Potentially life-threatening emergency
Neonatal herpes simplex virus
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Synopsis
Newborns with intrauterine HSV have skin lesions at birth or within the first 48 hours in the large majority of cases. These neonates are frequently premature and can have associated microcephaly, chorioretinitis, and cerebral abnormalities. Neonatal HSV can either be mucocutaneous, disseminated, or involve the central nervous system (CNS). Disseminated disease can involve the liver, lungs, or present as disseminated intravascular coagulation (DIC).
Maternal history of HSV infection could help aid the diagnosis, but most women are asymptomatic and it is, therefore, not a reliable clue. Prompt diagnosis and treatment is important for rapid treatment. Intrauterine infection presents typically with scarring skin lesions, ophthalmologic findings, and neurologic involvement. A majority of newborns acquire the infection during the peripartum period. Newborns will present with vesicles at birth or within the first few days of life. Lethargy and fever are common findings. Disseminated HSV infection in the neonate can cause encephalitis and is potentially a life-threatening condition. In disseminated disease, CNS infection, DIC, shock, and multiorgan failure are possible. Neonates with CNS involvement may have seizures. Rapid antiviral therapy is imperative in neonates with suspected HSV infection.
For a discussion of HSV acquired by older infants, see herpes simplex virus.
Codes
ICD10CM:P35.2 – Congenital herpesviral [herpes simplex] infection
SNOMEDCT:
91576008 – Neonatal herpes simplex
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Differential Diagnosis & Pitfalls
Intrauterine HSV infection usually presents within 2 days of birth. It may be associated with prematurity and brain abnormalities and may resemble epidermolysis bullosa.Neonatal infection may be disseminated, mucocutaneous, or may predominately involve the CNS.
- Listeriosis
- Gram-negative sepsis (see neonatal bacterial sepsis)
- Group B streptococcal infection (see neonatal bacterial sepsis)
- Incontinentia pigmenti
- Staphylococcal infection (see neonatal bacterial sepsis)
- Varicella / herpes zoster infection
- Erosion from fetal scalp electrode
- Sucking blisters
- Bullous impetigo
- Staphylococcal scalded skin syndrome
- Aplasia cutis
- Epidermolytic ichthyosis
- Junctional epidermolysis bullosa
- Dystrophic epidermolysis bullosa
- Erythropoietic protoporphyria
- Urticaria pigmentosa
- Congenital syphilis
- Neonatal or congenital varicella
- Aspergillosis
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References
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Last Reviewed:12/15/2016
Last Updated:12/15/2016
Last Updated:12/15/2016
Potentially life-threatening emergency
Neonatal herpes simplex virus