How is herpes neonatorum categorized?

Updated: Feb 27, 2019
  • Author: J Michael Klatte, MD; Chief Editor: Russell W Steele, MD  more...
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Herpes neonatorum can be categorized as follows [3, 4, 5, 6, 7] :

  • Skin, eye, and mucous membrane (SEM) disease: Infection with herpes simplex virus limited to SEM historically accounts for about 20% of all neonatal herpes simplex virus infections. Infants with SEM infections generally present at age 10-12 days. Skin lesions tend to appear at the site of trauma. Many newborns with herpes simplex virus–related SEM disease do not present with symptoms of systemic illness. Outcome of SEM disease is excellent with prompt antiviral therapy; however, without treatment 75% of the cases progress to disseminated disease.

  • Disseminated infection: Disseminated infection now accounts for approximately 25% of herpes simplex virus infections in newborns. The early recognition and prompt treatment of herpes simplex virus–related SEM disease has resulted in lower rates of progression to disseminated disease than in years past. Neonatal HSV infection acquired peripartum and manifesting as disseminated disease will usually present between days 2-12 of life, given a minimum incubation period for HSV infection of 2 days. [4, 41, 53] Disseminated disease manifests as severe infection, often with hepatic, pulmonary, and neurologic dysfunction or failure. In the absence of prompt recognition and early institution of antiviral treatment, disseminated disease has a high mortality rate.

  • CNS infection: Nearly one-third of infants with neonatal herpes simplex virus infection have meningoencephalitis as the sole manifestation of disease. Patients usually present with symptoms and signs of illness at 2-3 weeks of age. Initial manifestations include lethargy, irritability, and focal seizures. Without treatment, most children with CNS disease die and survivors sustain severe neurologic impairment.

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