Neonatal herpes is a potentially fatal infection caused by the herpes virus. Neonates catch the virus during the birthing process, especially if it is a vaginal delivery and the mother has active herpes lesions at the time. But most babies with neonatal herpes infection are born to mothers that had no history of symptoms or apparent active infection at the time of delivery. Herpes virus type 2, or genital herpes, causes these infections. A small number of newborns can catch herpes type 1, the type associated with cold sores, if they are in close contact with someone with active lesions. Newborn infants can present with different manifestations of the illness.
Disseminated Herpes Disease
In disseminated disease, the herpes virus affects several organs in the newborn. The liver and the lungs are affected most of the time, but the brain and central nervous system can also be affected. These babies present within the first 2 weeks of life with fever, irritability, poor feeding and lethargy. They can also present in respiratory distress, jaundice and seizures. Although herpes typically causes skin manifestations, it is important to remember that the majority of neonates with disseminated disease will not have the characteristic vesicles that accompany herpes infection.
Localized Central Nervous System Disease
In this variant of the disease, babies present with irritability and seizures. Seizure in neonates can be generalized tonic-clonic seizures, which present as whole body shaking and stiffening to partial seizures, which present with subtle signs like tongue thrusting or unilateral facial twitching or jerking. The virus causes encephalitis, an inflammation of the brain tissue. The virus affects the temporal lobe of the brain. This is important because involvement of this lobe can generate characteristic changes seen in brain imaging studies or in an electroencephalogram (a test that measures brain waves and seizure activity), which can help with diagnosis.
Skin, Eyes and Mouth Disease
Babies affected with this type of herpes disease present with the typical herpes rash. This is a vesicular rash, in which the skin becomes inflamed, and forms single vesicles or blisters that join into groups. These vesicles can form in the mouth and around the eyes. If seen close to the eyes, the patient should have an ophthalmologic exam to determine the extent of the involvement of the eyes, as this affects the type and duration of therapy.
References
- Red Book: 2009 Report of the Committee on Infectious Diseases, American Academy of Pediatrics, 2009
- American Family Physician
