19 Dec Study Aims To Predict Outcomes of Neonatal Herpes Simplex Infections
Medical Research: What is the background for this study? What are the main findings?
Dr. Melvin: While relatively uncommon, neonatal Herpes Simplex Virus is a potentially devastating infection with significant morbidity and mortality. We reviewed all of the neonatal HSV cases treated at our institution between 1993 and 2012 who had HSV DNA PCR results available from the plasma and/or CSF. Most of the infants had quantitative PCR results available. The objective of the study was to determine the clinical correlation of HSV PCR levels in the plasma and CSF. We found a clear association between the plasma HSV level, clinical presentation and mortality. All of the infants who died had HSV plasma DNA levels of greater than 7 log10 copies/ml. However, neither plasma nor CSF HSV levels predicted neurologic outcome. Clinical evidence of CNS disease was more predictive of neurologic outcome than was the CSF PCR level. We also showed the most sensitive test for diagnosis of neonatal HSV to be HSV PCR on the plasma. However, no single test diagnostic test (plasma PCR, CSF PCR, surface cultures) was positive across all infants, so it is important to obtain samples from plasma, CSF and surface swabs in infants with symptoms consistent with HSV infection.
Medical Research: What should clinicians and patients take away from your report?
Dr. Melvin: HSV PCR from the blood is useful in the diagnosis of Herpes Simplex Virus infection in neonates and should be included in the diagnostic work-up of neonatal HSV. Infants with HSV infection and compatible clinical symptoms and/or CSF findings should be treated for HSV CNS disease even if the HSV PCR from the CSF is negative. In contrast, detectable HSV DNA in the CSF in the absence of clinical symptoms of CNS infection does not predict a poor neurologic outcome. Plasma HSV DNA PCR is frequently positive in infants with SEM disease and does not by itself indicate disseminated HSV disease.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Melvin: Infants with disseminated Herpes Simplex Virus disease and high HSV DNA levels in the plasma took a long time to clear the HSV, frequently beyond the traditional 21 days of intravenous high-dose acyclovir treatment. Further research is needed on the significance of prolonged HSV viremia and the implications for treatment. Further prospective studies are needed to optimize the use of these assays in the care of infants with HSV disease.
Ann J. Melvin, MD, MPH , Kathleen M. Mohan, ARNP Joshua T. Schiffer, MD, MPH Linda M. Drolette, BS Amalia Magaret, PhD Lawrence Corey, MD Anna Wald, MD, MPH The Journal of Pediatrics
Available online 6 December 2014