Pediatric emergency medicine trisk 1451 1451
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within a few hours. A CBC may show a lymphocytosis with a left shift, and chest
radiographs may sometimes demonstrate diffuse patchy infiltrates or lobar
atelectasis.
Herpes simplex infections usually cause systemic symptoms and encephalitis at
7 to 21 days of life. Neonates present with fever, coma, apnea, fulminant
hepatitis, pneumonitis, coagulopathy, and seizures. History of maternal genital
herpes should lead to suspicion of systemic herpes infection in the neonate,
though the mother may be completely asymptomatic. Focal neurologic signs and
ocular findings (conjunctivitis, keratitis) may be noted. Vesicular lesions on the
skin are highly indicative of this infection, but they are present in only one-third
to one-half of patients. Rapid diagnostic studies include antigen detection tests
and enzyme-linked immunosorbent assay (ELISA) antibody tests. The Tzanck
preparation has low sensitivity and is not recommended. Direct fluorescent
antibody staining of vesicle scrapings is specific but less sensitive than culture.
PCR is a sensitive method to detect the virus from CSF in infants suspected of
herpes encephalitis and an electroencephalogram (EEG) or computed tomography
(CT) scan may also be helpful to reveal abnormalities of the temporal lobe. The
Magnetic Resonance Imaging (MRI) is preferred over CT but may be logistically
difficult. The diagnosis is confirmed by culture of a skin vesicle, mouth,
nasopharynx, eyes, urine, blood, CSF, stool, or rectum.
