acyclovir and Infant--Newborn--Diseases

We report three cases of patients with developmental-delay from neonatal herpetic encephalitis and/or meningitis who presented years later with acute retinal necrosis due to herpes simplex virus. The diagnosis was delayed in all cases due to the patients' inability to verbalize their ocular complaints and cooperate with eye examinations. This case series documents the clinical course, pathophysiologic mechanism, and treatment of acute retinal necrosis in this patient population. Clinicians should understand the importance of prudent consideration of acute retinal necrosis in patients with a history of neonatal herpetic encephalitis and/or meningitis presenting with a red eye.

Topics: Acyclovir; Adult; Antibodies, Viral; Antiviral Agents; Child; Developmental Disabilities; DNA, Viral; Drug Combinations; Encephalitis, Herpes Simplex; Eye Infections, Viral; Glucocorticoids; Humans; Infant, Newborn; Infant, Newborn, Diseases; Male; Polymerase Chain Reaction; Retinal Necrosis Syndrome, Acute; Simplexvirus; Virus Activation; Vitreous Body

Parenteral therapy of viral infections of the newborn and infant began with vidarabine (adenine arabinoside) for the treatment of neonatal herpes simplex virus (HSV) infections in the early 1980s. Acyclovir has become the treatment of choice for neonatal HSV infections and a variety of other herpesvirus infections. Ganciclovir is beneficial for the treatment of congenital cytomegalovirus (CMV) infections involving the central nervous system (CNS). This article reviews the use of acyclovir and ganciclovir in the treatment of neonatal HSV and congenital CMV infections. A brief summary precedes a detailed discussion of available established and alternative therapeutics.

Topics: Acyclovir; Antiviral Agents; Chickenpox; Cytomegalovirus Infections; Drug Interactions; Female; Ganciclovir; Herpes Simplex; Humans; Infant, Newborn; Infant, Newborn, Diseases; Pregnancy

Neonatal herpes infection is secondary to pre/perinatal viral contamination from mother by HSV2 (70 p. 100) or HSV1 (30 p. 100). Incidence in French population is closed to 3/100,000 live births corresponding to 20 cases per year. Risk for maternal viral transmission to the neonate is 30 p. 100 with genital herpetic primo infection and 3 p. 100 in recurrence. However, in 70 p. 100 of cases, maternal history is not contributive. Three main clinical presentations are described However atypical symptoms - as isolated fever - can be a telltale sign. Mean clinical delay from birth to first clinical symptoms is 6 to 12 days and neonate is usually symptom - free at birth. Viral cultures from pharynx, stools, cutaneous lesions and specific PCR in blood and cerebrospinal fluid confirm the diagnosis. Curative treatment is acyclovir at high dosage - 60 mg/kg/d - during 14 days for localized forms and 21 days for neurological and disseminated diseases. Compared to conventional dosages, this treatment leads to a reduction in mortality which however remains high in disseminated forms, 31 p. 100 and 6 to 11 p. 100 in CNS infection. Morbidity is also high in survived patients, 17 p. 100 and 31 p. 100 respectively. Efficacy of prophylactic viral decontamination by anti-herpetic eye drops and cutaneous polyvidone iodine bath, which is largely used at birth in France, has never been evaluated.

Topics: Acyclovir; Anti-Infective Agents, Local; Antiviral Agents; Drug Therapy, Combination; Female; France; Herpes Simplex; Herpesvirus 1, Human; Herpesvirus 2, Human; Humans; Infant, Newborn; Infant, Newborn, Diseases; Povidone-Iodine; Pregnancy; Pregnancy Complications, Infectious

Topics: Acyclovir; Ampicillin; Anti-Bacterial Agents; Antiviral Agents; Bacterial Infections; Cefotaxime; Cells, Cultured; Cephalosporins; Cytomegalovirus Infections; Diagnosis, Differential; Enzyme-Linked Immunosorbent Assay; Erythromycin; Female; Fetal Diseases; Herpes Genitalis; Humans; Infant, Newborn; Infant, Newborn, Diseases; Penicillins; Pregnancy; Pregnancy Complications, Infectious; Prenatal Diagnosis; Ultrasonography, Prenatal; Virus Diseases

Topics: Acyclovir; Cesarean Section; Female; Fluorescent Antibody Technique; Herpes Genitalis; Herpesviridae; Herpesviridae Infections; Humans; Infant, Newborn; Infant, Newborn, Diseases; Pregnancy; Pregnancy Complications, Infectious; Risk

Topics: Acyclovir; Adult; Antiviral Agents; Chickenpox; Clinical Trials as Topic; Encephalitis; Herpes Simplex; Herpes Zoster; Herpesviridae Infections; Humans; Idoxuridine; Infant, Newborn; Infant, Newborn, Diseases; Keratitis, Dendritic; Trifluridine; Vidarabine

Antiviral compounds have been developed for use in chemoprophylaxis and chemotherapy of a variety of infections in humans, including those caused by influenza viruses, respiratory syncytial virus, and herpesviruses. The efficacy of several of these compounds has been demonstrated in rigorously controlled trials. Advances in molecular virology have led to the identification of biochemically defined, virus-specific functions that serve as appropriate targets for the future development of antiviral compounds. Clinical investigators and practicing physicians are now confronting questions previously raised with the use of antibacterial antibiotics. These questions concern appropriate routes of administration for antiviral compounds, optimal dosage regimens, risks of long-term prophylaxis, and the emergence of resistant organisms.

Topics: Acyclovir; Adult; Aged; Amantadine; Antiviral Agents; Chickenpox; Clinical Trials as Topic; Cytomegalovirus; Encephalitis; Foscarnet; Guanosine Triphosphate; Herpes Simplex; Herpes Zoster; Herpesviridae Infections; Humans; Infant, Newborn; Infant, Newborn, Diseases; Influenza A virus; Influenza, Human; Phosphonoacetic Acid; Respiratory Tract Infections; Ribavirin; Rimantadine; Vidarabine; Virus Diseases

Topics: Acyclovir; Adult; Antiviral Agents; Chickenpox; Clinical Trials as Topic; Encephalitis; Herpes Simplex; Herpes Zoster; Herpesviridae Infections; Humans; Idoxuridine; Infant, Newborn; Infant, Newborn, Diseases; Keratitis, Dendritic; Trifluridine; Vidarabine

To describe a term newborn with acquired severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and multisystem involvement including seizures associated to ischemic lesions in the brain.. Coronavirus disease 2019 (COVID-19) is predominantly a respiratory infection, but it may affect many other systems. Most pediatric COVID-19 cases range from asymptomatic to mild-moderate disease. There are no specific clinical signs described for neonatal COVID-19 infections. In children, severe central nervous system compromise has been rarely reported.. We describe a 17-day-old newborn who acquired a SARS-CoV-2 infection in a family meeting that was admitted for fever, seizures and lethargy and in whom consumption coagulopathy, ischemic lesions in the brain and cardiac involvement were documented.. SARS-CoV-2 neonatal infection can be associated with multi-organic involvement. In our patient, significant central nervous system compromise associated to ischemic lesions and laboratory findings of consumption coagulopathy were found.. Although neonatal SARS-CoV-2 infections are infrequent, they can be associated with multi-organic involvement. Neonatologists and pediatricians should be aware of this unusual way of presentation of COVID-19 in newborn infants.

Topics: Acyclovir; Anti-Bacterial Agents; Antiviral Agents; Brain; Brain Ischemia; Ceftriaxone; COVID-19; COVID-19 Drug Treatment; Fever; Frontal Lobe; Humans; Infant, Newborn; Infant, Newborn, Diseases; Lethargy; Magnetic Resonance Imaging; Male; Nasopharynx; SARS-CoV-2; Seizures

A 10-day-old child was treated for neonatal herpes simplex virus (HSV) central nervous system (CNS) disease with 21 days of intravenous acyclovir and 6 months of oral acyclovir. She presented 7 years later with HSV CNS disease and new lesions in her brain, illustrating the non-benign nature of delayed recurrent HSV CNS disease.

Topics: Acyclovir; Antiviral Agents; Brain; Child; Encephalitis, Herpes Simplex; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Magnetic Resonance Imaging; Neuroimaging; Recurrence; Simplexvirus

The use of empiric acyclovir for suspected neonatal herpes simplex virus (HSV) infection has been debated for years. To identify the gap in the decision to initiate empiric acyclovir, we performed a retrospective chart review and administered a survey to pediatricians to assess current practices regarding evaluation for possible HSV infection. Seventy infants received empiric acyclovir over a 1-year period; of these, 3 infants (4.3%) had positive HSV testing. Fourteen infants were identified as "high-risk" for HSV infection; of these, 13 infants had incomplete testing. Survey results revealed uncertainty in the decision to initiate acyclovir and in the composition of complete diagnostic testing. This study confirmed the clinical uncertainty in the decision to initiate empiric acyclovir. Using this chart review and survey as a baseline, future efforts will focus on a quality improvement project to reduce empiric acyclovir use in low-risk infants and to ensure complete diagnostic evaluation in high-risk infants.

Topics: Acyclovir; Herpes Simplex; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Male; Prospective Studies; Retrospective Studies

Polymerase chain reaction testing of blood for herpes simplex virus (HSV) is recommended for newborns delivered to mothers with active genital HSV lesions at delivery. We report an infant who had a positive blood HSV polymerase chain reaction test before the onset of clinical signs of HSV disease.

Topics: Acyclovir; DNA, Viral; Female; Hematologic Tests; Herpes Simplex; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infectious Disease Transmission, Vertical; Polymerase Chain Reaction; Pregnancy; Pregnancy Complications, Infectious; Simplexvirus

Topics: Acyclovir; Antiviral Agents; Chickenpox; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Skin

The goal was to describe herpes simplex virus (HSV) disease in neonates whose mothers received suppressive acyclovir therapy for HSV infection.. A multicenter case series of 8 infants who developed neonatal HSV disease following maternal antiviral suppressive therapy during pregnancy.. Eight infants were identified from New Jersey (5), Maine (1), New York (1), and Texas (1) between 2005 and 2009. All 6 mothers of infants infected with HSV who were screened prenatally for group B Streptococcus were positive; 1 mother was not tested and the other had bacterial vaginosis and genital human papillomavirus infection. Six mothers had a first clinical episode of genital HSV infection during this pregnancy; mothers with a prior history of genital HSV had no clinically recognized outbreak during the pregnancy. Perinatal transmission of HSV occurred in 7 infants (despite suppressive therapy until the day of delivery in 5 instances). Seven of 8 patients were born at term; 6 infants were male. In 7 of 8 cases, HSV was diagnosed by 8 days of age. Five infants had skin, eye, and mucous membrane disease, 2 had central nervous system disease (without and with disseminated disease), and one had intrauterine/disseminated disease.. Although maternal antiviral suppressive therapy is an increasingly wide practice, physicians caring for neonates should be aware that suppressive therapy does not prevent neonatal HSV disease, which can have an atypical clinical presentation and drug resistance.

Topics: Acyclovir; Adult; Antiviral Agents; Female; Herpes Simplex; Humans; Infant, Newborn; Infant, Newborn, Diseases; Male; Pregnancy; Pregnancy Complications, Infectious; Retrospective Studies; Treatment Failure; Young Adult

Neonatal varicella infection is a rare condition since vaccine introduction. The authors report the case of a 12-day-old male who presented with a fever and generalised vesicular eruption. The patient's mother had varicella infection 1 day before delivery without treatment. The neonate initially did not receive prophylaxis or treatment. He subsequently was started on intravenous acyclovir and recovered without further complications or sequelae. Prompt diagnosis and treatment for maternal prenatal varicella infection is necessary to prevent infection in the newborn, and healthcare provider awareness to avoid nosocomial transmission.

Topics: Acyclovir; Adolescent; Antiviral Agents; Chickenpox; Female; Fever; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infectious Disease Transmission, Vertical; Male; Pregnancy; Pregnancy Complications, Infectious

Despite the tremendous advances made in the management of genital herpes, neonatal herpes has not been completely eradicated. In addition, the time from the onset of symptoms in the neonate to the diagnosis of herpes and institution of antiviral medication has remained unchanged in the past 20 years.. Neonatal herpes infection resulted from primary, first-episode peripartum genital herpes in the mother. Due to a high index of suspicion, herpes testing was performed on the infant and neonatal herpes diagnosed. Subsequently, the mother developed evidence of primary herpes infection.. This case report illustrates the problems with current management strategies for prevention of neonatal herpes.

Topics: Acyclovir; Adolescent; Antiviral Agents; Female; Herpes Simplex; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infectious Disease Transmission, Vertical; Obstetric Labor Complications; Pregnancy; Pregnancy Complications, Infectious

Herpes simplex virus (HSV) infection can affect various organs-systems in the neonatal period. Herpetic hepatitis was seldom reported in the literature. We report on 2 cases. Firstly, a 16 day-old newborn infant was admitted because of haemorrhagic syndrome and shock. Biological assessment showed a severe hepatic insufficiency. Antibiotic and aciclovir therapy was started as HSV infection was suspected. Five days later, the herpetic attack was confirmed by polymerase chain reaction (PCR) in blood and cerebrospinal fluid (CSF). The genotye of the virus in the CSF was HSV1. Treatment included aciclovir for 21 days intravenously and 2 months orally. At 10 months, the clinical and biological examinations were normal. Secondly, a 4 day-old newborn was hospitalised because of fever and polypnea. Pulmonary X rays showed heterogeneous opacities of the right base. Serum C reactive protein was 30 mg/l. Antibiotic therapy was started. Two days later, the fever persisted while a severe hepatic insufficiency developed. The diagnosis of herpetic hepatitis was evoked and the child was given aciclovir. Forty-eight hours later, the PCR confirmed a HSV in blood, while viral culture of a mouth swab found HSV 2. Evolution was favourable after 21 days of specific and symptomatic treatment. Aciclovir treatment was continued orally for six months. Herpetic hepatitis is rare in the neonatal period. Diagnosis must be evoked early when facing severe neonatal hepatic insufficiency. Provided specific treatment, prognosis is good.

Topics: Acyclovir; Antiviral Agents; Hepatitis, Viral, Human; Herpes Simplex; Humans; Infant, Newborn; Infant, Newborn, Diseases; Male; Prognosis; Simplexvirus

Herpes simplex virus (HSV) infections of the central nervous system (CNS) can occur within weeks after birth (neonatal HSV disease) or in childhood or adulthood [herpes simplex encephalitis (HSE)]. Most cases of neonatal HSV disease are caused by HSV type 2, whereas virtually all cases of HSE are caused by HSV type 1. Diagnostic advances made during the past decade include the application of polymerase chain reaction (PCR) technology to cerebrospinal fluid from patients with suspected HSV CNS disease to evaluate for the presence of HSV DNA. Although not foolproof, PCR is a powerful diagnostic tool that has supplanted brain biopsy as the modality of choice for diagnosing HSV CNS disease, in no small part because of the invasiveness of brain biopsy. PCR also can provide information regarding the therapeutic response to antiviral therapy. Efforts made during the past decade to improve the outcome of HSV CNS disease have focused on increased doses of intravenous acyclovir administered for longer durations of time. Although advances have been achieved, morbidity and mortality rates from neonatal HSV disease and HSE remain unacceptably high.

Topics: Acyclovir; Antiviral Agents; Central Nervous System Diseases; Encephalitis, Viral; Female; Herpes Simplex; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infectious Disease Transmission, Vertical; Polymerase Chain Reaction; Pregnancy; Pregnancy Complications, Infectious; Risk Factors; Simplexvirus

Involvement of the gastrointestinal tract in neonates with congenital herpes simplex virus (HSV) infection is rarely described. We report a case of a newborn with disseminated HSV infection associated with profuse hematochezia and late sigmoid colon perforation. Histologic examination showed patchy areas of ulceration with multinucleated giant cells and HSV nucleic acid was detected by polymerase chain reaction in colonic tissue. No clinically apparent episodes of recurrent colitis occurred in the first year of life.

Topics: Acyclovir; Ampicillin; Anti-Bacterial Agents; Antiviral Agents; Enterocolitis; Female; Gentamicins; Herpes Simplex; Humans; Infant, Newborn; Infant, Newborn, Diseases; Penicillins

Each year, about 1,600 infants in the United States are infected with neonatal herpes simplex virus. We conducted a cost-effectiveness analysis of antiviral drug therapy (acyclovir) for three forms of herpes simplex virus infection: skin, ear, and mouth (SEM), central nervous system (CNS), and disseminated multiorgan (DIS) disease. Five levels of patient outcomes were examined (normal, mild, moderate, severe, dead). We obtained information on disease occurrence and survival from clinical trials and historical reviews of untreated newborns. We considered approaches for treating all or any of the forms of the disease and compared them with no use of antiviral drugs. The main measure of effectiveness was lives saved, including those of descendants of survivors. Costs were measured from a societal perspective and included direct medical costs, institutional care, and special education. We used a discount rate of 3% and valued dollars at 1995 levels. We also considered the perspective of a managed care organization. From a societal viewpoint relative to no treatment, antiviral therapy for SEM resulted in a gain of 0.8 lives and a cost reduction of $78,601 per case. For the treatment of CNS and DIS disease, antiviral therapy saved more lives but at increased cost, with respective marginal costs per additional life saved of $75,125 and $46,619. From a managed care perspective, antiviral therapy is more cost-effective than from a societal viewpoint because costs of institutional care and special education are not the responsibility of managed care organizations. Development of at-home therapies will further improve the cost-effectiveness of antiviral therapy for neonatal herpes simplex virus infection.

Topics: Acyclovir; Antiviral Agents; Cost of Illness; Cost-Benefit Analysis; Disease Progression; Herpes Simplex; Humans; Infant, Newborn; Infant, Newborn, Diseases; Managed Care Programs; Quality-Adjusted Life Years; Treatment Outcome; United States

Topics: Acyclovir; Antiviral Agents; Encephalitis; Female; Herpes Genitalis; Herpes Simplex; Herpesviridae Infections; Humans; Infant, Newborn; Infant, Newborn, Diseases; Keratoconjunctivitis; Male; Skin Diseases, Infectious; Vidarabine

Topics: Acyclovir; Female; Herpes Genitalis; Humans; Infant, Newborn; Infant, Newborn, Diseases; Male; Pregnancy

Nine infants with symptomatic infections caused by herpes simplex virus or cytomegalovirus were treated with acyclovir. At the onset of therapy, the infants ranged in weight from 880 to 4550 gm. Five were premature. Acyclovir was administered intravenously in a dosage of 5 to 15 mg/kg every eight hours for five to 10 days. The peak serum acyclovir levels ranged from 20 to 163 microM and the trough levels ranged from 1 to 129 microM. The variation in peak serum acyclovir levels in different infants receiving the same dosage on a weight basis was large but correlated with the expected renal maturity of the individual infant. Hematologic values improved during therapy. No renal toxicity was noted. All of the infants survived, including the five with herpes simplex infections.

Topics: Acyclovir; Antiviral Agents; Cytomegalovirus Infections; Guanine; Herpes Simplex; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature, Diseases; Kidney; Leukocyte Count; Liver

A preliminary analysis is presented of the pharmacokinetics of acyclovir in neonatal patients with herpes simplex virus infections. Mean peak acyclovir levels (microM +/- SD) at 5, 10, and 15 mg/kg per dose were 30.0 +/- 9.9, 61.2 +/- 18.3, and 86.1 +/- 23.5, with corresponding mean trough levels (microM +/- SD) of 5.3 +/- 3.4, 10.1 +/- 8.4, and 13.8 +/- 11.1, respectively. The mean half-life (t 1/2 beta) of acyclovir was 3.78 +/- 1.21 hours. The mean percent urinary recovery of acyclovir (+/- SD) at each dosage level was similar, with an overall mean recovery of 65 percent. The mean acyclovir concentration in urine did not exceed the solubility of acyclovir in bladder urine (1,300 micrograms/ml). Generally, neonatal acyclovir pharmacokinetics was consistent with previous reports from studies of adults.

Topics: Acyclovir; Antiviral Agents; Cytomegalovirus Infections; Guanine; Herpes Simplex; Herpesviridae Infections; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Infusions, Parenteral; Kinetics

Topics: Acyclovir; Adolescent; Adult; Female; Herpes Genitalis; Humans; Infant, Newborn; Infant, Newborn, Diseases; Male