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Pitfalls in the diagnosis of neonatal herpes infection and learning from our mistake/a report of a case of disseminated neonatal herpes simplex with treatment failure
  1. M Ghazavi
  1. Paediatric, South Tyneside Foundation Trust, South Shields, UK

Abstract

Introduction Herpes Simplex Virus (HSV) infection is a serious neonatal infection with high mortality and morbidity. The fact that it has a relatively low prevalence in neonates, it may not be considered early as a differential diagnosis of neonatal sepsis. A high index of suspicion is necessary for an early diagnosis and an introduction of antiviral therapy should be considered to improve the outcome.

Method Case report.

Results We report a case of neonatal herpes who presented with apneas, poor feeding and temperature instability on day 5. She was born at term by elective section in good condition with no maternal risk factor for infection, who was discharged home on day 3. On admission, she looked pale, was floppy with temperature of 35.5 C, HR of 140/min, RR of 18/min and CRT of 3 s. She had frequent episodes of apneas. An infection screen was performed. She received broad spectrum antibiotics. She was commenced on CPAP. Investigations showed normal glucose and electrolytes, CRP of 16 (normal<5), normal FBC, negative virology and bacteriology from respiratory secretion, NPAs, blood and CSF. Her CSF showed clear fluid, protein 0.91g/dl, glucose 3.2 with WCC 8 *10.6 (75% PMN, 25%MN) and RBC 1. She had normal brain US and EEG. She first showed signs of improvement in feeding, colour, tone and breathing. However she suddenly deteriorated on day 4 admission with deranged liver function, renal function and clotting with a DIC picture. She was transferred to PICU and commenced on Acyclovir. She was then transferred to a hepatic unit for further support. On admission (day 6 of admission) she developed a few vesicles on the chest. Fluid from the vesicles and blood confirmed HSV type 1. She underwent a liver transplant, haemodialysis, bowel surgery for bowel perforation. She remained dependent on ventilator. Sadly, she died after 2 months of intense therapy.

Discussion She had negative blood and csf culture after 48 h of admission. She remained on CPAP for breathing despite slight improvement. There was no maternal risk factor for infection. If she had been commenced on acyoclovir early….

Conclusion Neonatal HSV carries high mortality and morbidity and needs a high index of suspicion.

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