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1、THEFIRSTAFFLIATEDHOSPITALOFGUANGXIMEDICALUNIVERSITYDEPARTMENTOFPEDIATRICSNICUNeonatalHerpesSimplexInfectionINTRODUCTIONDiscoveryofneonatalHerpesSimplexvirus(HSV)inthe1930sNeonatalinfectionwithHSVoccursin1/3200to1/10,000livebirthsInChina,2/10,000to5/10,000VIROLOGY●HSVisaDN
2、Avirus●HSV-I,HSV-IIHSV-IIassociatedwithpooreroutcomeTRANSMISSION~HSVentershumanhostthroughinoculationoforal,genital,orconjunctivalmucosaorbreakinskin1.Intrauterine2.Perinatal3.PostnatalMaternalviremiaAscendinginfectionUsuallyafterprolongedruptureofmembranesIntrauterine2.P
3、erinatal-HSVinfectionispresentinthegenitaltractofpregnantwomanattimeofdelivery-Mostcommonmode(85%)ofneonatalHSVinfection3.Postnatal-WhenactiveHSVinfectionhasclosecontactwiththenewbornintrauterine5%perinatal85%postnatal10%CLINICALMANIFESTATIONS-Skin,Eye,Mouth-CentralNervou
4、sSystem-DisseminatedDisease>90%presentbetween5-19daysofage>20%NEVERhaveskinlesionsInitialsymptomsvaguein30%LethargyPoorfeedingFeverIrritabilityskin-Usuallypresentsinthefirsttwoweeksoflife-clusteringvesicularlesionswithanerythematousbaseEyes-1.Excessivewateringoftheeye2.Cr
5、yingfromapparenteyepain3.Conjunctivalerythema4.Periorbitalskinvesicles5.CanprogresstocataractsandchorioretinitispermanentvisionlossMouth-Localizedulcerativelesionsofthemouth,palate,andtongueCNSDisease1/3ofneonatalHSVdiseaseinvolvestheCNSPresentsinsecond-thirdweekoflifeIr
6、ritabilityTremorsPoorfeedingHERPESENCEPHALITIS¼ofHSVdiseaseisinthedisseminatedformPresentinthefirstweekoflifeAffects:liver,lungs,adrenals,CNS,skin,eyes,andmouth,DICDisseminatedDiseaseDiagnosisofNeonatalHSVInfectionGoldstandard=Positivecultureof:lesion,nasopharynx,conjunct
7、iva,rectum,orCSFRapiddiagnosticmethodsPolymerasechainreactiononCSFandbloodFluorescentantibodystainonvesiclescrapingEEGBrainImagingChestRadiographMaydemonstratebilateral,diffusepneumoniaAbdominalUSMaydemonstrateascitesand/orenlargedliverinneonateswithHSVhepatitisandacuteli
8、verfailureTREATMENTAcycloviristhetreatmentofchoiceDose-skineyemouthinfection60mg/kg/daydividedq8