Neonatal herpes simplex virus infection presenting as acute liver failure: prevalent role of herpes simplex virus type I.
BACKGROUND
Acute liver failure (ALF) in neonates is rare but carries a high mortality without liver transplantation. Herpes simplex virus (HSV) is one of the microbes that more commonly causes ALF and is potentially treatable; hence, early diagnosis and treatment are important to avoid progression to liver failure.


RESULTS
We have analysed retrospectively the case notes of 11 patients with HSV-induced ALF. A history of possible herpes infection was elicited in 5 parents, but HSV had not been suspected clinically. All patients were asymptomatic when discharged from postnatal units and were presented with nonspecific symptoms of poor feeding and lethargy within 2 weeks from birth. Seven of the 11 patients had HSV-1 infection, 4 HSV-2. Only 2 patients who received early treatment with intravenous acyclovir survived.


CONCLUSIONS
HSV-related ALF in the neonatal period carries high morbidity and mortality and needs a high index of suspicion so that life-saving treatment can be started promptly. Both HSV-1 and HSV-2 can cause severe neonatal infection. It is important to recognise HSV infection in women of childbearing age and their sexual partners.
Verma
Anita
A
Department of Medical Microbiology and Virology, Health Protection Agency, London, King's College Hospital, London, UK. anita.verma@kingsch.nhs.uk
Dhawan
Anil
A
Zuckerman
Mark
M
Hadzic
Nedim
N
Baker
Alastair J
AJ
Mieli-Vergani
Giorgina
G
D000212:Acyclovir / Q000627:therapeutic use*; D000998:Antiviral Agents / Q000627:therapeutic use*; D005260:Female; D006558:Herpes Genitalis / Q000150:complications / Q000188:drug therapy / Q000401:mortality; D006561:Herpes Simplex / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D018259:Herpesvirus 1, Human / Q000187:drug effects / Q000302:isolation & purification / Q000472:pathogenicity*; D018258:Herpesvirus 2, Human / Q000187:drug effects / Q000302:isolation & purification / Q000472:pathogenicity; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D017114:Liver Failure, Acute / Q000188:drug therapy / Q000401:mortality / Q000821:virology*; D008297:Male; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy / Q000401:mortality / Q000821:virology*; D012189:Retrospective Studies
D000998:Antiviral Agents; D000212:Acyclovir