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Disseminated neonatal herpes simplex virus infection presenting with pneumonia and progressive respiratory failure. Safety and efficacy of high-dose intravenous acyclovir in the management of neonatal herpes simplex virus infections.
Tracheal aspirate as a substrate for polymerase chain reaction detection of viral genome in childhood pneumonia and myocarditis.
Role of real-time reverse transcription polymerase chain reaction for detection of respiratory viruses in critically ill children with respiratory disease: Is it time for a change in algorithm? We describe a 5-day-old infant with disseminated HSV-2 disease, who initially presented with pneumonia and progressive respiratory failure.
There was no maternal history or clinical findings suggestive of genital HSV infection prior to or during pregnancy.
He developed respiratory distress soon after birth and required oxygen supplementation for 6 h.


The infant improved clinically and was discharged on day 2 of life when blood cultures were negative for bacteria. Examination was notable for nasal flaring, severe subcostal and intercostal retractions, and bilateral coarse breath sounds. An arterial blood gas revealed a pH of 7.33, a partial pressure of oxygen of 45 mm Hg, and a partial pressure of carbon dioxide of 52 mm Hg. His clinical course was complicated by progressive respiratory failure requiring extracorporeal membrane oxygenation (ECMO) on hospital day 2. Following a 3 weeks course of IV acyclovir for disseminated HSV type 2 disease with pneumonitis, he was discharged home after 32 days of hospitalization. Other viruses such as enterovirus and adenovirus also can present with a clinical picture mimicking bacterial sepsis.
Although in a term infant in the 1 st week of life, the differential diagnosis surely includes bacterial sepsis (Group B Streptococcus, Escherichia coli, or Listeria monocytogenes), invasive fungal disease would be very unusual.


Noninfectious etiologies include cardiac disease and inborn errors of metabolism.Candidiasis is a major cause of morbidity and mortality among low birth weight infants in the NICU but fungal infection would be very unusual in an otherwise healthy term infant during the 1 st week of life. Risk factors for invasive candida infections in premature infants include exposure to broad-spectrum antibiotics (e.g. In the present case, the presence of yeast on the tracheal aspirate likely indicates colonization and not infection.
Thus, we started acyclovir therapy after obtaining tracheal aspirate for viral culture given the clinical suspicion of HSV sepsis.Genital herpes is a sexually transmitted infection caused by HSV-2 or HSV-1.
Early clinical diagnosis of disseminated neonatal HSV infection is difficult, since the clinical presentation often mimics bacterial sepsis and skin vesicles may be absent, as in this case.



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