K28 b Congenital HSV kbk.ppt

8/18/2019 K28 b Congenital HSV kbk.ppt

1/25

Congenital/Neonatal

Herpes Simplex InfectionsInfectious and Tropical Pediatric

Division

Department of Child Health

Medical Facult

!niversit of Sumatera !tara


2/25

Herpes Infections"Herpes# $ from the%ree& "to creep'cra(l#

"Herpeticeruptions#descri)ed as earl

as *++ ,D*-.+s $ HS0* andHS01 di2erentiated

HH0* $ HS0*

HH01 $ HS01

HH03 $ 040

HH05 $ 670

HH08 $ CM0

HH0. $ Causes9HH0: $

HH0;


3/25

Neonatal HS0* in 1'8++ 18


4/25

Boutes of Transmission;8? via infectedmaternal genital

tract,scendinginfection9

6n route

*+? postpartum

8? @or lessA $intrauterine/congenital infection


5/25

Congenital HS0Bare' mostdevastating

nl 8+ casesdescri)ed

S&in vesicles

Chorioretinitis

MicrocephalMicro


6/25

S&in' 6e' Mouth @S6MA,pproximatel G ofall HS0 infections

*st


7/25

S6M @contAong termneurologic

seuelae seen in3+? of cases $even if treated

phthalmolog

involvement


8/25

"Presenting Part# @S6MA

HSV / Arm (e$ion$

0 'ay$ of (ifePre$entin1 (imb in a .2 ee3

Premat4re Infant


9/25

HS0 < CNS Disease6ncephalitis (ithoutvisceral involvement'mainl involving the

temporal lo)es

6arl to 3rd (ee& oflife presentation

S&in lesions ma

appear late' if at all

38? of all cases'onl 1


10/25

Badiographic Findings


11/25

Disseminated Disease,pproximatel 1+?of all infections

Hepatitis

Pneumonitis

DIC

Infant ma )e ill onrst da of life

S&in lesions appearlate' or not at all


12/25

Signs


13/25

Postnatal acuisitionMost commonlHS0*

Moms (ith HS0Mas&

7reastfeeding $=J= if (ithout

lesions


14/25

Contacts"Personnel (ithan active herpetic

(hitlo( shouldnot have directpatient care ofneonates#=

Familtransmission has)een descri)ed


15/25

Mor)idit and Mortalit


16/25

Ta&e Home MessageInfection is most common (hen amother develops a genital infection

late in pregnanc @ her primarHS0* or HS01 infectionA $ thendelivers )efore the development of

protective maternal anti)odies


17/25

Herpes Simplex,pproximatel 5% of the generalpopulation has )een diagnosed

(ith genital herpes $ )utapproximatel 20-30% of (omenmay be infected (ith HS0


18/25

Herpes during Pregnanc,s man as 1? of pregnant (omen areinfected (ith HS01 during pregnanc

18? of (omen (ith a histor of genitalherpes have an out)rea& at some timeduring their pregnanc' **


19/25


20/25

7 Management:+s


21/25

Diagnostics

HS0 Cx $ positive

in *


22/25

PCB TestingDetects minuteamounts of DN,'BN,

DISS6M $ -3?

CNS $ :.?

S6M $ 15?

False negative ma

occur if CSF iso)tained "too earl#

rder through I0FK


23/25

Diagnostics @contASurface cultures

Mouth @5+


24/25

Treatment < ,cclovirS6M infections

.+mg/&g/da divided ;h for *5 das

Ma )e lengthened to 1* das in the nearfuture

ral ,cclovir needed later in life9

DISS6M and CNS HS0 infections

.+mg/&g/da divided ;h for 1* dasBe


25/25

Ta&e Home MessagesMost neonates (ithHS0 infection are)orn to mothers (ith

asmptomaticgenital shedding atdeliver' (ith nohistor of genitalherpetic lesions

No one test is *++?sensitive / specic

Keep HSV in mind

Documents

K28 b Congenital HSV kbk.ppt