Herpes simplex virus is the general name for a group of viruses. HSV is commonly the cause of cold sores around the mouth as well as genital warts. When babies are born with this virus, the condition is called neonatal HSV. Dr. Demmler-Harrison, of the Baylor College of Medicine, writing in the medical database UpToDate, suggests that 1 baby out of every 3,200 live births is infected with HSV. Symptoms range from serious--such as areas of skin infection--to fatal--multiple organ systems being involved and leading to death.
Symptoms Affecting the Skin, Eyes and Mouth
According to a 2007 study published in the medical journal Seminars in Perinatology, nearly half of the cases of neonatal HSV involve the skin, eyes and mouth. On the skin, the infection may appear as clusters of blister-like bumps that are red at the base. These bumps, called vesicles, may merge to form one larger area, or may remain in isolated clusters. In the eye, early symptoms of the infection include abnormal eye-watering; indications--such as crying--of eye pain; and redness in the eye. Vesicles may also be clustered around the eye.
Mouth-related symptoms of the HSV infection include ulcers of the mouth, tongue and roof of the mouth. An important note is that if the skin, eye and mouth symptoms are treated, before infection can spread to the central nervous system, the baby will generally have a more favorable outcome.
Symptoms Suggesting Central Nervous System Infection
Approximately one-third of neonatal HSV cases have some involvement of the central nervous system: that is, the brain of the baby is affected by the virus. Symptoms suggesting that the brain has been affected include seizures, poor feeding, tremors and lethargy.
In a newborn baby, lethargy is a particularly alarming sign--it is not simply that the baby is sleepy--it is a more serious situation in which the baby is difficult to awaken from sleep and appears sluggish and slow. An inability to regulate body temperature may be seen, as well as irritability and tremors.
Finally, the anterior fontanel, which is the soft spot at the front of the baby's head, may be bulging abnormally. These symptoms of HSV infection are generally seen within the first weeks of life, though symptoms may not be present immediately after the baby is born.
Symptoms Indicating Widespread Infection
If the HSV infection has spread throughout the body, this is called disseminated HSV. Nonspecific symptoms may be seen; these include some of the same symptoms seen in central nervous system infection--indeed, nearly 75 percent of cases of disseminated HSV have some central nervous system involvement.
Irritability, inability to regulate body temperature, lethargy and fever are all potential symptoms of this extremely serious infection. Episodes of not breathing, called apnea, may also occur in the newborn with disseminated HSV. As the disease progresses, a variety of organ systems begin to be affected: liver enzyme levels go up, the brain becomes inflamed, blood cells begin to be affected, the intestines begin to die, and severe pneumonia, requiring the use of a ventilator to help the baby breathe, may develop.
In addition, liver failure may occur; the only cure for this is a liver transplant in the newborn. Sadly, according to Dr. Harrison writing in UpToDate, about 80 percent of newborn babies with untreated disseminated HSV die from this disease; the goal for doctors is to try and identify infants who are at risk for HSV infection in order to catch it early and begin potentially life-saving treatment.
References
- "Seminars in Perinatology"; Herpes simplex virus infections of the newborn; D.W. Kimberlin; February 2007
- "UpToDate"; Denise S. Basow; 2010
