Neonates herpes infections

Herpes Simplex. There are two types of herpes simplex vims (HSV) that infect humans. Type I causes orofacial lesions and 30% of the U.S. population suffers from recurrent episodes. Type II is responsible for genital disease and anywhere from 3 x 3 x 10 cases per year (including recurrent infections) occur. The primary source of neonatal herpes infections, which are severe and often fatal, is the mother infected with type II. In addition, there is evidence to suggest that cervical carcinoma may be associated with HSV-II infection (78—80). 

Neonatal herpes simplex virus infection Treatment of neonatal herpes infections. Parenteral Treatment of initial and recurrent mucosal and cutaneous herpes simplex virus (HSV)-I and -2 and varicella-zoster virus (VZV/shingles) infections in immunocompromised patients. 

Neonatal herpes Infection in infants usually with HSV-2, most often acquired during passage through a birth canal contaminated with the virus. 

Oral acyclovir is useful in the treatment of HSV-1 and HSV-2 infections, such as genital herpes, herpes encephalitis, herpes keratitis, herpes labialis, and neonatal herpes. In initial episodes of genital herpes, oral acyclovir has been found to reduce viral shedding, increase the speed of healing of lesions, and decrease the duration of pain and new lesion formation. Acyclovir appears to be less effective in the treatment of recurrent herpes genitalis but may be used for the long-term suppression of recurrent HSV. 

Intravenous acyclovir is used in the treatment of herpes simplex encephalitis, neonatal HSV infection, and mucocutaneous HSV infection in immunocompromised individuals. Acyclovir ointment is used in the treatment of initial genital herpes but is not effective for recurrent disease. Ophthalmic acyclovir formulations, although not available in the United States, are effective in the treatment of herpes keratoconjunctivitis. 

Intravenous acyclovir is the treatment of choice for herpes simplex encephalitis, neonatal HSV infection, and serious HSV or VZV infections (Table 49-1). In immunocompromised patients with VZV infection, intravenous acyclovir reduces the incidence of cutaneous and visceral dissemination. 

Neonatal Herpes Simplex Virus Infections (Birth to 3 months)... 

The virus remains latent in the trigeminal nerve, may remain in the cornea, and has been reported in tears. HSV type 2 usually infects the genital area and is transmitted sexually but can cause ocular infection if transmitted to the eye via infected genital secretions. This most commonly occurs in neonates who are exposed to the virus in the birth canal. In neonates, herpes simplex can cause a fatal systemic infection. 

Kimberlin DW, Lakeman FD, Arvin AM, Prober CG, Corey L, Powell DA, et al. Application of the polymerase chain reaction to the diagnosis and management of neonatal herpes simplex virus disease. National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group. J Infect Dis 1996 174 1162-7. 

Malm G, Forsgren M. Neonatal herpes simplex virus infections HSV DNA in cerebrospinal fluid and serum. Arch Dis Child Fetal Neonatal Ed 1999 81 F24-9. 

Nicoll JAR, Love S, Burton PA, et al. Autopsy findings in two cases of neonatal herpes simplex virus infection detection of virus by immunohistochemistry, in situ hybridization and the polymerase chain reaction. Histopathology. 1994 24 257-264. 

Infection with herpes simplex virus type 1 (HSV-1) typically causes diseases of the mouth, face, skin, esophagus, or brain. Herpes simplex virus type 2 (HSV-2) usually causes infections of the genitals, rectum, skin, hands, or meninges. Both cause serious infections in neonates. HSV infection may be a primary one in a naive host, a nonprimary initial one in a host previously infected by other viruses, or the consequence of activation of a latent infection. 

Vidarabine, an antiviral agent (10 to 15 mg/kg/day for 5 to 10 days), is indicated in the treatment of herpes simplex virus encephalitis, neonatal herpes simplex virus infections, and herpes zoster in immunosuppressed patients. In addition, vidarabine (ophthalmic ointment 3% vidarabine monohydrate [equivalent to 2.8% vidarabine]) is indicated in the treatment of acute keratoconjunctivitis and recurrent epithelial keratitis due to herpes simplex virus types 1 and 2, or superficial keratitis caused by herpes simplex virus that has not responded to topical idoxuridine or when toxic or hypersensitivity reactions to idoxuridine have occurred. 

It is also found to be beneficial both in varicella-zoster infections and neonatal herpes. 

Vidarabine is used mainly in human HSV-1 and HSV-2 encephalitis, decreasing the mortality rate from 70 to 30%. Whitley et al. (57) reported that early vidarabine therapy is helpful in controlling complications of localized or disseminated herpes zoster in immunocompromised patients. Vidarabine also is useful in neonatal herpes labialis or genitalis, vaccinia virus, adenovirus, RNA viruses, papovavirus, CMV, and smallpox virus infections. Given the efficacy of vidarabine in certain viral infections, the U.S. FDA approved a 3% ointment for the treatment of herpes simplex keratoconjunctivitis and recurrent epithelial keratitis, and a 2% IV injection for the treatment of herpes simplex encephalitis and herpes zoster infections (Table 43.3). A topical ophthalmic preparation of vidarabine is useful in herpes simplex keratitis but shows little promise in herpes simplex labialis or genitalis. The monophosphate esters of vidarabine are more water-soluble and can be used in smaller volumes and even intramuscularly. These esters are under clinical investigation for the treatment of hepatitis B, systemic and cutaneous herpes simplex, and herpes zoster virus infections in immunocompromised patients. 

Kimberlin, D.W. and Whitley, R.J., Neonatal herpes what have we learned. Semin. Pediatr. Infect. Dis., 16, 7-16 (2005). 

Herpes simplex virus infections should be considered in all neonates who present with nonspecific symptoms such as... 

Herpes Simplex Virus Ophthalmia Neonatorum. HSY infection is an uncommon but important cause of neonatal infection and is associated with conjunctivitis in 5% to 10% of cases.The clinical manifestations are nonspecific and include conjimctival hyperemia, chemosis, periorbital edema, and mucous discharge. Corneal involvement is not uncommon and can include dendritic, geographic, or stromal keratitis. Herpetic ophthalmia neonatorum represents a primary herpetic infection. Central nervous system involvement, encephalitis, retinitis, optic neuritis, uveitis, choroiditis, and a fetal viremia can be serious sequelae of primary herpetic infections. 

Parenteral acyclovir is the drug of choice for the treatment of initial and recuiTent mucosal or cutaneous herpes simplex infections in immunocompromised patients and for the treatment of disseminated, neonatal, encephalitic, and severe first episodes of genital herpes simplex infections in immunocompetent patients (Whidey, 1997). Ind avenous acyclovir should also be used for severe diseases such as encephalids (Brady and Bernstein, 2004). 

Sexually transmitted infections with Herpes simplex (Herpesvirus hom-nls) type 2 is epidemic in Europe and North America. The importance of this infection is compounded by its recurrent nature, its probable etio-loglc association with squamous cell carcinoma of the cervix, its association with infrequent but devastating neonatal infections, and the lack of effective prophylaxis or therapy. Despite initial optimistic reports, all regimens that have been subjected to rigorously controlled clinical trials have demonstrated no benefit, either with regard to speed of healing or... 

Some of the most serious sequelae of STDs are associated with congenital or perinatal infections. Most neonatal infections are acquired at birth, after infant passage through an infected cervix or vagina. Neonatal Chlamydia trachomatis, Neisseria gonorrhoeae, and herpes simplex virus (HSV) infections are associated with this type of spread. For pregnant women with syphilis, infection is usu-... 

Valtrex is prescribed to treat herpes simplex 2 viral infections, but it is not administered routinely to neonates at birth. 

L. A. Bryan, R. A. Fenton, V. Misra and D. M. Haines, Fatal, generalised bovine herpes type-1 infection associated with a modified-live infectious bovine rhinotracheitis parainiluenza-3 vaccine administered to neonatal calves. Can. Vet. J., 1994, 35, 223-228. 

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