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.
Department of Medical Microbiology and Virology, Health Protection Agency, London, King's College Hospital, London, UK. anita.verma@kingsch.nhs.uk
Anita
A
Verma
Anil
A
Dhawan
Mark
M
Zuckerman
Nedim
N
Hadzic
Alastair J
AJ
Baker
Giorgina
G
Mieli-Vergani
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