HSV infection in the neonatal period potentially causes substantial morbidity and mortality. HSV2 accounts for most neonatal cases, while HSV1 causes less than third of reported cases. A high index of suspicion is essential while caring for neonatal patients. Because the clinical symptoms related to neonatal herpes infection are often nonspecific, they may not be recognized early or may be attributed to another serious infection as bacterial sepsis. Disseminated neonatal Herpes, if left untreated may cause mortality rates of approximately 85%, with multi organ involvement including respiratory illness, Disseminated Intravascular Coagulopathy, hepatitis and CNS involvement.
We present a case of neonatal disseminated Herpes, caused by HSV1. The neonate was admitted to our department due to neonatal Fever, on the 6th day of life. She had no reported risk factors for Herpes infection. Initial work up for Herpes infection, as practiced according to our departmental protocol, revealed negative PCR for HSV1&2 in CerebroSpinal Fluid. Bacterial and other viral work up were negative as well. She deteriorated acutely on the 10th day of life, on which acyclovir treatment was also initiated, and succumbed to her illness on the 13th day of live.
As a result of this regretful case, we attempt to offer a standardized protocol for neonatal fever that may assist in identifying the rare (though devastating) low risk neonatal Herpes infections.
