Midtrimester fetal herpes simplex-2 diagnosis by serology, culture and quantitative polymerase chain reaction.
The acquisition of herpes simplex virus (HSV) in utero comprises a minority of neonatal herpes infections. Prenatal diagnosis is rare. We describe a midtrimester diagnosis of fetal HSV-2 infection. Ultrasound at 20 weeks for elevated maternal serum α-fetoprotein (MSAFP) showed lagging fetal growth, echogenic bowel, echogenic myocardium, and liver with a mottled pattern of echogenicity. Amniocentesis demonstrated normal karyotype, elevated AFP and positive acetylcholinesterase. Culture isolated HSV-2 with an aberrant growth pattern. Maternal serology was positive for HSV-2. Quantitative DNA polymerase chain reaction (PCR) showed 59 million copies/ml. Fetal autopsy demonstrated widespread tissue necrosis but only sparse HSV-2 inclusions. Fetal HSV-2 infection can be suspected when an elevated MSAFP accompanies ultrasound findings suggesting perinatal infection. Maternal HSV serology, amniotic fluid culture and quantitative PCR are recommended for diagnostic certainty and counseling.
Department of Obstetrics, Gynecology and Pathology, Penn State University Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA, USA. wcurtin@hmc.psu.edu
William M
WM
Curtin
Marilyn A
MA
Menegus
Maria-Magdalena
MM
Patru
C Jeanne
CJ
Peterson
Leon A
LA
Metlay
Robert A
RA
Mooney
Nancy L
NL
Stanwood
Amy L
AL
Scheible
Angela
A
Dorgan
D000025:Abortion, Eugenic; D000328:Adult; D000653:Amniotic Fluid / Q000821:virology; D000914:Antibodies, Viral / Q000032:analysis; D005260:Female; D006561:Herpes Simplex / Q000175:diagnosis / Q000196:embryology* / Q000276:immunology / Q000821:virology; D018258:Herpesvirus 2, Human / Q000145:classification / Q000276:immunology / Q000302:isolation & purification*; D006801:Humans; D058889:Molecular Typing; D010353:Patient Education as Topic; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D011296:Prenatal Diagnosis; D055815:Young Adult; D000509:alpha-Fetoproteins / Q000032:analysis
C097353:AFP protein, human; D000914:Antibodies, Viral; D000509:alpha-Fetoproteins