Let’s switch now to congenital
herpes simplex virus or HSV.
So HSV is when an intrauterine infection
presents in the first week of life
This is congenital HSV.
This is different from
exposure during birth.
We don’t see this very often.
Usually, infants who get HSV
don’t get it transplacentally.
Mostly, they get it during
the birthing process
and then they have a
delay in those symptoms.
But congenital HSV can be very bad when
it’s from an intrauterine infection.
These infants have bad, severe,
disseminated disease in general.
However, they can also get it during birth.
In the first week of life, they may typically
present with skin/eye/mouth disease.
This carries an excellent prognosis
and if treated, will usually
not progress to other disease.
Between two and four weeks of life, they
may present with a simple meningitis,
which is not simple because it’s
very devastating if not treated
and even if it is, can result in
deafness and cognitive delay.
Or they may have disseminated
disease a little bit later,
that’s usually two to four weeks.
And again, these infants
are generally very sick
and have involvement of the liver,
the CNS, and multiple systems.
So the presentation of congenital
disease of congenital HSV
depends on which
organs are involved.
For skin/eye/mouth disease,
they simply present with a focal
or a disseminated skin rash,
which is typically described as a group
of vesicles on an erythematous base.
Any small vesicle in an infant must be
considered to be HSV until proven otherwise.
Or they can present with disseminated
diseases such as meningitis,
a mild or severe hepatitis,
other things like that.
The meningitis is the one
we really worry about.
For disseminated disease, these patients
may have a severe encephalitis.
This encephalitis often involves the temporal
lobes like you can see in this patient.
So if you see temporal lobe
involvement in an infant,
with seizing or brain
damage or fever,
that’s going to be HSV
until proven otherwise.
They may also have chorioretinitis,
those skin lesions,
they may have a mild
or severe hepatitis.
We will often get LFTs simply to confirm
the concern of disseminated disease.
They may go frankly coagulopathic or have
disseminated intravascular coagulation.
And they may have a pneumonitis,
a sort of pneumonia caused by a virus
that can be reasonably severe.
For HSV testing in infants, we
generally test very broadly
to maximize our chance of
figuring out what it is.
What’s controversial is
whether we should test
a simple, well-appearing,
Most centers do not do
this, some centers do.
But anyway, what are the tests?
We have the blood PCR, which is the
best test for disseminated disease.
We have an HSV-CSF-PCR, which is
your best test for meningitis.
And we also will culture the
eyes, the mouth, the rectum,
and we’ll send
those for culture.
The culture is very affective and
it grows reasonably quickly.
You should know the
results in a day or two.
Also, we usually call ophthalmology
to come see these infants
to check and do a comprehensive eye exam to
make sure there isn’t any eye involvement.
So that’s my summary of the
TORCH infections in kids.
Thanks for your time.