DOCSLIB.ORG

Evaluation of the Febrile Young Infant

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Evaluation of the Febrile Young Infant February 2013 Evaluation Of The Febrile Volume 10, Number 2 Young Infant: An Update Author Paul L. Aronson, MD Assistant Professor of Pediatrics, Department of Pediatrics, Abstract Section of Emergency Medicine, Yale School of Medicine, New Haven, CT Peer Reviewers The febrile young infant is commonly encountered in the emergency V. Matt Laurich, MD, FAAP department, and the incidence of serious bacterial infection in these Assistant Professor of Pediatrics, University of Connecticut patients is as high as 15%. Undiagnosed bacterial infections such School of Medicine, Connecticut Children’s Medical Center, as meningitis and bacteremia can lead to overwhelming sepsis and Hartford, CT Deborah A. Levine, MD, FAAP death or neurologic sequelae. Undetected urinary tract infection can Clinical Assistant Professor of Pediatrics and Emergency lead to pyelonephritis and renal scarring. These outcomes necessitate Medicine, New York University School of Medicine, New York, the evaluation for a bacterial source of fever; therefore, performance NY of a full sepsis workup is recommended to rule out bacteremia, CME Objectives urinary tract infection, and bacterial meningitis in addition to other Upon completion of this article, you should be able to: invasive bacterial diseases including pneumonia, bacterial enteritis, 1. Recognize and explain to parents the rationale for performance of the sepsis workup in the well-appearing cellulitis, and osteomyelitis. Parents and emergency clinicians often febrile young infant. question the necessity of this approach in the well-appearing febrile 2. Apply the low-risk criteria to the well-appearing febrile young infant with normal urine, serum, and cerebrospinal young infant, and it is important to understand and communicate studies to avoid unnecessary hospitalization. the evidence that guides the approach to these patients. Recent stud- 3. Consider testing for HSV infection in neonates, especially babies with skin vesicles, hypothermia, ill appearance, ies examining the risk of serious bacterial infection in young infants seizures, or hepatitis. with bronchiolitis and the role of viral testing in the febrile young infant will also be discussed in this review. Prior to beginning this activity, see the back page for faculty disclosures and CME accreditation information. Editor-in-Chief Ari Cohen, MD Division of Emergency Medicine, Tommy Y. Kim, MD, FAAP, FACEP Steven Rogers, MD Chief of Pediatric Emergency Phoenix, AZ Assistant Professor of Emergency Assistant Professor, University of Adam E. Vella, MD, FAAP Medicine Services, Massachusetts Medicine and Pediatrics, Loma Connecticut School of Medicine, Alson S. Inaba, MD, FAAP, Associate Professor of Emergency General Hospital; Instructor in Linda Medical Center and Attending Emergency Medicine PALS-NF Medicine, Pediatrics, and Medical Pediatrics, Harvard Medical School, Children’s Hospital, Loma Linda, Physician, Connecticut Children's Pediatric Emergency Medicine Education, Director Of Pediatric Boston, MA CA Medical Center, Hartford, CT Emergency Medicine, Mount Sinai Attending Physician, Kapiolani School of Medicine, New York, NY T. Kent Denmark, MD, FAAP, FACEP Medical Center for Women & Brent R. King, MD, FACEP, FAAP, Ghazala Q. Sharieff, MD, FAAP, Medical Director, Medical Simulation Children; Associate Professor of FAAEM FACEP, FAAEM AAP Sponsor Center, Professor, Emergency Pediatrics, University of Hawaii Professor of Emergency Medicine Associate Clinical Professor, Martin I. Herman, MD, FAAP, FACEP Medicine, Pediatrics, and Basic John A. Burns School of Medicine, and Pediatrics; Chairman, Children’s Hospital and Health Professor of Pediatrics, Attending Science, Loma Linda University Honolulu, HI; Pediatric Advanced Department of Emergency Medicine, Center/University of California; Physician, Emergency Medicine School of Medicine, Loma Linda, CA Life Support National Faculty The University of Texas Houston Director of Pediatric Emergency Representative, American Heart Medical School, Houston, TX Medicine, California Emergency Department, Sacred Heart Michael J. Gerardi, MD, FAAP, FACEP Association, Hawaii and Pacific Physicians, San Diego, CA Children’s Hospital, Pensacola, FL Clinical Assistant Professor of Robert Luten, MD Island Region Medicine, University of Medicine and Professor, Pediatrics and Gary R. Strange, MD, MA, FACEP Editorial Board Dentistry of New Jersey; Director, Madeline Matar Joseph, MD, FAAP, Emergency Medicine, University of Professor and Head, Department Jeffrey R. Avner, MD, FAAP Pediatric Emergency Medicine, FACEP Florida, Jacksonville, FL of Emergency Medicine, University Children’s Medical Center, Atlantic Professor of Emergency Medicine of Illinois, Chicago, IL Professor of Clinical Pediatrics Garth Meckler, MD, MSHS Health System; Department of and Pediatrics, Assistant Chair and Chief of Pediatric Emergency Associate Professor and Christopher Strother, MD Emergency Medicine, Morristown of Pediatrics, Department of Medicine, Albert Einstein College Fellowship Director, Pediatric Assistant Professor, Director, of Medicine, Children’s Hospital at Memorial Hospital, Morristown, NJ Emergency Medicine; Chief, Emergency Medicine, Oregon Undergraduate and Emergency Pediatric Emergency Medicine Montefiore, Bronx, NY Ran D. Goldman, MD Health & Science University, Simulation, Mount Sinai School of Division, Medical Director, Pediatric Richard M. Cantor, MD, FAAP, Associate Professor, Department Portland, OR Medicine, New York, NY Emergency Department, University FACEP of Pediatrics, University of Toronto; of Florida Health Science Center, Joshua Nagler, MD Professor of Emergency Medicine Division of Pediatric Emergency Research Editor Jacksonville, FL Assistant Professor of Pediatrics, and Pediatrics, Director, Pediatric Medicine and Clinical Pharmacology Harvard Medical School; Pediatric Vincent J. Wang, MD, MHA Emergency Department, Medical and Toxicology, The Hospital for Sick Anupam Kharbanda, MD, MS Emergency Medicine Fellowship Associate Professor of Pediatrics, Director, Central New York Poison Children, Toronto, ON Research Director, Associate Director, Division of Emergency Keck School of Medicine of the Fellowship Director, Department Control Center, Upstate Medical Mark A. Hostetler, MD, MPH Medicine, Boston Children's University of Southern California; University, Syracuse, NY Clinical Professor of Pediatrics and of Pediatric Emergency Medicine, Hospital, Boston, MA Associate Division Head, Emergency Medicine, University Children's Hospitals and Clinics of Division of Emergency Medicine, of Arizona Children’s Hospital Minnesota, Minneapolis, MN Children's Hospital Los Angeles, Los Angeles, CA Case Presentation nate is also at risk for neonatal herpes simplex virus (HSV) infection, a rare but life-threatening disease On an August afternoon, a 20-day-old male presents with that is controversial in its workup and manage- 11 his mother to the ED for a rectal temperature of 38°C. ment. Other current controversies include the util- The baby was born by spontaneous vaginal delivery at ity of the full sepsis workup in febrile young infants 39 weeks gestational age. The mother’s prenatal labs with alternative sources of fever such as respiratory were negative, including negative screening for group syncytial virus (RSV) and bronchiolitis. Understand- B streptococcus. The patient feels warm to the parents ably, parents will question why invasive testing today, but otherwise, he has been asymptomatic. The must be performed in their well-appearing febrile baby is feeding 3 ounces every 4 hours and is making an baby, and the emergency clinician needs to clearly appropriate amount of wet diapers. The physical examina- communicate the rationale behind the management tion is normal, including a flat anterior fontanel and good of patients in this high-risk age group. hydration. When you explain to the mother that the baby will need to undergo the full sepsis workup, including Critical Appraisal Of The Literature lumbar puncture, she asks if all the testing is necessary. What is the probability, since her baby looks so well, that An extensive literature search was performed in the he has a serious bacterial infection? After the testing is PubMed database using multiple combinations of completed, will the baby need to be admitted to the hospi- the search terms febrile young infant, low-risk criteria, tal? Can other infections besides bacterial infections cause neonate, serious bacterial infection, neonatal herpes sim- a fever, and does the baby need testing for these? Would plex virus, and infant less than 90 days old. All relevant the testing and treatment strategy change if the baby were articles were selected, reviewed, and included in the 40 days old? What if he had bronchiolitis with a fever? bibliography. Over 80 articles were reviewed, 68 of which are cited in this article. Emphasis was placed Introduction on reviewing the most important historical evidence as well as recent reports, studies, and guidelines. Commonly encountered in the emergency depart- ment (ED), the febrile young infant is defined as Etiology And Pathophysiology an infant < 90 days of age with a rectal temperature 1 ≥ 38.0°C. (See Table 1. ) Due to their immature im- The febrile young infant has an immature immune 12 2 mune systems and unique pathogens, the febrile system and a high incidence of SBI. In this age young infant is at high risk for bacterial infections, in group, SBIs include UTI/pyelonephritis, bacte- particular, urinary tract infection
Load more

Recommended publications
  • Fever Without Localizing Signs, 0-60 Days
    February 2021 TEXAS CHILDREN’S HOSPITAL EVIDENCE-BASED OUTCOMES CENTER Fever Without Localizing Signs (0-60 Days Old) Evidence-Based Guideline Definition: An acute febrile illness (temperature ≥100.4F Table 1. Signs and Symptoms of Shock (8,9) [38C]) with uncertain etiology after completion of a thorough Cold Warm Shock Non-specific history and physical examination. (1-3) Shock Etiology: The most common cause of fever without localizing Pulses Decreased Bounding signs (FWLS) is a viral infection. The challenge lies in the (central vs. or weak difficulty of distinguishing serious bacterial illness (SBI) from peripheral) viral illness in neonates and early infancy. (4,5) Capillary refill ≥3 sec Flash (<1 Inclusion Criteria: (central vs. sec) Age 0-60 days (Term infants ≥37 weeks gestation) peripheral) Neonates and infants without underlying conditions Mottled, Flushed, Petechiae Actual rectal temp ≥100.4F (38C) OR reported temp cool ruddy, below the (axillary or rectal) of ≥100.4F (38C) in home setting Skin erythroderma nipple, any (other than purpura Exclusion Criteria: face) History of prematurity Decreased, Underlying conditions that affect immunity or may otherwise irritability, increase risk of SBI confusion Toxic/Septic appearance inappropriate Receiving antibiotic treatment for FWLS crying or Routine vaccinations given within the previous 48 hours Mental drowsiness, Presenting with seizures status poor Requiring intensive care management interaction Identified focus of infection (e.g., cellulitis, acute otitis with parents, media in infants >28 days old) lethargy, diminished Differential Diagnosis: arousability, Meningitis obtunded Bone and joint infections *↑ HR followed by HR with BP changes will be noted as shock becomes Pneumonia uncompensated. Urinary tract infection (8,9) Sepsis/Bacteremia Table 2.
    [Show full text]
  • Genotypic and Phenotypic Diversity Within the Neonatal HSV-2
    bioRxiv preprint doi: https://doi.org/10.1101/262055; this version posted February 8, 2018. The copyright holder for this preprint (which was not certified by peer review) is the author/funder. All rights reserved. No reuse allowed without permission. Akhtar et al., biorxiv submission Feb.2018 Genotypic and phenotypic diversity within the neonatal HSV-2 population Lisa N. Akhtar1, Christopher D. Bowen2, Daniel W. Renner2, Utsav Pandey2, Ashley N. Della Fera3, David W. Kimberlin4, Mark N. Prichard4, Richard J. Whitley4, Matthew D. Weitzman3,5*, Moriah L. Szpara2* 1 Department of Pediatrics, Division of Infectious Diseases, Children’s Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine 2 Department of Biochemistry and Molecular Biology, Center for Infectious Disease Dynamics, and the Huck Institutes of the Life Sciences, Pennsylvania State University 3 Division of Protective Immunity and Division of Cancer Pathobiology, Children’s Hospital of Philadelphia 4 Department of Pediatrics, Division of Infectious Diseases, University of Alabama at Birmingham 5 Department of Pathology and Laboratory Medicine, University of Pennsylvania Perelman School of Medicine *Corresponding Authors Moriah L. Szpara Dept. of Biochemistry & Molecular Biology The Huck Institutes of the Life Sciences W-208 Millennium Science Complex (MSC) Pennsylvania State University University Park, PA 16802 USA Phone: 814-867-0008 Email: [email protected] Matthew D. Weitzman Division of Protective Immunity The Children’s Hospital of Philadelphia 4050 Colket Translational Research Building 3501 Civic Center Blvd Philadelphia, PA 19104-4318 Phone: 267-425-2068 Email: [email protected] 1 bioRxiv preprint doi: https://doi.org/10.1101/262055; this version posted February 8, 2018.
    [Show full text]
  • Cytomegalovirus and Herpes Simplex Virus Infections in the Fetus And
    Thesis for doctoral degree (Ph.D.) 2010 Thesis for doctoral degree (Ph.D.) 2010 Cytomegalovirus and herpes simplex virus infections in the fetus and newborn infant, with regard to neurodevelopmental disabilities Cytomegalovirus and herpes simplex virus infections in the fetus and newborn and infant. in the virusfetus herpes infections and simplex Cytomegalovirus Mona-Lisa Engman Mona-Lisa Engman From Division of Pediatrics, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden Cytomegalovirus and herpes simplex virus infections in the fetus and newborn infant, with regard to neurodevelopmental disabilities Mona-Lisa Engman Stockholm 2010 All previously published papers were reproduced with permission from the publisher. Cover: Picture published with permission from Dr Hong Zhou, Deartment of Pathology, Texas University, Houston, USA. Published by Karolinska Institutet. Printed by Reproprint AB © Mona-Lisa Engman, 2010 ISBN 978-91-7409-922-5 Printed by 2010 Gårdsvägen 4, 169 70 Solna To my beloved son Andreas ABSTRACT The congenital cytomegalovirus infection (CMV) is the most common congenital infection causing childhood morbidity. The majority (85%) of infected infants have no signs of infection in the newborn period, and when sequelae such as a hearing deficit or neurological impairment manifest themselves, the possibility of a CMV infection is easily overlooked. Neonatal herpes simplex virus (HSV) infection is a rare but devastating infection. Improvements with regard to outcome have been achieved by antiviral treatment, but the morbidity remains unacceptably high in children following neonatal HSV encephalitis. The general aim of the thesis is to increase the knowledge of childhood morbidity related to CMV and HSV infections.
    [Show full text]
  • Neurological Complications of Herpes Simplex Virus Type 2 Infection
    CLINICAL IMPLICATIONS OF BASIC NEUROSCIENCE RESEARCH SECTION EDITOR: HASSAN M. FATHALLAH-SHAYKH, MD Neurological Complications of Herpes Simplex Virus Type 2 Infection Joseph R. Berger, MD; Sidney Houff, MD, PhD erpes simplex virus type 2 (HSV-2) infection is responsible for significant neurologi- cal morbidity, perhaps more than any other virus. Seroprevalence studies suggest that as many as 45 million people in the United States have been infected with HSV-2, and the estimated incidence of new infection is 1 million annually. Substantial num- Hbers of these persons will manifest neurological symptoms that are generally, although not always, mild and self-limited. Despite a 50% genetic homology between HSV-1 and HSV-2, there are sig- nificant differences in the clinical manifestations of these 2 viruses. We herein review the neuro- logical complications of HSV-2 infection. Arch Neurol. 2008;65(5):596-600 The herpes viruses are responsible for sig- ready been infected by HSV-1. Primary nificant neurological morbidity. Three of HSV-2 infection in immunocompetent ado- the 8 human herpes virus types—herpes lescents and adults is usually asymptom- simplex virus type 1 (HSV-1), HSV-2, and atic, with most patients being unaware of varicella zoster virus—establish latency in their HSV-2 exposure. the peripheral sensory ganglia and per- sist in the host for a lifetime. Primary in- LATENCY AND REACTIVATION fection occurs at a mucocutaneous sur- face with retrograde transportation of the Neurons in the sacral ganglia tradition- virus to the peripheral sensory ganglia, ally have been considered to be the site of maintenance of the viral genome within HSV-2 latency.
    [Show full text]
  • <I>Papio Hamadryas Anubis</I>
    Journal of the American Association for Laboratory Animal Science Vol 45, No 1 Copyright 2006 January 2006 by the American Association for Laboratory Animal Science Pages 64–68 A Naturally Occurring Fatal Case of Herpesvirus papio 2 Pneumonia in an Infant Baboon (Papio hamadryas anubis) Roman F. Wolf,1,* Kristin M. Rogers,3 Earl L. Blewett,4 Dirk P. Dittmer,2 Farnaz D. Fakhari,2 Corey A. Hill,3 Stanley D. Kosanke,1 Gary L. White,1 and Richard Eberle3 Here we describe the unusual finding of herpesvirus pneumonia in a 7-d-old infant baboon Papio( hamadryas anubis). This animal had been separated from its dam the morning of its birth and was being hand-reared for inclusion in a specific- pathogen-free colony. The baboon was presented for anorexia and depression of 2 d duration. Physical examination revealed a slightly decreased body temperature, lethargy, and dyspnea. The baboon was placed on a warm-water blanket and was given amoxicillin–clavulanate orally and fluids subcutaneously. The animal’s clinical condition continued to deteriorate despite tube feeding, subcutaneous fluid administration, and antibiotic therapy, and it died 2 d later. Gross necropsy revealed a thin carcass and severe bilateral diffuse pulmonary consolidation. Histopathology of the lung revealed severe diffuse necrotizing pneumonia. Numerous epithelial and endothelial cells contained prominent intranuclear herpetic inclusion bodies. Virus isolated from lung tissue in cell culture was suspected to be Herpesvirus papio 2 (HVP2) in light of the viral cytopathic effect. Real-time polymerase chain reaction (PCR) analysis and DNA sequencing of PCR products both confirmed that the virus was HVP2.
    [Show full text]
  • Herpes Simplex Virus (Last Updated June 27, 2018; Last Reviewed June 27, 2018)
    Herpes Simplex Virus (Last updated June 27, 2018; last reviewed June 27, 2018) Panel’s Recommendations I. Will condoms (compared with not using condoms) prevent herpes simplex virus (HSV) infection in sexually active adolescents and young adults with HIV? • Condoms should be used to prevent HSV infection (and other sexually transmitted diseases) in adolescents and young adults with HIV (strong; low). The data regarding the level of protection provided by condoms are very limited for individuals with HIV in general, and for youth specifically. II. Will adolescents and young adults with HIV who have recurrent, genital HSV infection benefit from suppressive anti-HSV antiviral therapy (compared with not using suppressive therapy)? • Adolescents and young adults with HIV who suffer severe, frequent, and/or troubling recurrent genital HSV infection will benefit from anti-HSV suppression therapy (strong; moderate). III. Should children and adolescents with HIV who have severe primary or recurrent HSV (genital or orolabial) infection receive intravenous (IV) acyclovir (compared with receiving oral antiviral therapy)? • Children and youth with HIV who have severe mucocutaneous HSV infections should be treated with IV acyclovir. When improvement is noted, they can be switched to oral therapy until healing is complete (strong; moderate). IV. Should children and adolescents with HIV be treated with oral acyclovir, valacyclovir, or famciclovir for non-severe primary episodes or recurrent episodes of orolabial or genital HSV (compared with no antiviral therapy)? • Oral anti-HSV drugs will shorten the duration and reduce the severity of non-severe HSV infections in children and adolescents with HIV. Oral valacyclovir and famciclovir have superior pharmacokinetic profiles compared with oral acyclovir (strong; moderate).
    [Show full text]
  • NMPRA-Perspective-Spring-2021.Pdf
    Spring 2021 The Perspective A quarterly newsletter published by the National Med- Peds Residents’ Association in collaboration with the Med-Peds Program Directors Association & the AAP Section on Med-Peds What’s Inside 1 // 2020-2021 Executive Board 7 // Spotlight On 2 // President’s Welcome 8 // Topics in Med-Peds 3 // NMPRA Elections 10 // Essays 4 // AAP Section on Med-Peds 16 // Cases 5 // Match Day 2021 24 // NMPRA Notes 6 // Classifieds The Perspective 2020-2021’Executive Board Jonathan Phillips Phillips Jonathan Maximillian Cruz Maximillian Urban Sophia Colby Dendy ColbyDendy President President-Elect Past President Treasurer Alexis Tchaconas AlexisTchaconas DeSalvo Jen Adrianna Stanley Stanley Adrianna Leyens Kathryn Secretary PR Secretary Webmaster MPAC Liaison Sasha Kapil Kapil Sasha Lao-Tzu Allan-Blitz Allan-Blitz Lao-Tzu Sophie Sun SophieSun Nick Lee NickLee Dir Community Dir Recruitment/ Dir Health Dir Professional Service/Outreach Med Students Policy/Advocacy Advancement 1 NMPRA medpeds.org The Perspective President’s Welcome Hey Med-Peds family! As I hang up my cleats and transition out of the Presidency role, I just want to thank everyone in our Med-Peds community for all the inspiration you have provided me over the past years. This last year especially highlighted all the reasons that I was initially drawn to this specialty; the advocacy, the stick- to-itiveness, the collaboration, and the growth-mindset that seems to be ever prevalent in this community. I saw applicants come together and help each other out amidst
    [Show full text]
  • Neonatal Herpes: What Lessons to Learn
    CASE REPORT Neonatal herpes: what lessons to learn KL Hon 韓錦倫 TF Leung 梁廷勳 Vesicular rashes in neonates are challenging in terms of diagnosis and management. Herpes 張漢明 HM Cheung infection is an important diagnostic consideration. We report two illustrative neonatal cases 陳基湘 Paul KS Chan of herpesvirus infections with vesicular rashes. Such babies may be remarkably asymptomatic. A high index of suspicion leading to a prompt diagnosis, timely quarantine measures, and institution of antiviral treatment are pivotal for desirable outcomes. Case reports Case 1 An afebrile and asymptomatic neonate with 39 weeks and 6 days of gestation received a 5-day course of intravenous penicillin and gentamicin, because of prolonged rupture of maternal membranes and a slightly elevated plasma C-reactive protein level (14.6 mg/L; reference level, <10 mg/L). He developed a vesicular rash on day 12 of life, initially involving the face and forehead that subsequently spread to the entire body. Spontaneous rupture of the vesicles yielded yellow non-purulent fluid. He was admitted to a newborn unit (Fig 1), and cared for in a cubicle. The mother had childhood chickenpox, and developed some vesicles (which became crusted) on the dorsum of her right hand and arm 2 days before delivery. As chickenpox is an air-borne infection, the neonate was immediately transferred to an isolation room. He was treated as having herpes or a bacterial skin infection with acyclovir plus intravenous ampicillin and cloxacillin, and remained asymptomatic. Immunofluorescence staining of vesicular fluid confirmed the presence of varicella-zoster virus (VZV). Consequently, one cubicle of the newborn unit (involving 12 babies and their parents) was quarantined.
    [Show full text]
  • A Puzzling Diagnosis of Neonatal Herpes Simplex Virus Infection
    Case report BMJ Case Rep: first published as 10.1136/bcr-2020-241405 on 10 March 2021. Downloaded from Prolonged fever and hyperferritinaemia: a puzzling diagnosis of neonatal herpes simplex virus infection during COVID-19 pandemic Mohammed Kamal Badawy ,1 Sophie Hurrell ,1 Catherine Baldwin ,2 Heba Hassan1 1Paediatrics, Southend University SUMMARY lymphohistiocytosis (HLH) that could be induced Hospital NHS Foundation Trust, Neonatal herpes simplex virus (HSV) infection is rare, by infection with HSV. Disseminated infection or Westcliff- on- Sea, UK severe organ dysfunction may also be associated 2 with an estimated incidence of 3.58 per 100 000 Paediatrics, East and North live births in the UK and should be suspected in any with hyperferritinaemia.5 Hertfordshire NHS Trust, newborn with fever and bacterial culture-negative We report the case of disseminated HSV infec- Stevenage, UK sepsis. We describe a case of a previously well full- term tion in a clinically well-term neonate who presented with a persistent unexplained fever that could not Correspondence to male neonate who presented with persistent fever Dr Mohammed Kamal Badawy; and elevated ferritin level that was carried out during be attributed to neonatal sepsis because of the mohammed. badawy@ doctors. the era of the COVID-19 pandemic as part of SARS- absence of other manifestations of sepsis and nega- net. uk CoV-2 panel investigations. Despite the initial negative tive cultures. Extensive screening of SARS-CoV -2 HSV serology, HSV-1 PCR from a scalp lesion returned inflammatory biomarkers was carried out during Accepted 3 March 2021 positive. He made a full recovery after acyclovir therapy.
    [Show full text]
  • Rational Design of Live-Attenuated Vaccines Against Herpes Simplex Viruses
    viruses Review Rational Design of Live-Attenuated Vaccines against Herpes Simplex Viruses Brent A. Stanfield 1, Konstantin G. Kousoulas 2,3,*, Agustin Fernandez 3 and Edward Gershburg 3,* 1 Department of Pathobiological Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA 70803, USA; [email protected] 2 Division of Biotechnology and Molecular Medicine, Louisiana State University, Baton Rouge, LA 70803, USA 3 Rational Vaccines Inc., Woburn, MA 01801, USA; [email protected] * Correspondence: [email protected] (K.G.K.); [email protected] (E.G.) Abstract: Diseases caused by human herpes simplex virus types 1 and 2 (HSV-1 and HSV-2) affect millions of people worldwide and range from fatal encephalitis in neonates and herpes keratitis to orofacial and genital herpes, among other manifestations. The viruses can be shed efficiently by asymptomatic carriers, causing increased rates of infection. Viral transmission occurs through direct contact of mucosal surfaces followed by initial replication of the incoming virus in skin tissues. Subsequently, the viruses infect sensory neurons in the trigeminal and lumbosacral dorsal root ganglia, where they are primarily maintained in a transcriptionally repressed state termed “latency”, which persists for the lifetime of the host. HSV DNA has also been detected in other sympathetic ganglia. Periodically, latent viruses can reactivate, causing ulcerative and often painful lesions primarily at the site of primary infection and proximal sites. In the United States, recurrent genital herpes alone accounts for more than a billion dollars in direct medical costs per year, while there are much higher costs associated with the socio-economic aspects of diseased patients, such as loss of productivity due to mental anguish.
    [Show full text]
  • Management of Genital Herpes in Pregnancy
    Management of Genital Herpes in Pregnancy October 2014 Management of Genital Herpes in Pregnancy Foley E, Clarke E, Beckett VA, Harrison S, Pillai A, FitzGerald M, Owen P, Low-Beer N, Patel R. Guideline date: October 2014 Date of review: by 2018 Guideline development group: Elizabeth Foley MB BS BSc FRCP FRCOG (lead author), Consultant in Genitourinary and HIV Medicine, Solent NHS Trust Emily Clarke BSc BM MSc MRCP (UK), ST3 Genitourinary Medicine, Solent NHS Trust Virginia Beckett MB BS BSc FRCOG (lead author on behalf of RCOG), Consultant Obstetrician and Gynaecologist, Bradford Teaching Hospitals NHS Foundation Trust, Honorary Senior Lecturer, University of Bradford Sam Harrison MRCOG, ST6 Obstetrics and Gynaecology, Bradford Teaching Hospitals NHS Foundation Trust Anil Pillai MRCP, Consultant Neonatologist, Bradford Teaching Hospitals NHS Foundation Trust Mark FitzGerald FRCP, Lead Editor, BASHH guideline on Management of Genital Herpes (2014), BASHH Clinical Effectiveness Group, Consultant Physician in Genitourinary Medicine, Musgrove Park Hospital, Taunton Philip Owen MD FRCOG, Chair (to May 2014), RCOG Guidelines Committee, Consultant Obstetrician and Gynaecologist, Princess Royal Maternity, Glasgow Naomi Low-Beer MBBS MD MRCOG MEd, Consultant Gynaecologist, Chelsea and Westminster Hospital NHS Foundation Trust, Honorary Senior Clinical Lecturer, Imperial College London Rajul Patel FRCP, Senior Lecturer, University of Southampton, Consultant in Genitourinary and HIV Medicine, Solent NHS Trust 2 Contents 1. Objective and scope 4 2. Search strategy 5 3. Background 6 4. Management of pregnant women with first episode genital herpes 8 5. Management of pregnant women with recurrent genital herpes 10 6. Management of women with primary or recurrent genital lesions at the onset of labour 11 7.
    [Show full text]
  • Intrauterine Infection and the Eye
    INTRAUTERINE INFECTION AND THE EYE ISABELLE RUSSELL-EGGITT' and SUSAN LIGHTMAN2 London SUMMARY similar with considerable overlap in the cross-reactivity. This paper reviews the manifestations of intrauterine Primary infection with herpes simplex is uncommon in infection with toxoplasma gondii, rubella, cytomegalovi­ pregnancy and may be asymptomatic or limited to a mild rus, herpes simplex, varicella-zoster and syphilis with pharyngitis with a cutaneous vesicular eruption. Fetal particular emphasis on the ocular findings. infection with herpes simplex is often fatal usually result­ ing in abortion, but if the fetus survives and is born, skin Intrauterine infection is a major cause of inflammation in vesicles or scarring, microcephaly or hydrancephaly, the neonatal eye. Infection in utero can result in resorption encephalitis, chorioretinitis and hepatitis can occur. of the embryo, abortion or stillbirth. If the infant survives Severe disease can result from fetal infection at any time it may be born prematurely, suffer from intrauterine during gestation. growth retardation, be malformed, scarred and the infec­ Like other herpes viruses immunosuppression lights up tion may be still active. Microorganisms may be ter­ latent infection. Most maternalherpes simplex infection is atogenic by causing cell death, alteration in cell growth or a localised recurrent genital vesicular eruption. Herpes chromosomal damage. The varicella-zoster virus, CMV simplex infection in neonates is therefore mostly acquired and rubella probably act in a combination of these ways. by infection at delivery and type 2 is most commonly Inflammationwith subsequent tissue destruction are prob­ responsible. The mortality of newborn infants infected ably the major causes of structural abnormalities in con­ with herpes simplex is high and for this reason caesarean genital syphilis and toxoplasma infection.
    [Show full text]