Herpes simplex virus (HSV) is a widespread pathogen. Comparatively neonatal HSV infections are rare but frequently severe with high mortality and morbidity. Early detection and treatment, has been shown to decrease the mortality significantly.
We present a rare presentation of neonatal herpes in an 8 day old neonate who presented with fever and pustules around the umbilicus. Baby was treated with intravenous benzylpenicillin and flucloxacillin. However, baby was still febrile after 48 hours of treatment with vesicular lesions now appearing around the umbilicus. There was no history of genital herpes or cold sores in family. Viral swab was taken and acyclovir started. Wound swab and blood PCR was positive for HSV 2. Lumbar puncture done at day 14 was clear. Baby was treated with two weeks of intravenous acyclovir. There were problems with intravenous access with difficult access and later central line causing thrombosis.
Baby represented at 5 weeks age with vesicular umbilical lesions and was treated with 2 weeks course of oral acyclovir.
Many issues were highlighted in this case.
Lumbar puncture was not done early on as umbilical sepsis was thought to be focus of infection. It was difficult to establish whether this neonate had CNS herpes.
Long term intravenous treatment is easily said than can be given. This neonate had difficult access; central line was not without complication. What is the best way forward?
The lesions recurred within 2 weeks of the baby going home. Suppressive Acyclovir therapy - Would it be beneficial for him?