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Infectious DiseasesViral Infections

Herpes Simplex Virus HSV Infection in Pregnant women and Newborn/Neonate

Herpes Simplex (HSV)

          There are two forms of HSV, HSV1 or HSV2
          Primarily transmitted through the infected maternal genital tract
          The rationale for C-section delivery prior to membrane rupture
          Primary infection with greater transmission risk than reactivation

Clinical Manifestations:

          Most are asymptomatic at birth
          3 patterns of ~ equal frequency with symptoms between birth and 4wks:
          Skin, eyes, mouth (SEM)
          CNS disease
          Disseminated disease (present earliest)
          Initial manifestations very nonspecific with skin lesions NOT necessarily present

Diagnosis:

          The culture of maternal lesions if present at the delivery
          Cultures in an infant:
          Skin lesions, oro/nasopharynx, eyes, urine, blood, rectum/stool, CSF
          CSF PCR
          Serologies again not helpful given the high prevalence of HSV antibodies in the population

Treatment;

          High dose acyclovir 60mg/kg/day divided q8hrs
          X21days for disseminated, CNS disease
          X14days for SEM
          Ocular involvement requires topical therapy as well

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