单纯疱疹病毒

THE FIRST AFFLIATED HOSPITAL OF GUANGXI MEDICAL UNIVERSITY,DEPARTMENT OF PEDIATRICS NICU,Neonatal Herpes Simplex Infection,INTRODUCTION,Discovery of neonatal Herpes Simplex virus (HSV) in the 1930sNeonatal infection with HSV occurs in 1/3200 to 1/10,000 live birthsIn China，2/10,000 to 5/10,000,VIROLOGY, HSV is a DNA virus HSV-I, HSV-II HSV-II associated with poorer outcome,TRANSMISSION,HSV enters human host through inoculation of oral, genital, or conjunctival mucosa or break in skin,1.Intrauterine2. Perinatal3. Postnatal,Maternal viremiaAscending infectionUsually after prolonged rupture of membranes,Intrauterine,2. Perinatal-HSV infection is present in the genital tract of pregnant woman at time of delivery-Most common mode (85%) of neonatal HSV infection,3. Postnatal-When active HSV infection has close contact with the newborn,intrauterine 5% perinatal 85%postnatal 10%,CLINICAL MANIFESTATIONS,-Skin, Eye, Mouth-Central Nervous System-Disseminated Disease, 90% present between 5-19 days of age 20% NEVER have skin lesionsInitial symptoms vague in 30%LethargyPoor feedingFeverIrritability,skin,-Usually presents in the first two weeks of life-clustering vesicular lesions with an erythematous base,Eyes-,1.Excessive watering of the eye2.Crying from apparent eye pain3.Conjunctival erythema4.Periorbital skin vesicles5.Can progress to cataracts and chorioretinitis permanent vision loss,Mouth,-Localized ulcerative lesions of the mouth, palate, and tongue,CNS Disease,1/3 of neonatal HSV disease involves the CNSPresents in second-third week of life IrritabilityTremorsPoor feeding,HERPES ENCEPHALITIS, of HSV disease is in the disseminated formPresent in the first week of lifeAffects: liver, lungs, adrenals, CNS, skin, eyes, and mouth,DIC,Disseminated Disease,Diagnosis of Neonatal HSV Infection,Gold standard = Positive culture of: lesion, nasopharynx, conjunctiva, rectum, or CSF Rapid diagnostic methodsPolymerase chain reaction on CSF and bloodFluorescent antibody stain on vesicle scraping,EEGBrain ImagingChest RadiographMay demonstrate bilateral, diffuse pneumoniaAbdominal USMay demonstrate ascites and/or enlarged liver in neonates with HSV hepatitis and acute liver failure,TREATMENT,Acyclovir is the treatment of choiceDose-skin eye mouth infection 60mg/kg/day divided q8h for 14 daysMay be lengthened to 21 days in the near futureDissiminated and CNS HSV infections60mg/kg/day divided q8h for 21 days,INFECTION CONTROL STEPS,Pregnant women primary or first episode: Acyclovir therapy at 36 wk 400mg tidPrimary HSV in 3rd trimester: C-section should be offeredHand washing before and after care of infantsMother with lesions on hands hand hygiene and gloves,references,Neonatal Herpes Simplex Virus Infection: Clinical Features and Diagnosis. UptoDate. Demmier-Harrison, Gail MDNeonatal Herpes Simplex Virus Infection: Management and Prevention. UptoDate. Demmie