Herpes neonatorum

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Classification according to ICD-10
P35.2 Congenital herpesvirus infection [herpes simplex]
ICD-10 online (WHO version 2019)

The herpes neonatorum (lat. Neonatus : Newborn), and neonatal herpes , herpes sepsis in the newborn is an often fatal infection with herpes simplex virus (HSV), which during the birth is transmitted to the child. HSV-2 is predominantly found in herpes neonatorum , as it is almost always triggered by an existing genital herpes in the mother.

Epidemiology

There are no published figures on herpes neonatorum for the German-speaking area . In the Netherlands , the annual incidence between 1999 and 2005 was 3.2 per 100,000 live births. In Denmark between 1977 and 1991 it was 2.4 to 4.6.

illness

The herpes neonatorum occurs during or shortly after birth ( perinatal ) either by ascending infection after rupture of membranes or infected birth canal; the herpes simplex virus 2 is predominantly detected. The risk of a child's infection is particularly high in the case of a first genital infection of the mother shortly before delivery, as no antibodies, some of which alleviate the infection, are passed through the placenta to the child and virus production is significantly increased in the case of primary infections. The probability of disseminated infection in the newborn is 75% when genital HSV lesions are detectable in the mother. However, the virus can be excreted even if no lesions are evident. Very rarely, an infection from a herpes labialis in the mother, father or medical staff can also occur after the birth . The herpes neonatorum is a generalized, disseminated herpes simplex infection ( herpes neonatorum generalized satus ) because it both the skin and internal organs and the central nervous system may include (CNS). Typical herpes vesicles can be seen scattered on the skin, which quickly open spontaneously and confluent to form larger ulcers . HSV pharyngitis , pneumonia , hepatitis , keratitis and herpes simplex encephalitis as a disease-determining disease are possible . Typical skin lesions can be absent in 20–40% of infected children. The disease progresses rapidly in a few days.

Diagnosis

In the mother, direct virus detection using cell culture or PCR from herpes simplex vesicles, vaginal and cervical swabs can prove the presence of HSV and show the risk of infection in the child. The pathogen is detected directly in the child. The test should be performed using skin swabs, vesicular fluid, blood serum, and throat swabs. The virus can also be present in the CSF after the 3rd day at the earliest . The serological detection of antibodies in the child is useless because maternal antibodies are detected and even a negative antibody test cannot rule out the disease.

Dermatitis exfoliativa neonatorum , urticaria neonatorum , Bloch-Sulzberger syndrome ( Incontinentia pigmenti ) or a perinatal infection with the varicella-zoster virus can be considered as differential diagnosis of the skin symptoms .

therapy

In the event of clinical suspicion and / or direct detection of the virus, intravenous therapy with aciclovir or valaciclovir should be initiated as soon as possible .

prophylaxis

The effectiveness of antiviral drugs is controversial; local treatment and vaccines against HSV-1/2 for the prophylaxis of infection in newborns are currently being discussed; their benefits are still unclear. The proof of a genital HSV initial infection, a clinically manifest reactivation or the proof of HSV-1/2 in the birth canal or the vulva is an indication for a caesarean section . Since the time from the opening of the amniotic sac to delivery goes hand in hand with a growing risk of neonatorial herpes , a quick decision must be made.

forecast

Mortality depends on the organ systems affected; Developing encephalitis in particular means a very poor prognosis. Untreated herpes neonatorum is fatal in 50–80% of cases; surviving newborns show severe neurological, motor and cognitive deficits. If the CNS is not affected, early therapy is usually successful.
As a late complication, dangerous reactivation of HSV can occur in children after years, even if neonatorial herpes was mild and treated in good time. The reactivation often affects the retina in the form of acute, necrotizing herpes simplex retinitis.

literature

  • R. Marre, T. Mertens, M. Trautmann, E. Vanek: Clinical Infectiology . Munich Jena 2000 ISBN 3-437-21740-2 pp. 802f
  • E. Anzivino et al .: Herpes simplex virus infection in pregnancy and in neonate: status of the art of epidemiology, diagnosis, therapy and prevention . Virol J. (2009) 6:40 (Review) PMID 19348670 , PMC 2671497 (free full text)

Individual evidence

  1. ↑ J. Poeran et al .: The incidence of neonatal herpes in The Netherlands . J. Clin. Virol. (2008) 42 (4): pp. 321-325 PMID 18359271
  2. ↑ G. Fonnest et al .: Neonatal herpes in Denmark 1977-1991 . Acta Obstet. Gynecol. Scand. (1997) 76 (4): pp. 355-358 PMID 9174431
  3. ↑ CC Linnemann jr. et al .: Transmission of herpes-simplex virus type 1 in a nursery for the newborn. Identification of viral isolates by DNA “fingerprinting” . In: The Lancet (1978) 1 (8071): pp. 964-966 PMID 76893
  4. ^ RF Jacobs: Neonatal herpes simplex virus infections . In: Semin Perinatol . (1998) 22 (1): pp. 64-71 PMID 9523400
  5. ↑ A. Sauerbrei and P. Wutzler: Herpes simplex and varicella-zoster virus infections during pregnancy: current concepts of prevention, diagnosis and therapy. Part 1: herpes simplex virus infections . Med. Microbiol. Immunol. (2007) 196 (2): pp. 89-94 (Review) PMID 17165093
  6. ↑ CA Jones, AL Cunningham: Vaccination strategies to prevent genital herpes and neonatal herpes simplex virus (HSV) disease . Herpes (2004) 11 (1): pp. 12-17 (Review) PMID 15115632
  7. ↑ ML Engman et al .: Neuropsychologic outcomes in children with neonatal herpes encephalitis . Pediatr. Neurol. (2008) 38 (6): pp. 398-405 PMID 18486821
  8. ↑ ML Landry et al .: Herpes simplex virus type 2 acute retinal necrosis 9 years after neonatal herpes . J. Pediatr. (2005) 146 (6): pp. 836-838 (Review) PMID 15973328