单纯疱疹病毒

THEFIRSTAFFLIATEDHOSPITALOFGUANGXIMEDICALUNIVERSITY,DEPARTMENTOFPEDIATRICSNICU,NeonatalHerpesSimplexInfection,INTRODUCTION,DiscoveryofneonatalHerpesSimplexvirus(HSV)inthe1930sNeonatalinfectionwithHSVoccursin1/3200to1/10,000livebirthsInChina，2/10,000to5/10,000,VIROLOGY,HSVisaDNAvirusHSV-I,HSV-IIHSV-IIassociatedwithpooreroutcome,TRANSMISSION,HSVentershumanhostthroughinoculationoforal,genital,orconjunctivalmucosaorbreakinskin,1.Intrauterine2.Perinatal3.Postnatal,MaternalviremiaAscendinginfectionUsuallyafterprolongedruptureofmembranes,Intrauterine,2.Perinatal-HSVinfectionispresentinthegenitaltractofpregnantwomanattimeofdelivery-Mostcommonmode(85%)ofneonatalHSVinfection,3.Postnatal-WhenactiveHSVinfectionhasclosecontactwiththenewborn,intrauterine5%perinatal85%postnatal10%,CLINICALMANIFESTATIONS,-Skin,Eye,Mouth-CentralNervousSystem-DisseminatedDisease,90%presentbetween5-19daysofage20%NEVERhaveskinlesionsInitialsymptomsvaguein30%LethargyPoorfeedingFeverIrritability,skin,-Usuallypresentsinthefirsttwoweeksoflife-clusteringvesicularlesionswithanerythematousbase,Eyes-,1.Excessivewateringoftheeye2.Cryingfromapparenteyepain3.Conjunctivalerythema4.Periorbitalskinvesicles5.Canprogresstocataractsandchorioretinitispermanentvisionloss,Mouth,-Localizedulcerativelesionsofthemouth,palate,andtongue,CNSDisease,1/3ofneonatalHSVdiseaseinvolvestheCNSPresentsinsecond-thirdweekoflifeIrritabilityTremorsPoorfeeding,HERPESENCEPHALITIS,ofHSVdiseaseisinthedisseminatedformPresentinthefirstweekoflifeAffects:liver,lungs,adrenals,CNS,skin,eyes,andmouth,DIC,DisseminatedDisease,DiagnosisofNeonatalHSVInfection,Goldstandard=Positivecultureof:lesion,nasopharynx,conjunctiva,rectum,orCSFRapiddiagnosticmethodsPolymerasechainreactiononCSFandbloodFluorescentantibodystainonvesiclescraping,EEGBrainImagingChestRadiographMaydemonstratebilateral,diffusepneumoniaAbdominalUSMaydemonstrateascitesand/orenlargedliverinneonateswithHSVhepatitisandacuteliverfailure,TREATMENT,AcycloviristhetreatmentofchoiceDose-skineyemouthinfection60mg/kg/daydividedq8hfor14daysMaybelengthenedto21daysinthenearfutureDissiminatedandCNSHSVinfections60mg/kg/daydividedq8hfor21days,INFECTIONCONTROLSTEPS,Pregnantwomenprimaryorfirstepisode:Acyclovirtherapyat36wk400mgtidPrimaryHSVin3rdtrimester:C-sectionshouldbeofferedHandwashingbeforeandaftercareofinfantsMotherwithlesionsonhandshandhygieneandgloves,references,NeonatalHerpesSimplexVirusInfection:ClinicalFeaturesandDiagnosis.UptoDate.Demmier-Harrison,GailMDNeonatalHerpesSimplexVirusInfection:ManagementandPrevention.UptoDate.Demmier-