Diagnostic and therapeutic management for suspected neonatal herpes simplex virus infection

BackgroundNeonatal herpes simplex virus (HSV) is a rare disease associated with high mortality and morbidity rates. HSV infection can be subdivided into 3 clinical manifestations: isolated skin, eye and mouth (SEM) disease, central nervous system (CNS) disease and disseminated disease. Consensus guidelines for diagnostic and therapeutic management are not available.ObjectivesTo evaluate the diagnostic work-up and therapeutic management in neonates with suspected or proven HSV infection.Study designRetrospective study of diagnostic and therapeutic management in all neonates with suspected HSV infection admitted to our neonatal nursery between January 2005 and July 2010.ResultsA total 53 neonates with suspected HSV infection were included in the study and classified as SEM disease (n = 2), CNS disease (n = 41) or disseminated disease (n = 10). None of the included infants tested positive for HSV infection. Correct and complete diagnostic work-up was performed in only 11% (6/53) of the cases. All neonates were treated with intravenous acyclovir.ConclusionsNone of the neonates with suspected HSV tested positive. Diagnostic management in neonates with suspected HSV infection was often improper and incomplete. Consensus guidelines to identify low-risk infants in whom HSV testing and acyclovir treatment is not warranted, are urgently needed.