2342. Treatment Implications of Herpes Simplex Virus Central Nervous System Infection in Canadian Infants <90 days old: A Pediatric Investigators Collaborative Network on Infections in Canada (PICNIC) Study
Session: Poster Abstract Session: Pediatric Viral Infections
Saturday, October 6, 2018
Room: S Poster Hall
Posters
  • IDSA poster.pdf (880.9 kB)
  • Background: In the pre-acyclovir era, HSV CNS infection was associated with very high morbidity and mortality. Since antiviral drugs recommended for therapy and long-term prophylaxis improve outcomes, clinicians need to be able to clinically detect young infants most likely to have HSV to facilitate early initiation of therapy. Limited data exist on outcomes of infants who require prolonged therapy and those completing prophylaxis. The objective of this study is to identify clinical and laboratory features associated with HSV CNS disease and describe outcomes following antiviral therapy and prophylaxis.

    Methods: Infants <90 days old with a discharge diagnosis of meningitis or encephalitis from whom a virus was identified from cerebrospinal fluid (CSF) were included. These were identified using PICNIC’s retrospective database of microbiologically-confirmed CNS infections detected January 2013 to December 2014. Clinical features and outcomes of HSV and non-HSV infection were compared.

    Results: Of the 112 cases of viral infections, HSV accounted for 8 (7%) and enterovirus for 103 (92%). Eight (100%) HSV cases and 45 (43%) non-HSV cases presented at <21 days. Four (50%) HSV cases had no pleocytosis. HSV cases were more likely to require ICU admission (p=0.016), present with seizures (p<0.001) and have extra-CNS disease (p<0.001). Among infants <3 weeks of age, seizures were more likely in HSV than non-HSV cases (4 (50%) vs. 4 (8%); p=0.013). All HSV cases received acyclovir for a median of 23 days. Two (25%) remained PCR-positive at 21 days; these were treated for 51 and 42 days respectively until PCR negative or death (acyclovir resistance was confirmed post-mortem). Four infants received suppressive acyclovir until 6 months, one of whom developed virologically-proven CNS recurrence and subsequent infantile spasms. Neurodevelopmental morbidity (4 (57%) versus 7 (7%)) was more likely in HSV than non-HSV (p=0.003).

    Conclusion: High levels of suspicion for viral infections must be maintained for young infants presenting with seizures in the first 3 weeks of life. CSF pleocytosis may often be absent. Resistance testing should be considered if PCR remains positive beyond 21 days. CNS recurrences may still occur beyond the recommended period of prophylaxis.

    Dara Petel, MD1, Michelle Barton, MBBS1, Christian Renaud, MD, MSc, FRCPC2, Lynda Ouchenir, MD3, Jason C. Brophy, MD, MSc, DTM4, Jennifer Bowes, M Sc5, Sarah Khan, MD, FRCPC6, Ari Bitnun, MD, MSc7, Jane Mcdonald, MD8, André-Anne Boisvert, MD9, Joseph Ting, MBBS, FRCPC, MPH10, Ashley Roberts, MD, M.Ed., FRCPC10 and Joan Robinson, MD11, (1)Department of Paediatrics, Western University, London, ON, Canada, (2)Infectious Diseases Division, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, QC, Canada, (3)Pediatrics, CHU Sainte-Justine, Montreal, QC, Canada, (4)Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada, (5)Infectious Diseases, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada, (6)Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada, (7)The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada, (8)Mcgill University, Montreal, QC, Canada, (9)MCUH, Montreal, QC, Canada, (10)Pediatrics, University of British Columbia, Vancouver, BC, Canada, (11)University of Alberta, Edmonton, AB, Canada

    Disclosures:

    D. Petel, None

    M. Barton, None

    C. Renaud, None

    L. Ouchenir, None

    J. C. Brophy, None

    J. Bowes, None

    S. Khan, None

    A. Bitnun, None

    J. Mcdonald, None

    A. A. Boisvert, None

    J. Ting, None

    A. Roberts, None

    J. Robinson, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.