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Multicenter Study
. 2018 Feb;141(2):e20171688.
doi: 10.1542/peds.2017-1688. Epub 2018 Jan 3.

Herpes Simplex Virus Infection in Infants Undergoing Meningitis Evaluation

Andrea T Cruz  1 , Stephen B Freedman  2 , Dina M Kulik  3 , Pamela J Okada  4 , Alesia H Fleming  5 , Rakesh D Mistry  6 , Joanna E Thomson  7 , David Schnadower  8 , Joseph L Arms  9 , Prashant Mahajan  10 , Aris C Garro  11 , Christopher M Pruitt  12 , Fran Balamuth  13 , Neil G Uspal  14 , Paul L Aronson  15 , Todd W Lyons  16 , Amy D Thompson  17 , Sarah J Curtis  18 , Paul T Ishimine  19 , Suzanne M Schmidt  20 , Stuart A Bradin  21 , Kendra L Grether-Jones  22 , Aaron S Miller  23 , Jeffrey Louie  24 , Samir S Shah  7 , Lise E Nigrovic  16 ; HSV Study Group of the Pediatric Emergency Medicine Collaborative Research Committee
Affiliations
Multicenter Study

Herpes Simplex Virus Infection in Infants Undergoing Meningitis Evaluation

Andrea T Cruz et al. Pediatrics. 2018 Feb.

Abstract

Background: Although neonatal herpes simplex virus (HSV) is a potentially devastating infection requiring prompt evaluation and treatment, large-scale assessments of the frequency in potentially infected infants have not been performed.

Methods: We performed a retrospective cross-sectional study of infants ≤60 days old who had cerebrospinal fluid culture testing performed in 1 of 23 participating North American emergency departments. HSV infection was defined by a positive HSV polymerase chain reaction or viral culture. The primary outcome was the proportion of encounters in which HSV infection was identified. Secondary outcomes included frequency of central nervous system (CNS) and disseminated HSV, and HSV testing and treatment patterns.

Results: Of 26 533 eligible encounters, 112 infants had HSV identified (0.42%, 95% confidence interval [CI]: 0.35%-0.51%). Of these, 90 (80.4%) occurred in weeks 1 to 4, 10 (8.9%) in weeks 5 to 6, and 12 (10.7%) in weeks 7 to 9. The median age of HSV-infected infants was 14 days (interquartile range: 9-24 days). HSV infection was more common in 0 to 28-day-old infants compared with 29- to 60-day-old infants (odds ratio 3.9; 95% CI: 2.4-6.2). Sixty-eight (0.26%, 95% CI: 0.21%-0.33%) had CNS or disseminated HSV. The proportion of infants tested for HSV (35%; range 14%-72%) and to whom acyclovir was administered (23%; range 4%-53%) varied widely across sites.

Conclusions: An HSV infection was uncommon in young infants evaluated for CNS infection, particularly in the second month of life. Evidence-based approaches to the evaluation for HSV in young infants are needed.

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Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
HSV cases and testing by week of life.
FIGURE 2
FIGURE 2
Association between HSV testing, empirical acyclovir usage, and HSV frequency for the 22 study sites that contributed data on acyclovir usage for each variable (HSV testing, acyclovir usage, and HSV burden); hospitals were categorized into pentiles. Hospitals were assigned an aggregate ranking based on the sum of the 3 pentile rankings and are ordered in the figure according to their aggregate ranking. Therefore, hospital 1 had the lowest aggregate rank for HSV testing, acyclovir use, and HSV burden.
See this image and copyright information in PMC

Comment in

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