Pediatric emergency medicine trisk 1331 1331
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FIGURE 69.7 Clusters of vesicles and erosions on the cheek of a child with HSV.
Since neonatal herpes infection can be seen up until 4 weeks of age, clinicians
caring for newborns in clinics, offices, and emergency department must be
familiar with the clinical manifestations of this disease process. Once there is
suspicion of neonatal HSV, obtain the following samples before starting antiviral
therapy:
1. CSF for indices and HSV DNA PCR,
2. Swab for viral culture +/− PCR from base of vesicles,
3. Swab from the mouth, conjunctiva, nasopharynx and rectum for viral culture +/–
PCR, and
4. Whole blood for HSV DNA PCR.
Start empiric intravenous acyclovir therapy (60 mg/kg/day divided in 3 doses).
For SEM disease, treat for 14 days. For disseminated and CNS diseases, treat for
21 days and then treat with oral acyclovir suppressive therapy for 6 months (900
