474. Initial Presentation of Herpes Simplex Virus Infection in Infants Age 0-60 Days
Session: Poster Abstract Session: Pediatric Viral Infections
Thursday, October 8, 2015
Room: Poster Hall
Posters
  • IDSA HSV poster 9.29.15.4 (FINAL).pdf (731.3 kB)
  • Background: Neonatal HSV is a rare infection with high morbidity and mortality.  Although this disease classically presents with seizures, vesicular rash and/or a sepsis-like illness, it can occasionally present with only non-specific symptoms such as fever, poor feeding and decreased activity.  Given that delay in acyclovir initiation results in worse clinical outcomes, we sought to describe the initial clinical presentation and laboratory findings of infants with a confirmed diagnosis of neonatal HSV.  

    Methods: We conducted a retrospective case series study at two large pediatric tertiary care centers from 2002-2012.  We reviewed the initial clinical presentation of infants aged 0-60 days with laboratory confirmed HSV.  We excluded infants who were <34 weeks gestation and those who developed illness prior to being discharged after delivery. 

    Results: We identified 50 infants with HSV. Most infants presented in the neonatal period (≤28 days of age), but 7 (14%) were older than 28 days at presentation. Of 50 infants, 22 (44%) had disseminated disease, 17 (34%) CNS, and 10 (20%) SEM disease. Initial laboratory testing of the affected infants showed that 8% had thrombocytopenia and 21% had transaminitis, although these laboratory abnormalities were limited to those with disseminated disease.  CSF pleocytosis was present in 82% of those infants with CNS disease, but was seen in only 28% of those with disseminated disease and 29% of those with SEM disease.  Nine infants (18%) presented without the classic findings of rash, neurologic abnormalities, or critical illness.  All nine of the infants who presented with a non-specific presentation were either younger than 14 days, had CSF pleocytosis, or both. Overall mortality was 14%.

    Conclusion: Seizure, vesicular rash, or critical illness in infants younger than 60 days should prompt consideration for HSV disease. Clinicians should be aware that neonatal HSV can present in a non-specific pattern, without any of the above symptoms. All patients with HSV disease and non-specific clinical findings at presentation were either very young (<14 days) or had CSF pleocytosis.

    Aaron Miller, MD, MSPH, Pediatrics, St. Louis University School of Medicine, St. Louis, MO, Alison Curfman, MD, Pediatrics, Washington University in St. Louis, St. Louis, MO, Fahd Ahmad, MD, MSCI, Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO, Eric Glissmeyer, MD, Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, Carrie L. Byington, MD, FIDSA, Pediatrics, University of Utah, Salt Lake City, UT, Anne J. Blaschke, MD, PhD, FIDSA, FPIDS, Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Utah School of Medicine, Salt Lake City, UT and Kent Korgenski, MS, University of Utah, Salt Lake City, UT

    Disclosures:

    A. Miller, None

    A. Curfman, None

    F. Ahmad, None

    E. Glissmeyer, None

    C. L. Byington, NIH: Grant Investigator , Grant recipient
    BioFire Diagnostics: Intellectual Property for the FilmArray , Intellectual Property

    A. J. Blaschke, BioFire Diagnostics, LLC: Collaborator , Consultant and Scientific Advisor , Consulting fee , Licensing agreement or royalty and Research support
    bioMerieux, Inc: Collaborator , Investigator and Scientific Advisor , Consulting fee and Research support
    Merck: Investigator , Research grant

    K. Korgenski, None

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