Thursday, June 23, 2011

Neonatal infections - Infection with herpes simplex virus (HSV)

Mode of transmission-for VHS-2, the most common route of transmission is during expulsion from the mother with genital infection.For HSV-1 mode of transmission is airborne.A 95% of neonatal infections result from intrapartum infection.Infection in newborns can be located in the skin, eyes, mouth, in 40% and can occur in 6-9 day life.Generalized infection occurring in 22%, with a mortality of 57%.Symptoms occurring within 3 days of life with severe lung, liver or other visceral determination (CNS). Manifestations include respiratory distress syndrome, shock, convusii, encephalitis, disseminated intravascular coagulation (DIC).
Intrauterine infection with herpes simplex virus is rare, only 5% of neonatal infections develop this type of infection.The most common transmission is intrapartum, maternal genital tract.
Genital infection with herpes simplex virus (HSV) is complex because: Many infections are asymptomatic, the virus reactivates periodically throughout life, primary and recurrent infection can not be differentiated clinically.Neonatal exposure to secondary genital infection is more common than exposure to a primary infection. Neonatal risk of contamination is higher in primary infection (30-35%) than secondary (5%).
Clinical signs:
Infection acquired in utero is clinically different from that acquired at birth.If infection in utero, the infant may have skin lesions, scars, chorioretinitis, micro or hydrocephalus.
Fatal cases can evolve. Survivors of severe neurological sequelae may: developmental delays, hearing and eye defects.
Perinatal infection can be divided into three clinical entities:- Located in the skin, eyes, mouth 42%.- Located in the central nervous system (CNS) in 35%.- Disseminated, multiorgan damage involving the rate of 23%.Mimic bacterial infection and sepsis amnifesta by: irritability, temperature instability, seizures, apnea, jaundice, disseminated intravascular coagulation (DIC), shock, hepatomegaly, seizures.
Diagnosis:
Direct determination methods such as imunfluorescenta ensure the quickest diagnosis, but may be used only when lesions are present.Viral culture is the most sensitive method and allows detection of the type of virus involved.Time to obtain results of the cultures is between 18 hours and 3 days and depends on viral concentration.ELISA serological tests are useful in the diagnosis of neonatal herpes. Infected children can be negative if the infection is primary maternal antibodies are present only if the infection tarnsplacentari is recurrent maternal
Treatment:
Prophylactic treatment consists of: avoid exposing the infant to the mother with active lesions, extraction by caesarean section, prohibit breastfeeding if mothers breast lesions, prohibiting contact with parents or care staff with oral herpes if lesions are open for cleaning proper hands, isolating newborn.Preventing contamination of the newborn from the mother is problematic because the primary infection is asymptomatic, as most recurrent infections.Screening tests to pregnant women and the carriers could lead to groups at risk for primary or recurrent infection in pregnancy.Prevention of neonatal exposure to HSV is the indication of cesarean when obiectiveaza injuries. But history of genital herpes is not an indication for caesarean section.
Curative treatment requires taking acyclovir by intra-venous, at a dose of 10 mg / kc / slow infusion dose 1-2 h, then 1 dose every 8 hours for 14 days.Apply and supportive treatment.

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