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The following text is from an archived Red Book® edition and may not reflect current recommendations or information. To view the current edition, click here.
Section 3. Summaries of Infectious Diseases
Herpes Simplex
Clinical Manifestations
Etiology
Epidemiology
Diagnostic Tests
Treatment
Isolation of the Hospitalized Patient
Control Measures
CLINICAL MANIFESTATIONS:
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Neonatal. In newborns, herpes simplex virus (HSV) infection can manifest as the following: (1) disseminated disease involving multiple organs, most prominently liver and lungs; (2) localized central nervous system (CNS) disease; or (3) disease localized to the skin, eyes, and mouth. Approximately one third of cases are disseminated, one third are CNS disease, and one third affect the skin, eyes, and mouth, although there may be clinical overlap among disease types. In many neonates with disseminated or CNS disease, skin lesions do not develop or the lesions appear late in the course of infection. In the absence of skin lesions, the diagnosis of neonatal HSV infection is difficult. Disseminated infection should be considered in neonates with sepsis syndrome, negative bacteriologic culture results, and severe liver dysfunction. Herpes simplex virus also should be considered as a causative agent in neonates with fever, irritability, and abnormal cerebrospinal fluid (CSF) findings, especially in the presence of seizures. Although asymptomatic HSV infection is common in older children, it rarely, if ever, occurs in neonates.
Neonatal herpetic infections often are severe, with attendant high mortality and morbidity rates, even when antiviral therapy is administered. Recurrent skin lesions are common in surviving infants and may be associated with CNS sequelae if skin lesions occur frequently during the first 6 months of life.
Initial symptoms of HSV infection can occur anytime between birth and approximately 4 weeks of age. Disseminated disease has the earliest age of onset, often during the first week of life; CNS disease manifests latest, usually between the second and third weeks of life.
Children Beyond the Neonatal Period and Adolescents. Most primary HSV infections are asymptomatic.
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