title: Plasma and cerebrospinal fluid herpes simplex virus levels at diagnosis and outcome of neonatal infection.
abstract: OBJECTIVE
  To evaluate the utility of quantitative herpes simplex virus (HSV) polymerase chain reaction (PCR) levels for prognosis and management of neonatal HSV disease.
  
  
  METHODS
  Clinical and virologic data were abstracted by medical record review from neonatal HSV cases treated at Seattle Children's Hospital between 1993 and 2012. HSV PCR results from plasma (n = 47), cerebrospinal fluid (n = 56), or both (n = 40) at the time of diagnosis were available from 63 infants; 26 with skin-eye-mouth (SEM), 18 with central nervous system (CNS), and 19 with disseminated (DIS) disease.
  
  
  RESULTS
  Plasma HSV PCR was positive in 78% of the infants with SEM, 64% with CNS and 100% with DIS disease. Mean plasma viral level was 2.8 log10 copies/mL in SEM, 2.2 log10 copies/mL in CNS, and 7.2 log10 copies/mL in DIS infants. The HSV levels were higher among infants who died compared with surviving infants, 8.1 log10 copies/mL (range 7.7-8.6) vs 3.8 log10 copies/mL (range 0.0-8.6), P = .001, however, level of HSV DNA in the cerebrospinal fluid or in plasma did not correlate with neurologic outcome. Dynamics of HSV clearance from plasma during high-dose acyclovir treatment showed single-phase exponential decay with a median viral half-life of 1.26 days (range: 0.8-1.51).
  
  
  CONCLUSIONS
  Plasma HSV levels correlate with clinical presentation of neonatal HSV disease and mortality, but not neurologic outcome.
authors.affiliation: Division of Pediatric Infectious Disease, Department of Pediatrics, University of Washington and Seattle Children's Research Institute, Seattle, WA. Electronic address: ann.melvin@seattlechildrens.org.
authors.forename: Ann J
authors.initials: AJ
authors.lastname: Melvin
authors.affiliation: Division of Pediatric Infectious Disease, Department of Pediatrics, University of Washington and Seattle Children's Research Institute, Seattle, WA.
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Mohan
authors.affiliation: Department of Medicine, University of Washington, Seattle, WA; Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA.
authors.forename: Joshua T
authors.initials: JT
authors.lastname: Schiffer
authors.affiliation: Department of Epidemiology, University of Washington, Seattle, WA.
authors.forename: Linda M
authors.initials: LM
authors.lastname: Drolette
authors.affiliation: Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Laboratory Medicine, University of Washington, Seattle, WA.
authors.forename: Amalia
authors.initials: A
authors.lastname: Magaret
authors.affiliation: Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Laboratory Medicine, University of Washington, Seattle, WA.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Corey
authors.affiliation: Department of Medicine, University of Washington, Seattle, WA; Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Epidemiology, University of Washington, Seattle, WA; Department of Laboratory Medicine, University of Washington, Seattle, WA.
authors.forename: Anna
authors.initials: A
authors.lastname: Wald
mesh_terms: D002555:Cerebrospinal Fluid / Q000821:virology*; D004279:DNA, Viral / Q000032:analysis*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006561:Herpes Simplex / Q000097:blood* / Q000134:cerebrospinal fluid / Q000175:diagnosis; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016133:Polymerase Chain Reaction; D011251:Pregnancy Complications, Infectious / Q000097:blood* / Q000134:cerebrospinal fluid / Q000175:diagnosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D018139:Simplexvirus / Q000235:genetics / Q000302:isolation & purification*
chemical_list: D004279:DNA, Viral