00:01
Let’s switch now to congenital
herpes simplex virus or HSV.
00:07
So HSV is when an intrauterine infection
presents in the first week of life
with severe
disseminated disease.
00:16
This is congenital HSV.
00:18
This is different from
exposure during birth.
00:22
We don’t see this very often.
00:24
Usually, infants who get HSV
don’t get it transplacentally.
00:28
Mostly, they get it during
the birthing process
and then they have a
delay in those symptoms.
00:33
But congenital HSV can be very bad when
it’s from an intrauterine infection.
00:38
These infants have bad, severe,
disseminated disease in general.
00:43
However, they can also get it during birth.
00:46
In the first week of life, they may typically
present with skin/eye/mouth disease.
00:51
This carries an excellent prognosis
and if treated, will usually
not progress to other disease.
00:57
Between two and four weeks of life, they
may present with a simple meningitis,
which is not simple because it’s
very devastating if not treated
and even if it is, can result in
deafness and cognitive delay.
01:11
Or they may have disseminated
disease a little bit later,
that’s usually two to four weeks.
01:16
And again, these infants
are generally very sick
and have involvement of the liver,
the CNS, and multiple systems.
01:25
So the presentation of congenital
disease of congenital HSV
depends on which
organs are involved.
01:33
For skin/eye/mouth disease,
they simply present with a focal
or a disseminated skin rash,
which is typically described as a group
of vesicles on an erythematous base.
01:44
Any small vesicle in an infant must be
considered to be HSV until proven otherwise.
01:50
Or they can present with disseminated
diseases such as meningitis,
a mild or severe hepatitis,
other things like that.
02:00
The meningitis is the one
we really worry about.
02:04
For disseminated disease, these patients
may have a severe encephalitis.
02:09
This encephalitis often involves the temporal
lobes like you can see in this patient.
02:13
So if you see temporal lobe
involvement in an infant,
with seizing or brain
damage or fever,
that’s going to be HSV
until proven otherwise.
02:23
They may also have chorioretinitis,
those skin lesions,
they may have a mild
or severe hepatitis.
02:29
We will often get LFTs simply to confirm
the concern of disseminated disease.
02:34
They may go frankly coagulopathic or have
disseminated intravascular coagulation.
02:40
And they may have a pneumonitis,
a sort of pneumonia caused by a virus
that can be reasonably severe.
02:49
For HSV testing in infants, we
generally test very broadly
to maximize our chance of
figuring out what it is.
02:56
What’s controversial is
whether we should test
a simple, well-appearing,
febrile infant.
03:01
Most centers do not do
this, some centers do.
03:04
But anyway, what are the tests?
We have the blood PCR, which is the
best test for disseminated disease.
03:11
We have an HSV-CSF-PCR, which is
your best test for meningitis.
03:18
And we also will culture the
eyes, the mouth, the rectum,
and we’ll send
those for culture.
03:25
The culture is very affective and
it grows reasonably quickly.
03:28
You should know the
results in a day or two.
03:31
Also, we usually call ophthalmology
to come see these infants
to check and do a comprehensive eye exam to
make sure there isn’t any eye involvement.
03:41
So that’s my summary of the
TORCH infections in kids.
03:45
Thanks for your time.