Neonatal herpes simplex virus infection (Complete)

Question 1

Define neonatal herpes simplex virus infection

Answer 1

HSV infection occuring in neonates following vaginal delivery

Question 2

Summarise the aetiology of neonatal HSV infection

Answer 2

Mother infected with HSV and develops primary vesicles in genital tract

During delivery, infant can contract HSV via contact with primary vesicles

Question 3

What serious complications can occur secondary to HSV infection?

Answer 3

Can disseminate resulting in:

Encephalitis

Seizures

Hepatitis

Sepsis

Question 4

What are the main clinical features of HSV in neonates?

Answer 4

Onset: Within first-4th week of life

Local features:

Vesicular lesions

• Skin
• Mucosa
• Eyes

Disseminated features:

Encephalitis

Seizures

Hepatitis

Sepsis

Question 5

What investigations should be conducted in neonates with suspected HSV infection?

Answer 5

Bedside:

Basic obs: Check haemodynamic status

Skin/muscosal swabs: For PCR testing

Bloods:

Virus PCR: Check for disseminated HSV

FBC: May show thrombocytopenia

CRP: Raised

LFTs: May be raised in disseminated cases

U&Es: If unwell

Imaging:

MRI: If worried about encephalitis

Lumbar puncture: If worried about encephalitis

Question 6

When is active management of HSV advised in pregnancy?

Answer 6

If primary lesions present at term

OR

If primary outbreak has been detected within 6 weeks of labour

Question 7

How is HSV managed during pregnancy?

Answer 7

Medicine:

Intrapartum IV aciclovir

Surgical:

Elective C-section

Can do either medical or surgical based on clinical context/preference

Question 8

How are neonates with confirmed HSV managed?

Answer 8

Parenteral aciclovir

Intensive supportive care (in severe cases)