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| __NOTOC__ | | __NOTOC__ |
| {{SI}}
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| {{CMG}} {{AE}} {{AKI}}
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| {{SK}} | | {{Roseola}} |
| ==Overview==
| | {{CMG}}:{{AE}}{{DAMI}} |
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| ==Historical Perspective==
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| *In 1935, the first case resembling neonatal HSV, was described with the presence of intranuclear inclusion bodies in a premature infant in the liver and the adrenals.<ref name="pmid19970188">{{cite journal| author=Hass GM| title=Hepato-Adrenal Necrosis with Intranuclear Inclusion Bodies: Report of a Case. | journal=Am J Pathol | year= 1935 | volume= 11 | issue= 1 | pages= 127-142.5 | pmid=19970188 | doi= | pmc=1910753 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19970188 }} </ref>
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| ==Classification== | | ==[[Roseola overview|Overview]]== |
| ===Neonatal Herpes Simplex Classification===
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| Neonatal herpes simplex is classified based on the organ system involvement in the neonate into the following:
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| *Disseminated herpes simplex: Involving visceral organs such as lung, liver, adrenal glands, skin, eye, and/or brain
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| *Central nervous system disease: Involvement of the CNS with or without skin lesions
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| *Disease limited to the involvement of skin, eye and mouth (SEM)
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| ===Maternal Genital Herpes Classification===
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| Maternal genital herpes is classified based on HSV type and maternal serology. It is essential to distinguish the type of maternal infection, as the type of infection has influence on the management approach.
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| {| class="wikitable"
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| !Classification of maternal infection
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| !PCR / Culture from the genital lesion
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| !Maternal HSV-1/ HSV-2 Antibody status
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| |-
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| |First episode primary infection
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| |Positive for either virus
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| |Negative for both
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| |-
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| | rowspan="2" |Recurrent infection
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| |Positive for HSV-1
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| |Positive for HSV-1
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| |-
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| |Positive for HSV-2
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| |Positive for HSV-2
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| |}
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| ==Pathophysiology== | | ==[[Roseola historical perspective|Historical Perspective]]== |
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| ===Pathogenesis=== | | ==[[Roseola classification|Classification]]== |
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| *The risk of transmission of infection to the neonate from an infected mother is high (30-50%) who have genital herpes at term and low (<1%) in mothers with prenatal history of recurrent herpes or who have genital HSV during the first and second trimester.<ref name="BrownSelke1997">{{cite journal|last1=Brown|first1=ZaneA.|last2=Selke|first2=Stacy|last3=Zeh|first3=Judy|last4=Kopelman|first4=Jerome|last5=Maslow|first5=Arthur|last6=Ashley|first6=Rhoda L.|last7=Watts|first7=D. Heather|last8=Berry|first8=Sylvia|last9=Herd|first9=Millie|last10=Corey|first10=Lawrence|title=The Acquisition of Herpes Simplex Virus during Pregnancy|journal=New England Journal ofMedicine|volume=337|issue=8|year=1997|pages=509–516|issn=0028-4793|doi=10.1056/NEJM199708213370801}}</ref><ref name="pmid23303485">{{cite journal| author=Pinninti SG, Kimberlin DW| title=Maternal and neonatal herpes simplex virus infections. | journal=Am J Perinatol | year= 2013 | volume= 30 | issue= 2 | pages= 113-9 | pmid=23303485 | doi=10.1055/s-0032-1332802 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23303485 }} </ref><ref name="pmid1849612">{{cite journal| author=Brown ZA, Benedetti J, Ashley R, Burchett S, Selke S, Berry S et al.| title=Neonatal herpes simplex virus infection in relation to asymptomatic maternal infection at the time of labor. | journal=N Engl J Med | year= 1991 | volume= 324 | issue= 18 | pages= 1247-52 | pmid=1849612 | doi=10.1056/NEJM199105023241804 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1849612 }} </ref>
| | ==[[Roseola pathophysiology|Pathophysiology]]== |
| ====Timing of infection====
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| *Exposure to the fetus from active genital herpes lesions during delivery, accounts for majority of neonatal herpes simplex cases. <ref name="pmid12517231">{{cite journal| author=Brown ZA, Wald A, Morrow RA, Selke S, Zeh J, Corey L| title=Effect of serologic status and cesarean delivery on transmission rates of herpes simplex virus from mother to infant. | journal=JAMA | year= 2003 | volume= 289 | issue= 2 | pages= 203-9 | pmid=12517231 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12517231 }} </ref>
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| *Intrauterine infection accounts for 5% of cases with neonatal herpes simplex.
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| *Postnatal trasmission by contact with HSV shed from infected patients. It accounts for 10% of the cases.
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| ====Factors that influence transmission of HSV from the mother to the neonate==== | | ==[[Roseola causes|Causes]]== |
| The factors which influence the transmission of infection include:
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| *Women with primary infection have higher rate of infection transmission when compared to women with recurrent infection.<ref name="Brown2003">{{cite journal|last1=Brown|first1=Zane A.|title=Effect of Serologic Status and Cesarean Delivery on Transmission Rates of Herpes Simplex Virus From Mother to Infant|journal=JAMA|volume=289|issue=2|year=2003|pages=203|issn=0098-7484|doi=10.1001/jama.289.2.203}}</ref>
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| *Maternal HSV antibody status, women with recurrent infection have IgG antibodies aganist HSV which can protect the fetus from infection.
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| *Prolonged duration of rupture of membranes increases the risk of infection transmission.
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| *Use of scalp electrodes can breech the integrity of mucocutaneous barrier increasing the risk of transmission.
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| *Vaginal delivery has a higher risk of transmission of infection compared to cesarean section.
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| ==Epidemiology and Demographics== | | ==[[Roseola differential diagnosis|Differentiating Any Disease from other Diseases]]== |
| *The annual incidence of neonatal herpes is estimated to be 10 cases per 100,000 livebirths.
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| ==Causes== | | ==[[Roseola epidemiology and demographics|Epidemiology and Demographics]]== |
| The causative pathogen for neonatal herpes simplex is herpes simplex virus. The different types involved in the disease are as follows:
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| *85% of cases are caused by HSV type 1
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| *15% of cases are caused by HSV type 2
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| ==Differentiating Neonatal Herpes Simplex From Other Diseases== | | ==[[Roseola risk factors|Risk Factors]]== |
| The most important congenital infections, which can be transmitted vertically from mother to fetus are the [[TORCH infections]]. These infections have overlapping features and hence, must be differentiated from Congenital Varicella Syndrome:<ref name="pmid25677998">{{cite journal |vauthors=Neu N, Duchon J, Zachariah P |title=TORCH infections |journal=Clin Perinatol |volume=42 |issue=1 |pages=77–103, viii |year=2015 |pmid=25677998 |doi=10.1016/j.clp.2014.11.001 |url=}}</ref><ref name="pmid25654000">{{cite journal |vauthors=Ajij M, Nangia S, Dubey BS |title=Congenital rubella syndrome with blueberry muffin lesions and extensive metaphysitis |journal=J Clin Diagn Res |volume=8 |issue=12 |pages=PD03–4 |year=2014 |pmid=25654000 |pmc=4316306 |doi=10.7860/JCDR/2014/10271.5293 |url=}}</ref>
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| <small>
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| {| class="wikitable"
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| !Congenital Infection
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| !Cardiac Findings
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| !Skin Findings
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| !Ocular Findings
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| !Hepatosplenomegaly
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| !Hydrocephalus
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| !Microcephaly
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| !Intracranial Calcifications
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| !Hearing deficits
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| |-
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| !Congenital Varicella Syndrome
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| | -
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| *Cicatrical Skin Lesions
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| *Skin Edema
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| *Micropthalmus
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| *Cataracts
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| |✔
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| |✔
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| |✔
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| |-
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| ![[Toxoplasmosis congenital|Toxoplasmosis]]
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| * [[Petechiae]]
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| * [[Purpura]]
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| * [[Maculopapular rash]]
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| * [[Chorioretinitis]]
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| |✔
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| |✔
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| |✔
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| |Diffuse intracranial calcifications
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| |-
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| ![[Congenital Syphils]]
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| * [[Petechiae]]
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| * [[Purpura]]
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| * [[Maculopapular rash]]
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| * [[Chorioretinitis]]
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| * [[Glaucoma]]
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| |✔
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| |-
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| ![[Rubella, congenital|Rubella]]
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| * [[Patent ductus arteriosus (PDA)]]
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| * [[Pulmonary artery stenosis]]
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| * [[Coarctation of the aorta]]
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| * [[Myocarditis]]
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| * [[Petechiae]]
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| * [[Purpura]]
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| * [[Chorioretinitis]]
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| * [[Cataracts]]
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| * [[Glaucoma]]
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| * [[Microphthalmia]]
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| |✔
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| |✔
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| |✔
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| |✔
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| |-
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| ![[Cytomegalovirus (CMV)]]
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| |✔
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| * [[Petechiae]]
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| * [[Purpura]]
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| * [[Chorioretinitis]]
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| |✔
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| |✔
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| |Periventricular calcifications
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| |✔
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| |-
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| ![[Herpes simplex virus (HSV)]]
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| * [[Myocarditis]]
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| * [[Petechiae]]
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| * [[Purpura]]
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| * [[Vesicles]]
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| * [[Chorioretinitis]]
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| |✔
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| |✔
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| |✔
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| |✔
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| |-
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| ![[Parvovirus B19]]
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| * [[Myocarditis]]
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| * [[Petechiae]]
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| * [[Subcutaneous]] [[edema]]
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| * [[Chorioretinitis]]
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| * [[Cataracts]]
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| |✔
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| |}
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| </small>
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| ==Natural History, Prognosis and Complications== | | ==[[Roseola screening|Screening]]== |
| ===Natural History=== | | |
| ===Prognosis===
| | ==[[Roseola natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
| ===Complications===
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| ==Diagnosis== | | ==Diagnosis== |
| | [[Roseola history and symptoms|History and Symptoms]] | [[Roseola physical examination|Physical Examination]] | [[Roseola laboratory findings|Laboratory Findings]] | [[Roseola electrocardiogram|Electrocardiogram]] | [[Roseola chest x ray|Chest X Ray]] | [[Roseola CT|CT]] | [[Roseola MRI|MRI]] | [[Roseola echocardiography or ultrasound|Echocardiography or Ultrasound]] | [[Roseola other imaging findings|Other Imaging Findings]] | [[Roseola other diagnostic studies|Other Diagnostic Studies]] |
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| ===History and Symptoms===
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| ===Physical Examination===
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| ===Laboratory Findings===
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| ==Treatment== | | ==Treatment== |
| ==Medical Therapy==
| | [[Roseola medical therapy|Medical Therapy]] | [[Roseola surgery|Surgery]] | [[Roseola primary prevention|Primary Prevention]] | [[Roseola secondary prevention|Secondary Prevention]] | [[Roseola cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Roseola future or investigational therapies|Future or Investigational Therapies]] |
| ==Surgical Therapy==
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| ==Prevention==
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| ===Primary Prevention===
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| *Women without known genital herpes should be counseled to abstain from vaginal intercourse during the third trimester with partners known or suspected of having genital herpes.
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| *Pregnant women without known orolabial herpes are advised to abstain from receptive oral sex during the third trimester with partners known or suspected to have orolabial herpes.
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| *All pregnant women should be asked about history of genital herpes. At the onset of labor, all women should be questioned carefully about symptoms of genital herpes, including prodromal symptoms, and all women should be examined carefully for herpetic lesions. Women without symptoms or signs of genital herpes or its prodrome can deliver vaginally. Cesarean delivery does not completely eliminate the risk for HSV transmission to the neonate, women with recurrent genital herpetic lesions at the onset of labor should deliver by cesarean delivery to reduce the risk for neonatal HSV infection.
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| ===Secondary Prevention===
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| *Suppressive acyclovir treatment late in pregnancy reduces the frequency of cesarean delivery among women who have recurrent genital herpes by reducing the frequency of recurrences at term. However, such treatment may not protect against transmission to neonates in all cases. Recommended Regimen : Acyclovir 400 mg orally three times a day OR Valacyclovir 500 mg orally twice a day, beginning from 36weeks of gestation. <ref name="pmid14662233">{{cite journal| author=Sheffield JS, Hollier LM, Hill JB, Stuart GS, Wendel GD| title=Acyclovir prophylaxis to prevent herpes simplex virus recurrence at delivery: a systematic review. | journal=Obstet Gynecol | year= 2003 | volume= 102 | issue= 6 | pages= 1396-403 | pmid=14662233 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14662233 }} </ref><ref name="pmid12634667">{{cite journal| author=Watts DH, Brown ZA, Money D, Selke S, Huang ML, Sacks SL et al.| title=A double-blind, randomized, placebo-controlled trial of acyclovir in late pregnancy for the reduction of herpes simplex virus shedding and cesarean delivery. | journal=Am J Obstet Gynecol | year= 2003 | volume= 188 | issue= 3 | pages= 836-43 | pmid=12634667 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12634667 }} </ref><ref name="pmid12530483">{{cite journal| author=Scott LL, Hollier LM, McIntire D, Sanchez PJ, Jackson GL, Wendel GD| title=Acyclovir suppression to prevent recurrent genital herpes at delivery. | journal=Infect Dis Obstet Gynecol | year= 2002 | volume= 10 | issue= 2 | pages= 71-7 | pmid=12530483 | doi=10.1155/S1064744902000054 | pmc=1784606 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12530483 }} </ref>
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| ==References== | | ==Case Studies== |
| {{reflist|2}}
| | [[Roseola case study one|Case #1]] |