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Viral infections
Published in Biju Vasudevan, Rajesh Verma, Dermatological Emergencies, 2019
The diagnosis of neonatal herpes is confirmed by viral culture or preferably immediate direct fluorescent antibody (DFA) staining of material from skin or ocular lesions. CNS involvement is detected by polymerase chain reaction (PCR) of the cerebrospinal fluid (CSF). PCR of the CSF is negative in 24% of neonatal CNS herpes infections, so pending other testing, empiric therapy may be required.
Infections
Published in Anne Lee, Sally Inch, David Finnigan, Therapeutics in Pregnancy and Lactation, 2019
Neonatal herpes infection is serious but extremely rare, occurring in less than two per 100 000 live births.109 Greatest risk to the fetus occurs with vaginal delivery during a primary infection, which is often asymptomatic, when about 40% of infants become infected.107–109 Transmission rates are lowest for women who acquire herpes before pregnancy, with a risk of about 0.04% if there are no signs of an outbreak at delivery. Even if lesions are present the risk of transmission is still low (0.25–5%), probably because of transplacental transfer of maternal antibodies.107 A small number of cases are acquired post-partum, usually HSV-1 infection from oro-labial herpes or herpetic whitlow.107
Understanding and Diagnosing Herpes Simplex Virus
Published in Marie Studahl, Paola Cinque, Tomas Bergström, Herpes Simplex Viruses, 2017
Infants with neonatal HSV can be divided into three groups: (a) skin, eye, or mouth (SEM) involvement only, (b) encephalitis with or without SEM, (c) disseminated infection (177). The clinical picture and outcome varies significantly between the three groups, as well as the efficacy of antiviral treatment and long-term prognosis. The laboratory diagnostic techniques useful for neonatal HSV infection are dependent on disease presentation. For example, if the baby has skin lesions a presumptive diagnosis can be obtained within an hour, using type-specific IFA of a blister base scraping. For laboratories that provide real-time PCR service, vesicle fluid or scrapings can be analyzed with same day results. However, as approximately 2/3 of babies with neonatal herpes present without skin lesions (178), other test modalities are necessary. If the baby presents with CNS symptomatology, neuroimaging and HSV PCR on CSF will provide a rapid diagnosis. If the baby presents with sepsis and without a history of genital herpes in mother, a comprehensive workup is warranted, including a combination of neuroimaging, PCR on blood, CSF, urine, stool, and conjunctival and nasopharyngeal secretions. Virus culture should also be performed on these specimens but could require anywhere from two to seven days to produce positive results. HSV IgM determination and type-specific serology in mother and in baby are also appropriate in this circumstance (179). It is important to note that HSV subtyping is important in the diagnosis of neonatal HSV, because it helps with both epidemiology and prognostication (180).
INCIDENCE OF HERPES SIMPLEX VIRUS KERATITIS AND OTHER OCULAR DISEASE: GLOBAL REVIEW AND ESTIMATES
Published in Ophthalmic Epidemiology, 2022
Ian McCormick, Charlotte James, Nicky J Welton, Philippe Mayaud, Katherine M. E Turner, Sami L Gottlieb, Allen Foster, Katharine J Looker
We aimed to review available data on the incidence of HSV ocular disease through a systematic literature search. We also aimed to summarise the best-available data through a quantitative meta-analysis to estimate the global burden of HSV keratitis and other ocular disease where appropriate. We considered the following clinical entities attributable to HSV (or specifically HSV-1 or HSV-2 where typed): keratitis (evaluating the different forms separately where possible), uveitis, retinitis, and blepharo-conjunctivitis. We considered both new disease (defined as the first episode) and recurrent disease (defined as a subsequent episode). We considered data for all ages >1 month old, and all geographic locations and study years. Neonatal HSV studies were excluded, as the burden of neonatal herpes has been separately quantified.20
Multimodal Imaging of a Severe Case of Neonatal Acute Retinal Necrosis and Lens Vacuoles Associated with Herpes Simplex Virus Infection
Published in Ocular Immunology and Inflammation, 2022
Takamasa Kinoshita, Akira Hatanaka, Junya Mori, Kei Akaiwa, Hiroko Imaizumi
Neonatal herpes simplex virus (HSV) infection is commonly acquired from the genital tract at birth, and infrequently acquired through transplacental transmission of the HSV virus. It is associated with considerable morbidity and mortality.1 It affects the skin, mouth, eyes, central nervous system, and the visceral organs such as the lungs, liver, and adrenal glands. Ocular involvement includes blepharoconjunctivitis, keratitis and, very rarely, acute retinal necrosis (ARN). Several reports have described the characteristics of neonatal ARN associated with HSV infection with fundus photography.2–6 However, to the best of our knowledge, this is the first report that documents the clinical course of extremely severe neonatal ARN with multimodal imaging, including fundus photography, fluorescein angiography (FA), and optical coherence tomography (OCT). Furthermore, in the same case, we demonstrate bilateral lens vacuoles with asymmetrical clinical course; these have not been described previously, as far as we know. Signed informed consent was obtained from the patient’s parents.
Bilateral recurrent pseudodendritic keratopathy as the initial manifestation of tyrosinemia type II
Published in Ophthalmic Genetics, 2022
Bruno Avelar Miranda, Anna Christina Higino Rocha, Rodrigo Rezende Arantes, Viviane de Cássia Kanufre, Sabrina Cavaglieri Silva, Daniel Vitor Vasconcelos-Santos
A 1-year-old Brazilian boy was referred to ophthalmology for the first time when he was 2 months old with a history of photophobia, bilateral eyelid edema, conjunctival hyperemia, blepharospasm and frequent tearing. He had been previously treated for “conjunctivitis” since birth, with topical antibiotics and corticosteroid eye drops, with no response. Bilateral herpetic keratitis was diagnosed and treated with intravenous acyclovir (20 mg/kg tid—adjusted dose for neonatal herpes) for 21 days, with subsequent prophylactic antiviral therapy (acyclovir 300 mg/m2 tid). He was the second offspring of a non-consanguineous marriage, being born at full-term, after unremarkable pregnancy and delivery. His parents and sister were free from any ocular or cutaneous lesions.