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51 Cards in this Set

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What percent of infants born vaginally to mothers with primary genital infection develop HSV infection?
33% to 50%
What percent of infant born vaginally to mothers shedding HSV as a result of reactivated infection develop HSV infection?
0 to 5%
What percentage of infants who acquire HSV infection have been born to women who had no signs or symptoms suggestive of HSV infection before or during pregnancy?
More than 75%
Most HSV disease in neonates is due to
HSV-2.
When does Neonatal HSV infection occur?
between birth and 4 weeks of age.
What is SEM?
HSV disease localized to any area of the skin, eyes and mouth
What are the 3 ways neonatal HSV disease may present?
1) disseminated disease involving multiple organs, most prominently the liver and lungs and possibly with a central nervous system (CNS) component; 2) disease localized to any area of the skin, eyes, and mouth (SEM); or 3) localized CNS disease
When does disseminated HSV disease usually present?
during the first postnatal week
When does CNS HSV disease usually present?
usually between the second and third weeks after birth.
Which kind of genital HSV infection is more likely to recur?
infections due to HSV-2 are more likely to recur than genital HSV-1 infections.
How long does HSV shedding continue after an initial HSV infection?
About 1 week
How long does HSV shedding continue after recurrent infection?
About 3 to 4 days
How is SEM infection treated?
IV Acyclovir
How is CNS HSV treated?
IV Acyclovir
How is disseminated neonatal HSV treated?
IV Acyclovir
What kind of outcome is there after neonatal HSV infection?
SEM-excellent; others--poor
How is Eczema herpeticum treated?
Consider acyclovir PO
How is genital HSV treated?
Acyclovir, famciclovir, or valaciclovir PO
How is HSV Conjunctivitis/keratitis treated?
Trifluridine, idoxuridine, or vidarabine topical
How is HSV treated in an Immunocompromised host?
Acyclovir IV or foscarnet IV
What causes gingivostomatitis?
usually a primary HSV-1 infection
How does Eczema herpeticum present?
Fever, widespread eruption of vesicles that rapidly become umbilicated pustules, particularly in areas of eczematous involvement.
How does one develop HSV conjunctivitis and keratitis?
usually due to autoinoculation from oral shedding.
What percentage of cases of HSV encephalitis have RBCs in the CSF?
About 50%
Which has worse outcome, HSV encephalitis or meningitis?
Encephalitis; meningitis frequently mild and self-limited.
EEG in patients with HSV Encephalitis
periodic lateralizing epileptiform discharges particularly in the temporal lobe region
MRI in patients with HSV Encephalitis
demonstrates typical abnormalities of edema or hemorrhagic necrosis, particularly in the temporal lobe region involving the white matter.
PCR is the diagnostic test used for
CSF
When is a Tzanck preparation used?
Skin scraping
What sites are cultured for HSV?
Conjunctivae, nasopharynx, skin, rectal swab, blood
Which culture sites have greatest diagnostic yield?
skin or conjunctival cultures
HSV culture is good for what kind of infection?
Skin vesicles; not good yield for encephalitis
Is DFA as good as culture for HSV?
As specific but less sensitive; used for typing
Is serology useful in diagnosing neonatal HSV?
Not very, but specific IgM antibodies may be helpful—usually appear in first 4 weeks after birth and last for months.
Is PCR of CSF useful?
sensitive method in very experienced laboratories
Is Tzanck Preparation a useful test for HSV?
low sensitivity; useful only if positive
Positive Tzanck Preparation
herpes and varicella
Does Cesarean delivery help avoid HSV in neonates?
Cesarean delivery performed in women who have clinically apparent HSV infection may reduce the risk of neonatal HSV infection from 50% to 5% if performed within 4 to 6 hours of membrane rupture
Management of neonate born to mothers who have primary genital infection with HSV?
Cultures +/- empiric treatment
Management of neonate born to mothers who have recurrent genital infection with HSV?
culture of lesions (nasopharynx, conjunctivae, stool, umbilicus) and careful observation for signs of infection, including the development of vesicular lesions of the skin, jaundice, respiratory distress, or seizures
Fall back to treatment with high dose acyclovir?
Neutropenia
What must be monitored during acyclovir treatment?
Renal function and twice weekly neutrophil levels
If neutropenia occurs?
either the acyclovir dose should be decreased or granulocyte-stimulating factor should be added to the regimen
Ophthalmic involvement:
topical ophthalmic drug (1% to 2% trifluridine, 1% iododeoxyuridine, or 3% vidarabine) as well as parenteral antiviral therapy.
does topical acyclovir help with mucocutaneous HSV disease?
Topical acyclovir is ineffective; oral acyclovir has been noted to have a modest clinical effect in children who have primary gingivostomatitis
Do topical corticosteroids help with herpes keratitis?
Topical corticosteroids are contraindicated in suspected HSV conjunctivitis, except in conjunction with antiviral drugs in locally invasive infections.
Treatment of primary genital herpes
oral acyclovir therapy, initiated within 6 days of the onset of disease. Valacyclovir and famciclovir not more effective but more convenient dosing
When is daily oral acyclovir therapy used?
adults who have frequent genital HSV recurrences (at least six episodes per year)
Treatment of acyclovir-resistant HSV in immunocompromised patient
Foscarnet is the drug of choice for disease caused by acyclovir-resistant HSV isolates.
Which results in more morbidity and mortality in neonatal HSV encephalitis, HSV-1 or HSV-2?
HSV-2
Which results in more mortality in HSV disseminated disease, HSV-1 or HSV-2?
HSV-1