Clinical and Laboratory Markers and Risk for CSF HSV DNA Persistence (pHSV) in Neonatal Disseminated and Central Nervous System (CNS) Infection
William Otto, MD; Angela Myers, MD, MPH; Barrett LaRussa, BS; David Kimberlin, MD; Mary Anne Jackson, MD
Of the estimated 1500 neonates diagnosed annually in the US with HSV infection, over 30% have CNS involvement; 21 days of IV acyclovir is recommended. For those with positive HSV DNA on PCR testing of CSF at the end of the therapy (pHSV), extension of treatment is recommended, but risk factors for and implications of pHSV are lacking. Our objective was to identify neonatal HSV cases between 01/2003-12/2014 at our freestanding childrens hospital and define clinical and laboratory markers associated with pHSV.
Patients <3 months of age with possible HSV infection were identified from an ID tracking list. Clinical, laboratory and outcome data was collected on those with initial positive CSF HSV PCR result those with negative end of therapy PCR result and those with pHSV were then compared. Descriptive statistics were utilized for analysis.
90 charts were reviewed; 46 neonates had HSV infection 20 SEM, 9 CNS, 17 disseminated (12 with CNS disease). Of 21 with HSV in the CSF, 3 were excluded for onset >3 months of age, early death, or recurrence. 4/18 patients had pHSV and were treated for ≥28 days; 2/4 had disseminated disease. Baseline characteristics and lab results were similar in both groups. Patients with pHSV showed seizure activity after >14 days of treatment, prolonged transaminitis and CSF protein elevation at end of therapy (Table 1, Figures 1 and 2). Infants with pHSV had a higher rate of moderate or severe impairment noted at follow up visits. One patient with clearance of HSV died shortly after completing therapy.
Infants with pHSV tended to have more severe disease than those with CSF clearance of HSV. They had persistent seizure activity, prolonged transaminitis and elevated CSF protein at the end of standard therapy. They were more likely to have worse neurodevelopmental outcomes.
B. Larussa, None
D. W. Kimberlin, Alios: Investigator , Served as one of scores of clinical trial sites for RSV treatment study; all monies went to my university and not to me
M. A. Jackson, None
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