acyclovir and Infant--Premature--Diseases

We report a case of non-immune hydrops fetalis (NIHF) caused by herpes simplex virus type 2 (HSV-2) in an infant whose mother had recurrent HSV-2 infection. In spite of prematurity, severe disseminated infection and hydrops, the infant survived and was neurologically intact. HSV-2-induced NIHF is extremely rare, particularly in the setting of recurrent maternal infection, and this case is, to our knowledge, the first report of a surviving infant. HSV-2 should be considered in the differential diagnosis of NIHF and early initiation of empiric acyclovir therapy is recommended in this setting, pending the results of virologic diagnostic tests.

Topics: Acyclovir; Antiviral Agents; Extraembryonic Membranes; Female; Fetal Membranes, Premature Rupture; Herpes Genitalis; Humans; Hydrops Fetalis; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Male; Pregnancy; Pregnancy Complications, Infectious; Recurrence; Young Adult

Topics: Acyclovir; Anti-Bacterial Agents; Antiviral Agents; Diagnosis, Differential; Drug Therapy, Combination; Exanthema; Female; Herpes Simplex; Herpesvirus 1, Human; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Infectious Disease Transmission, Vertical; Mouth Mucosa; Skin Diseases, Vesiculobullous

Eczema herpeticum is caused by herpes simplex infection of atopic dermatitis. The infection typically causes a vesiculopustular rash, but can disseminate and be life threatening.. A primigravida with a history of eczema and hypogammaglobulinemia presented at 28 weeks of gestation with preterm labor, fever, and extensive rash. After failed tocolysis, she delivered vaginally. Prompt treatment with parenteral acyclovir was initiated for both patients based on a clinical diagnosis of maternal eczema herpeticum. Cultures confirmed the diagnosis of eczema herpeticum and rectal swab of the infant was positive for herpes simplex virus. The mother and infant did well.. Early diagnosis and treatment of eczema herpeticum is necessary to prevent poor outcomes in pregnancy. Prophylactic acyclovir may help prevent eczema herpeticum in pregnancy.

Topics: Acyclovir; Adolescent; Antiviral Agents; Female; Humans; Infant, Newborn; Infant, Premature, Diseases; Kaposi Varicelliform Eruption; Pregnancy; Pregnancy Complications, Infectious

Cutaneous herpes simplex virus type 2 (HSV-2) infection was recognized at 19 days of age in a 1415-g female infant born at 31 weeks of gestation. Cerebrospinal fluid (CSF) HSV polymerase chain reaction (PCR) was negative, and MRI of the brain was normal. After a 14-day course of high-dose intravenous acyclovir, the infant developed a cutaneous recurrence at 38 days of age. CSF HSV PCR again was negative. She was subsequently begun on oral acyclovir to prevent cutaneous reactivation of HSV. At 3 months of age, the infant developed HSV encephalitis as manifested by fever, seizures, abnormal CSF indices, abnormal brain MRI, and positive CSF HSV PCR. No cutaneous disease was present. It is not known whether the HSV encephalitis in our patient represented reactivation of previously unrecognized central nervous system infection or new onset of central nervous system disease as a result of spread from other tissue or site to the brain. The failure of oral acyclovir to prevent such an occurrence, however, highlights gaps in our understanding of the pathogenesis of neonatal HSV disease and questions the use of acyclovir suppression to prevent neurologic sequelae.

Topics: Acyclovir; Administration, Oral; Antiviral Agents; Brain; Encephalitis, Herpes Simplex; Female; Herpes Simplex; Herpesvirus 2, Human; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Injections, Intravenous; Magnetic Resonance Imaging; Polymerase Chain Reaction; Radiography; Recurrence; Seizures; Virus Activation

The authors present a case of a preterm newborn with congenital infection of herpes simplex virus type 2. The patient was treated with newly recommended high intravenous doses of acyclovir. It can be supposed that it reduces mortality, but the high morbidity continues to be a problem.

Topics: Acyclovir; Encephalitis, Viral; Herpes Simplex; Herpesvirus 2, Human; Humans; Infant, Newborn; Infant, Premature, Diseases

We describe a 14-month-old patient with atypical presentation of herpes simplex encephalitis. She initially presented with fever, lethargy, seizures, and large hemorrhages in the right parietal lobe, and clinical findings suggestive of a hypercoagulable state. The etiology of coagulation abnormality was not identified, although it was suggested as a possible causative factor in severe bleeding along with acute neuronal lysis as a result of infection. Although large intracerebral hemorrhages are occasionally described with systemic herpes infection, this presentation is unusual beyond the infant period.

Topics: Acyclovir; Adolescent; Blood Coagulation Tests; Cerebral Cortex; Cerebral Hemorrhage; Diagnosis, Differential; Encephalitis, Herpes Simplex; Female; Follow-Up Studies; Humans; Infant; Infant, Newborn; Infant, Premature, Diseases; Magnetic Resonance Imaging; Neurologic Examination; Polymerase Chain Reaction; Pregnancy; Tomography, X-Ray Computed

During the 2 decades in which effective antiviral therapies have been available for neonatal herpes simplex virus (HSV) disease, changes have been documented not only in the outcomes of infected infants, but also in the natural history of the disease itself. Numerous studies previously have reported that early institution of antiviral therapy is beneficial to the outcome of the disease. The objective of this study was to provide an update of neonatal HSV disease to identify means by which future improvements in the management of HSV-infected neonates can be made.. Neonates enrolled in 2 studies of parenteral acyclovir for the treatment of neonatal HSV disease provided the data source. The National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group conducted the studies between 1981 and 1997. A total of 186 patients are summarized, all of whom were treated with acyclovir. Demographic and clinical characteristics of these patients are reported.. Comparisons between patients treated in the periods between 1981-1988 and 1989-1997 according to extent of disease revealed that the mean time between the onset of disease symptoms and initiation of therapy has not changed significantly from the early 1980s to the late 1990s. Of all patients evaluated, 40% had fetal scalp monitors during the delivery process. A significant minority of patients did not have skin vesicles at the time of their presentation and did not develop them during the acute HSV disease (39% of patients with disseminated disease; 32% of patients with central nervous system [CNS] disease; and 17% of patients with skin, eye, and/or mouth disease). Among patients with CNS disease, mortality was associated with prematurity. Among patients with disseminated HSV disease treated with acyclovir at 30 mg/kg/d, mortality was associated with aspartate transaminase elevations of >/=10 times the upper limit of normal at the time of initiation of acyclovir therapy. Mortality was also associated with lethargy at initiation of antiviral therapy for patients with disseminated disease. Patients' morbidity status was associated with the extent of disease (skin, eye, and/or mouth disease vs CNS vs disseminated). For those patients with CNS disease, morbidity was also associated with seizures at initiation of antiviral therapy.. Data presented in the current comparison of neonatal HSV disease over the 2 periods (1981-1988 vs 1989-1997) demonstrate that no progress has been made in decreasing the interval between onset of HSV symptoms and initiation of antiviral therapy. Additional strides in the improvement of disease outcome may occur only if the interval between onset of symptoms and initiation of therapy is shortened. The means by which this will be accomplished lie in increased consideration of neonatal HSV infections in acutely ill infants. Specific data and recommendations to facilitate this goal are contained within.

Topics: Acyclovir; Antiviral Agents; Aspartate Aminotransferases; Diagnosis, Differential; Diagnostic Imaging; Electroencephalography; Herpes Simplex; Herpesvirus 1, Human; Herpesvirus 2, Human; Humans; Infant; Infant, Newborn; Infant, Premature, Diseases; Infusions, Parenteral; Proportional Hazards Models; Prospective Studies; Treatment Outcome

A fatal case of fulminant hepatic failure that occurred in the neonatal period is reported in a premature infant born after 27 4/7-weeks' gestation. Immediately after birth the infant had severe hypoxia and hypotension resulting from birth asphyxia, hypovolemic shock, and septicemia. At autopsy, histological appearance of the liver showed virtually total hepatocellular necrosis without features of fibrosis. Although the exact cause of hepatocellular injury cannot be fully ascertained, it is assumed that hypoxia and hypotension must have been the predominant factors leading to massive hepatic necrosis.

Topics: Acyclovir; Alanine Transaminase; Aspartate Aminotransferases; Bicarbonates; Cloxacillin; Dopamine; Female; Fetal Hypoxia; Fetal Membranes, Premature Rupture; Humans; Infant, Newborn; Infant, Premature, Diseases; Liver; Male; Necrosis; Netilmicin; Pancuronium; Partial Thromboplastin Time; Penicillins; Pregnancy; Prothrombin Time; Sepsis; Shock; Sodium; Sodium Bicarbonate

Topics: Acyclovir; Adult; Diseases in Twins; Drug Therapy, Combination; Female; HIV Infections; HIV-1; Humans; Infant, Newborn; Infant, Premature, Diseases; Ketoconazole; Patient Compliance; Pregnancy; Pregnancy Complications, Infectious; Zidovudine

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