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.
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