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1、THEFIRSTAFFLIATEDHOSPITALOFGUANGXIMEDICALUNIVERSITYDEPARTMENTOFPEDIATRICSNICUNeonatalHerpesSimplexInfectionINTRODUCTIONDiscoveryofneonatalHerpesSimplexvirus(HSV)inthe1930sNeonatalinfectionwithHSVoccursin1/3200to1/10,000livebirthsInChina,2/10,000to5/10,000VIROLOGY●HSVisaDNAvirus●HSV-I,H
2、SV-IIHSV-IIassociatedwithpooreroutcomeTRANSMISSION~HSVentershumanhostthroughinoculationoforal,genital,orconjunctivalmucosaorbreakinskin1.Intrauterine2.Perinatal3.PostnatalMaternalviremiaAscendinginfectionUsuallyafterprolongedruptureofmembranesIntrauterine2.Perinatal-HSVinfectionisprese
3、ntinthegenitaltractofpregnantwomanattimeofdelivery-Mostcommonmode(85%)ofneonatalHSVinfection3.Postnatal-WhenactiveHSVinfectionhasclosecontactwiththenewbornintrauterine5%perinatal85%postnatal10%CLINICALMANIFESTATIONS-Skin,Eye,Mouth-CentralNervousSystem-DisseminatedDisease>90%presentbetw
4、een5-19daysofage>20%NEVERhaveskinlesionsInitialsymptomsvaguein30%LethargyPoorfeedingFeverIrritabilityskin-Usuallypresentsinthefirsttwoweeksoflife-clusteringvesicularlesionswithanerythematousbaseEyes-1.Excessivewateringoftheeye2.Cryingfromapparenteyepain3.Conjunctivalerythema4.Periorbit
5、alskinvesicles5.CanprogresstocataractsandchorioretinitispermanentvisionlossMouth-Localizedulcerativelesionsofthemouth,palate,andtongueCNSDisease1/3ofneonatalHSVdiseaseinvolvestheCNSPresentsinsecond-thirdweekoflifeIrritabilityTremorsPoorfeedingHERPESENCEPHALITIS¼ofHSVdiseaseisinthediss
6、eminatedformPresentinthefirstweekoflifeAffects:liver,lungs,adrenals,CNS,skin,eyes,andmouth,DICDisseminatedDiseaseDiagnosisofNeonatalHSVInfectionGoldstandard=Positivecultureof:lesion,nasopharynx,conjunctiva,rectum,orCSFRapiddiagnosticmethodsPolymerasechainreactiononCSFandbloodFluorescen
7、tantibodystainonvesiclescrapingEEGBrainImagingChestRadiographMaydemonstratebilateral,diffusepneumoniaAbdominalUSMaydemonstrateascitesand/orenlargedliverinneonateswithHSVhepatitisandacuteliverfailureTREATMENTAcycloviristhetreatmentofchoiceDose-skineyemouthinfection60mg/kg/daydividedq8