Neonatal herpes
Neonatal herpes simplex | |
---|---|
Other names | Neonatal herpes |
Specialty | Pediatrics |
Neonatal herpes simplex, or simply neonatal herpes, is a
The cause is HSV 1 and 2.[1] It can infect the unborn baby, but more often passes to the baby during childbirth.[3] Onset is typically in the first six weeks after birth.[2] The baby is at greater risk of being affected if the mother contracts HSV in later pregnancy.[1] In such scenarios a prolonged rupture of membranes or childbirth trauma may increase the risk further.[1]
Globally, it is estimated to affect one in 10,000 births.[4] Around 1 in every 3,500 babies in the United States contract the infection.[5]
Signs and symptoms
Neonatal herpes manifests itself in three forms: skin, eye, and mouth herpes (SEM, sometimes referred to as "localized"); disseminated herpes (DIS); and central nervous system herpes (CNS).[6]
- SEM herpes is characterized by external lesions but no internal organ involvement. Lesions are likely to appear on trauma sites such as the attachment site of nasopharynx; and in areas associated with trauma or surgery (including circumcision).[7]
- DIS herpes affects internal organs, particularly the liver.[citation needed]
- CNS herpes is an infection of the nervous system and the brain that can lead to encephalitis. Infants with CNS herpes present with seizures, tremors, lethargy, and irritability. They feed poorly, have unstable temperatures, and their fontanelle (soft spot of the skull) may bulge.[8]
CNS herpes is associated with higher
Death from neonatal HSV disease in the U.S. is currently decreasing; the current death rate is about 25%, down from as high as 85% in untreated cases just a few decades ago. Other complications from neonatal herpes include prematurity, with approximately 50% of cases having a gestation of 38 weeks or less, and concurrent sepsis in approximately one-quarter of cases that further clouds speedy diagnosis.[citation needed]
Cause
The cause is HSV 1 and 2.[1] It can infect the unborn baby, but more often passes to the baby during childbirth.[3] Onset is typically in the first six weeks after birth.[2] The baby is at greater risk of being affected if the mother contracts HSV in later pregnancy.[1] In such scenarios a prolonged rupture of membranes may increase the risk further.[1] Sites of injury such as forceps or scalp electrodes may provide a portal of entry for HSV.[3]
Risk factors
Maternal risk factors for neonatal HSV-1 include: White non-Hispanic race,[9] young maternal age (<25), primary infection in third trimester,[10] first pregnancy, HSV (1&2) seronegativity,[8][11] a discordant partner,[12] gestation <38 weeks,[10] and receptive oral sex in the third trimester.[13]
Neonatal HSV-2 maternal risk factors: Black race,[14] young maternal age (<21),[8][10] a discordant partner, primary or non-primary first episode infection in the third trimester,[15] four or more lifetime sexual partners,[14] lower level of education,[14] history of previous STD, history of pregnancy wastage, first viable pregnancy, and gestation <38 weeks.[8][10]
Transmission
The majority of cases (85%) occur during birth when the baby comes in contact with infected genital secretions in the birth canal, most common with mothers that have newly been exposed to the virus (mothers that had the virus before pregnancy have a lower risk of transmission). An estimated 5% are infected in utero, and approximately 10% of cases are acquired
Post-natal transmission incidences can happen from a source other than the mother, such as an Orthodox Jewish
Diagnosis
Diagnosis is by blood tests and culture.
Differential diagnosis
Other skin conditions that may appear similar include
Treatment
Reductions in morbidity and mortality are due to the use of antiviral treatments such as
Harrison's Principles of Internal Medicine recommends that pregnant women with active genital herpes lesions at the time of labor be delivered by caesarean section. Women whose herpes is not active can be managed with acyclovir.[26] The current practice is to deliver women with primary or first episode non-primary infection via caesarean section, and those with recurrent infection vaginally (even in the presence of lesions) because of the low risk (1–3%) of vertical transmission associated with recurrent herpes.[citation needed]
Epidemiology
Neonatal HSV rates in the U.S. are estimated to be between 1 in 3,000 and 1 in 20,000 live births. Approximately 22% of pregnant women in the U.S. have had previous exposure to HSV-2, and an additional 2% acquire the virus during pregnancy, mirroring the HSV-2 infection rate in the general population.[27] The risk of transmission to the newborn is 30–57% in cases where the mother acquired a primary infection in the third trimester of pregnancy. Risk of transmission by a mother with existing antibodies for both HSV-1 and HSV-2 has a much lower (1–3%) transmission rate. This in part is due to the transfer of a significant titer of protective maternal antibodies to the fetus from about the seventh month of pregnancy.[8][28] However, shedding of HSV-1 from both primary genital infection and reactivations is associated with higher transmission from mother to infant.[8]
HSV-1 neonatal herpes is extremely rare in
References
- ^ ISBN 978-0-323-71159-3.
- ^ PMID 29939674.
- ^ PMID 32809363.
- ^ "Herpes simplex virus". www.who.int. Archived from the original on 18 August 2023. Retrieved 18 August 2023.
- ^ "Neonatal herpes simplex". Boston Children's Hospital. 14 July 2009. Archived from the original on 20 February 2014. Retrieved 2 February 2014.
- ^ PMID 30602444.
- ^ Prober, Charles G. (1997). "Herpes simplex virus". In Long, Sarah S.; Pickering, Larry K.; Prober, Charles G. (eds.). Principles and Practices of Pediatric Infectious Diseases (3rd rev. ed.). New York: Churchhill Livingstone. p. 1138.
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- ^ S2CID 8336377.
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- ^ PMID 8106731.
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- ^ S2CID 9632498.
- ^ "Baby Dies of Herpes in Ritual Circumcision by Orthodox Jews". ABC News.
- Independent.co.uk. 10 March 2017. Archivedfrom the original on 2022-06-18.
- ^ "4 NY babies get herpes from Jewish circumcision rite in past 6 months". The Times of Israel.
- PMID 15685144.
- S2CID 22544225.
- ^ "Neonatal Herpes Simplex Virus (HSV) Infection - Pediatrics". Merck Manuals Professional Edition.
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- S2CID 13294240.
- ^ Kasper, Dennis L.; Braunwald, Eugene; Fauci, Anthony S.; Hauser, Stephen L.; Longo, Dan L.; Jameson, J. Larry (2005). "Medical Disorders During Pregnancy". Harrison's Principles Of Internal Medicine (16th ed.). McGraw-Hill Medical Publishing Division.
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