Herpes in newborns
Herpes viral infection in newborns. Symptoms and signs, treatment.
Herpes virus in newborns
Neonatal herpes viral infection is usually transmitted during childbirth. Manifestations in typical cases include a vesicular rash and subsequent generalized infection. The diagnosis is made on the basis of virus isolation, histological data, serological or molecular biological research. Treatment includes high doses of acyclovir parenteral as well as maintenance therapy.
The incidence of neonatal infection caused by the herpes simplex virus is significant, with a high mortality rate. The incidence is 1 / 3000-1 / 20 000 births. Approximately 80% of cases cause HSV type 2; 20% are caused by HSV type 1.
HSV is usually transmitted to the child during childbirth when passing through the infected birth canal of the mother. Transplacental transmission and infection in the maternity hospital from one newborn to another by transferring to the maternity hospital staff or family members account for about 15% of all cases of neonatal disease.More often, when a newborn with an HSV infection is born, the woman does not have a history or symptoms of a genital infection during childbirth.
Symptoms and signs of herpes in newborns
The clinical symptoms of herpes in newborns usually appear between the first and second weeks of life, but may not be observed up to 4 weeks. Patients may have a localized or generalized form of the disease. Typical blister rashes are often found in both forms, occurring in approximately 55% of patients. In the absence of typical eruptions in patients, the disease usually manifests with a localized lesion of the central nervous system. In patients with isolated lesions of the skin or mucous membranes, often without treatment for 7–10 days, the disease progresses or develops more severe forms.
Newborns with localized forms can be divided into 2 groups. Patients in the same group have encephalitis, manifested by neurological disorders, pleocytosis and elevated protein content in the cerebrospinal fluid, with or without simultaneous damage to the skin, eyes and mucous membranes of the oral cavity.In the other group, only lesions of the skin, eyes and mucous membranes of the oral cavity without signs of damage to the central nervous system or other organs are noted.
In newborns with generalized herpetic infection and involvement of internal organs, hepatitis, pneumonitis and or disseminated intravascular coagulation of blood with or without encephalitis or skin lesions develop.
Other manifestations of herpes symptoms in newborns that can occur in isolation or in combination include unstable body temperature, adynamia, hypotension, respiratory failure, apnea, and seizures.
With the herpes virus in newborns, a rapid diagnosis by the virological method or PCR is necessary. The most commonly examined skin vesicle contents. You can also take samples of saliva, cerebrospinal fluid, corneal scrapings and erosions. In some patients with encephalitis, the virus is found only in the brain. Also, the diagnosis of the herpes virus can be made using a neutralization reaction with an appropriate antiserum with a high antibody titer; reactions of immunofluorescence in scrapings from the affected areas, especially when using monoclonal antibodies; and electron microscopy.If there is no possibility of a virological examination, the Pap test from the base of the affected area can reveal the presence of characteristic giant multinucleated cells and intranuclear inclusions, but this method is less sensitive than the virological one, and false positive results can also be noted.
The consequences of herpes among newborns can be deplorable: mortality in the absence of treatment of generalized forms of herpes infection is 85%; with untreated localized forms and encephalitis lethality about 50%. At least 95% of those who have had herpes infection in the neonatal period of children develop neurological consequences. Lethal outcome rarely occurs in patients with localized skin lesions without affecting the CNS or other organs, with the exception of the presence of concomitant diseases, but 30% develop neurological disorders that may appear in 2-3 years.
Treatment of herpes in newborns
Acyclovir reduces lethality by 50% and increases the percentage of children who develop normally, from 10 to 50%; the dose is 20 mg / kg intravenously after 8 hours for 14-21 days.Also, with the herpes virus in newborns, active supportive therapy is required, including adequate infusion therapy, nutrition, respiratory support, correction of coagulation disorders, and control of the convulsive syndrome. In case of herpetic keratoconjunctivitis, a combined systemic therapy with acyclovi-rum and topical therapy with such preparations, as trifluridine, is necessary.
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