and Findings: Data were obtained on 186 neonates enrolled in 2 studies of parenteral acyclovir for neonatal HSV disease. Patients treated between 1981 and 1988 were compared with those treated between 1989 and 1997. The mean time between onset of symptoms and initiation of treatment did not change significantly between those time periods. Forty present of the patients had fetal scalp monitors during delivery. A significant minority did not have skin vesicles at presentation and did not experience them during acute disease. Mortality was associated with prematurity among neonates with CNS disease. In those with disseminated HSV disease treated with acyclovir, 30 mg/kg/d, mortality rate correlated with aspartate transaminase increases of 10 or more times the upper limit of normal at acyclovir initiation. In addition, mortality was associated with lethargy at treatment initiation among patients with disseminated disease. Morbidity status correlated with disease extent. For neonates with CNS disease, morbidity was also associated with seizures at initiation of treatment.

Conclusions: In the past 2 decades, no progress appears to have been made in reducing the interval between onset of HSV symptoms and initiation of antiviral treatment. Such intervals need to be shortened. Clinicians need to consider the possibility of neonatal HSV infections in acutely ill infants.