Which physical findings are characteristic of neonatal herpes simplex virus (HSV) infections?

Updated: Feb 27, 2019
  • Author: J Michael Klatte, MD; Chief Editor: Russell W Steele, MD  more...
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Skin lesions in SEM disease appear as macules which progress rapidly to vesicles on an erythematous base in areas of trauma, most commonly the site of insertion of a fetal scalp electrode (but also the oropharynx, circumcision site, or the presenting part). [19] Vesicular scalp lesions are shown in the image below.

Vesicular scalp lesions caused by herpes simplex v Vesicular scalp lesions caused by herpes simplex virus (HSV) in a 7-day-old infant.

Herpes simplex virus CNS disease usually presents between the ages of 2-3 weeks with lethargy and focal seizures. [6] Skin lesions are present in about 50% of patients. Cerebrospinal fluid (CSF) examination reveals pleocytosis and modestly elevated protein. The electroencephalogram is diffusely abnormal.

Disseminated herpes simplex virus disease in neonates usually mimics severe bacterial infection, and can present within the first few days of life. Skin lesions are often absent at the onset of illness but 70% of the patients demonstrate skin lesions at some point during the illness. Disease manifestations may include vascular instability, jaundice, hepatomegaly, and pneumonitis. [58]

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