Herpes simplex virus infection in infants undergoing meningitis evaluation

Andrea T. Cruz, Stephen B. Freedman, Dina M. Kulik, Pamela J. Okada, Alesia H. Fleming, Rakesh D. Mistry, Joanna E. Thomson, David Schnadower, Joseph L. Arms, Prashant Mahajan, Aris C. Garro, Christopher M. Pruitt, Fran Balamuth, Neil G. Uspal, Paul L. Aronson, Todd W. Lyons, Amy D. Thompson, Sarah J. Curtis, Paul T. Ishimine, Suzanne M. SchmidtStuart A. Bradin, Kendra L. Grether-Jones, Aaron S. Miller, Jeffrey Louie, Samir S. Shah, Lise E. Nigrovic

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31 Scopus citations


BACKGROUND: Although neonatal herpes simplex virus (HSV) is a potentially devastating infection requiring prompt evaluation and treatment, large-scale assessments of the frequency in potentially infected infants have not been performed. METHODS: We performed a retrospective cross-sectional study of infants .60 days old who had cerebrospinal fluid culture testing performed in 1 of 23 participating North American emergency departments. HSV infection was defined by a positive HSV polymerase chain reaction or viral culture. The primary outcome was the proportion of encounters in which HSV infection was identified. Secondary outcomes included frequency of central nervous system (CNS) and disseminated HSV, and HSV testing and treatment patterns. RESULTS: Of 26 533 eligible encounters, 112 infants had HSV identified (0.42%, 95% confidence interval [CI]: 0.35%.0.51%). Of these, 90 (80.4%) occurred in weeks 1 to 4, 10 (8.9%) in weeks 5 to 6, and 12 (10.7%) in weeks 7 to 9. The median age of HSV-infected infants was 14 days (interquartile range: 9.24 days). HSV infection was more common in 0 to 28-day-old infants compared with 29- to 60-day-old infants (odds ratio 3.9; 95% CI: Sixty-eight (0.26%, 95% CI: 0.21%.0.33%) had CNS or disseminated HSV. The proportion of infants tested for HSV (35%; range 14%.72%) and to whom acyclovir was administered (23%; range 4%.53%) varied widely across sites. CONCLUSIONS: An HSV infection was uncommon in young infants evaluated for CNS infection, particularly in the second month of life. Evidence-based approaches to the evaluation for HSV in young infants are needed.

Original languageEnglish (US)
Article numbere20171688
Issue number2
StatePublished - Feb 2018

Bibliographical note

Funding Information:
FundinG: Supported by the Section of Emergency Medicine of the American Academy of Pediatrics and Baylor College of Medicine. Dr Freedman is supported by the Alberta Children’s Hospital Foundation Professorship in Child Health and Wellness. This work was supported, in part, by a Clinical and Translational Science Award grant (KL2 TR001862 for Dr Aronson) from the National Center for Advancing Translational Science, a component of the National Institutes of Health (NIH). Fran Balamuth was supported in part by a career development award from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (K23 HD082368). Article contents are solely the responsibility of the authors and do not necessarily represent the official view of NIH. Funded by the National Institutes of Health (NIH).

Publisher Copyright:
© 2018 by the American Academy of Pediatrics. All rights reserved.


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