417 - Detection of Herpes Simplex Virus (HSV) From Only Neonatal Mucosal Sites: What’s the Significance?

Sunday, April 30, 2023

3:30 PM – 6:00 PM ET

Poster Number: 417
Publication Number: 417.335

Rachel Graf, Ohio State University College of Medicine, Columbus, OH, United States; Asuncion Mejias, Nationwide Children's Hospital, Columbus, OH, United States; Traci Pifer, Nationwide Children's Hospital, Columbus, OH, United States; Rachelle Crisan, Nationwide Children's Hospital, Canal Winchester, OH, United States; Natalie O. White, Pediatrix, BEXLEY, OH, United States; Pablo J. Sanchez, Nationwide Children's Hospital -OSU, Columbus, OH, United States

Presenting Author(s)

Rachel Graf, BS (she/her/hers)

Medical Student
Ohio State University College of Medicine
Columbus, Ohio, United States

Background: Timely diagnosis and early initiation of acyclovir therapy for neonatal HSV infection improves neonatal outcomes. At Nationwide Children’s Hospital (NCH), all neonates hospitalized with suspected sepsis are tested for HSV infection by PCR. In addition, infants born to mothers with active genital HSV lesions are screened for HSV within 24-48 hours of birth. Scant information is known on neonates who test positive for HSV PCR only from mucosal sites.

Objective:

To describe the clinical characteristics of neonates with only mucosal sites positive for HSV

Design/Methods:

Since 2001, all neonates (≤28 days old) admitted to the NCH pediatric ward or affiliated NICUs and have a positive HSV PCR from a body site (mucosal/"surface" [conjunctiva, mouth/throat/nasopharynx, rectum, or “pooled"], blood, or CSF) are entered into a REDcap database as part of an ongoing HSV surveillance study (prospective since 2014). We retrospectively analyzed those neonates whose HSV PCR test(s) was positive only from a mucosal site. Pertinent clinical, laboratory, and outcome data were obtained from mothers’ and infants’ health records.

Results:

From 2001-2022, 117 neonates tested positive for HSV by PCR of a body site and 12% (14/117) only had a mucosal site positive for HSV (71%, HSV-1; n=10). The positive mucosal sites were pooled specimens (n=8), mouth/throat/nasopharynx (n=4), and conjunctiva (n=2); none had a vesicular lesion. 11 infants had blood PCR performed and all were negative. 12 infants had a negative CSF HSV PCR. The 14 neonates (57%, female; 71% white) had mean (±SD) gestational age of 37±4 weeks and birth weight of 2784±701 g. Reasons for HSV testing of the 14 neonates were: temperature instability (n=8, 57%), active maternal genital lesions at delivery (n=2, 14%), or both (n=4, 29%). 8 (57%) neonates were admitted from home. Presenting signs included fever (n=6, 43%), hypothermia (n=1, 7%), jaundice (n=4, 29%), lethargy (n=3, 21%), and poor feeding (n=2, 14%). One of nine infants had an elevated ALT. None had seizure. Evaluation for other sites of infection was normal: ophthalmologic exam (n=6), cranial ultrasound (n=2), and brain MRI (n=2). Enterovirus was co-detected in 2 neonates and bacteremia with viridans streptococci occurred in 1. Duration of intravenous acyclovir ranged from 7 to 17 days (median 15 days). 3 infants were discharged home on acyclovir suppression.

Conclusion(s): Neonatal HSV infection may only involve mucosal sites. Whether this reflects early infection that may lead to dissemination, transient colonization, or false-positive PCR results remains a clinical conundrum and needs further study.