Herpes Simplex Virus (HSV) is a significant cause of neonatal infections, which can lead to severe illness and even death if not promptly diagnosed and treated. HSV is typically transmitted from mother to infant during childbirth, although it can also occur in utero or postnatally. The virus exists in two main types: HSV-1 and HSV-2, both of which can affect neonates.
Neonates usually acquire HSV during delivery through exposure to infected genital secretions. The risk of transmission is higher if the mother has a primary HSV infection during childbirth, as viral shedding is more pronounced. However, transmission can also occur in the absence of visible lesions. Less commonly, the virus may be transmitted in utero or postnatally through close contact with HSV-positive individuals.
Neonatal HSV infection can present in three major forms:
1. Localized Skin, Eye, and Mouth (SEM) Disease: This form involves herpetic lesions on the skin, eyes, or mouth. It is the least severe but can progress to more serious forms if not treated.
2. Central Nervous System (CNS) Disease: Characterized by seizures, lethargy, irritability, and poor feeding. This form can lead to long-term neurological impairment.
3. Disseminated Disease: This is the most severe form, involving multiple organs such as the liver, lungs, and brain. It often presents with symptoms of sepsis and has a high mortality rate.
Early diagnosis is crucial for effective management. Diagnosis typically involves:
- Polymerase Chain Reaction (PCR): This is the gold standard for detecting HSV DNA in blood, cerebrospinal fluid (CSF), and swabs from lesions.
- Viral Culture: Though less sensitive than PCR, it can be useful for confirming infection.
- Serological Tests: These are generally not useful in the neonatal period due to the presence of maternal antibodies.
The primary treatment for neonatal HSV is intravenous acyclovir. The duration of treatment depends on the type of infection:
- SEM Disease: Typically treated for 14 days.
- CNS Disease: Requires a minimum of 21 days.
- Disseminated Disease: Also treated for at least 21 days.
After completion of intravenous treatment, oral acyclovir is often recommended for several months to prevent relapse, especially in cases involving CNS disease.
The prognosis varies depending on the form of the disease and the timeliness of treatment:
- SEM Disease: With prompt treatment, the prognosis is generally good, although recurrences are common.
- CNS Disease: Even with treatment, infants may suffer from long-term neurological deficits, including developmental delays and seizures.
- Disseminated Disease: Mortality is high, and survivors may have significant long-term sequelae.
Prevention strategies include:
- Screening and Counseling: Pregnant women should be screened for HSV and counseled on the risks of transmission.
- Cesarean Delivery: May be recommended for women with active genital lesions at the time of labor to reduce the risk of neonatal transmission.
- Antiviral Prophylaxis: Pregnant women with a history of HSV may be prescribed antiviral medications in the third trimester to reduce viral shedding and the risk of transmission.
Conclusion
Neonatal HSV is a serious condition that requires prompt diagnosis and treatment to minimize morbidity and mortality. Awareness and preventive measures can significantly reduce the risk of transmission and improve outcomes for affected infants.
