單純皰疹病毒課件

THEFIRSTAFFLIATEDHOSPITALOFGUANGXIMEDICALUNIVERSITYDEPARTMENTOFPEDIATRICSNICUTHEFIRSTAFFLIATEDHOSPITALONeonatalHerpesSimplexInfectionNeonatalHerpesSimplexInfectINTRODUCTIONDiscoveryofneonatalHerpesSimplexvirus(HSV)inthe1930sNeonatalinfectionwithHSVoccursin1/3200to1/10,000livebirthsInChina，2/10,000to5/10,000INTRODUCTIONDiscoveryofneonaVIROLOGY●HSVisaDNAvirus●HSV-I,HSV-II

HSV-IIassociatedwithpooreroutcomeVIROLOGY●HSVisaDNAviruTRANSMISSION~HSVentershumanhostthroughinoculationoforal,genital,orconjunctivalmucosaorbreakinskinTRANSMISSION~HSVentershuman1.Intrauterine2.Perinatal3.Postnatal1.IntrauterineMaternalviremiaAscendinginfectionUsuallyafterprolongedruptureofmembranesIntrauterineMaternalviremiaIntrauterine2.Perinatal-HSVinfectionispresentinthegenitaltractofpregnantwomanattimeofdelivery-Mostcommonmode(85%)ofneonatalHSVinfection2.Perinatal3.Postnatal-WhenactiveHSVinfectionhasclosecontactwiththenewborn3.Postnatalintrauterine5%perinatal85%postnatal10%intrauterine5%CLINICALMANIFESTATIONS-Skin,Eye,Mouth-CentralNervousSystem-DisseminatedDiseaseCLINICALMANIFESTATIONS-Skin,>90%presentbetween5-19daysofage>20%NEVERhaveskinlesionsInitialsymptomsvaguein30%LethargyPoorfeedingFeverIrritability>90%presentbetween5-19dayskin-Usuallypresentsinthefirsttwoweeksoflife-clusteringvesicularlesionswithanerythematousbaseskin-Usuallypresentsinthef單純皰疹病毒課件Eyes-1.Excessivewateringoftheeye2.Cryingfromapparenteyepain3.Conjunctivalerythema4.Periorbitalskinvesicles5.CanprogresstocataractsandchorioretinitispermanentvisionlossEyes-1.Excessivewateringoft單純皰疹病毒課件Mouth-Localizedulcerativelesionsofthemouth,palate,andtongueMouth-LocalizedulcerativelesCNSDisease1/3ofneonatalHSVdiseaseinvolvestheCNSPresentsinsecond-thirdweekoflifeIrritabilityTremorsPoorfeedingCNSDisease1/3ofneonatalHSVHERPESENCEPHALITISHERPESENCEPHALITIS?ofHSVdiseaseisinthedisseminatedform PresentinthefirstweekoflifeAffects:liver,lungs,adrenals,CNS,skin,eyes,andmouth,DICDisseminatedDiseaseDisseminatedDisease單純皰疹病毒課件DiagnosisofNeonatalHSVInfectionGoldstandard=Positivecultureof:lesion,nasopharynx,conjunctiva,rectum,orCSFRapiddiagnosticmethodsPolymerasechainreactiononCSFandbloodFluorescentantibodystainonvesiclescrapingDiagnosisofNeonatalHSVInfeEEGBrainImagingChestRadiographMaydemonstratebilateral,diffusepneumoniaAbdominalUSMaydemonstrateascitesand/orenlargedliverinneonateswithHSVhepatitisandacuteliverfailureEEGTREATMENTAcycloviristhetreatmentofchoiceDose-skineyemouthinfection60mg/kg/daydividedq8hfor14daysMaybelengthenedto21daysinthenearfutureDissiminatedandCNSHSVinfections60mg/kg/daydividedq8hfor21daysTREATMENTAcycloviristhetreaINFECTIONCONTROLSTEPSPregnantwomenprimaryorfirstepisode:Acyclovirtherapyat36wk400mgtidPrimaryHSVin3rdtrimester:C-sectionshouldbeofferedHandwashingbeforeandaftercareofinfantsMotherwithlesionsonhandshandhygieneandglovesINFECTIONCONTROLSTEPSPregnan

references

NeonatalHerpesSimplexVirusInfection:ClinicalFeaturesandDiagnosis.UptoDate.Demmier-Harrison,GailMDNeonatalHerpesSimplexVirusInfection:ManagementandPrevention.UptoDate.Demmier-Harrison,GailMDNeonatalHerpesSimplexVirusInfections.AmericanFamilyPhysician.Rudnick,CarolineMD,Hoekzema,GrantMD.03/15/2002,1138-1142

references

NeonatalHerpesS單純皰疹病毒課件THEFIRSTAFFLIATEDHOSPITALOFGUANGXIMEDICALUNIVERSITYDEPARTMENTOFPEDIATRICSNICUTHEFIRSTAFFLIATEDHOSPITALONeonatalHerpesSimplexInfectionNeonatalHerpesSimplexInfectINTRODUCTIONDiscoveryofneonatalHerpesSimplexvirus(HSV)inthe1930sNeonatalinfectionwithHSVoccursin1/3200to1/10,000livebirthsInChina，2/10,000to5/10,000INTRODUCTIONDiscoveryofneonaVIROLOGY●HSVisaDNAvirus●HSV-I,HSV-II

HSV-IIassociatedwithpooreroutcomeVIROLOGY●HSVisaDNAviruTRANSMISSION~HSVentershumanhostthroughinoculationoforal,genital,orconjunctivalmucosaorbreakinskinTRANSMISSION~HSVentershuman1.Intrauterine2.Perinatal3.Postnatal1.IntrauterineMaternalviremiaAscendinginfectionUsuallyafterprolongedruptureofmembranesIntrauterineMaternalviremiaIntrauterine2.Perinatal-HSVinfectionispresentinthegenitaltractofpregnantwomanattimeofdelivery-Mostcommonmode(85%)ofneonatalHSVinfection2.Perinatal3.Postnatal-WhenactiveHSVinfectionhasclosecontactwiththenewborn3.Postnatalintrauterine5%perinatal85%postnatal10%intrauterine5%CLINICALMANIFESTATIONS-Skin,Eye,Mouth-CentralNervousSystem-DisseminatedDiseaseCLINICALMANIFESTATIONS-Skin,>90%presentbetween5-19daysofage>20%NEVERhaveskinlesionsInitialsymptomsvaguein30%LethargyPoorfeedingFeverIrritability>90%presentbetween5-19dayskin-Usuallypresentsinthefirsttwoweeksoflife-clusteringvesicularlesionswithanerythematousbaseskin-Usuallypresentsinthef單純皰疹病毒課件Eyes-1.Excessivewateringoftheeye2.Cryingfromapparenteyepain3.Conjunctivalerythema4.Periorbitalskinvesicles5.CanprogresstocataractsandchorioretinitispermanentvisionlossEyes-1.Excessivewateringoft單純皰疹病毒課件Mouth-Localizedulcerativelesionsofthemouth,palate,andtongueMouth-LocalizedulcerativelesCNSDisease1/3ofneonatalHSVdiseaseinvolvestheCNSPresentsinsecond-thirdweekoflifeIrritabilityTremorsPoorfeedingCNSDisease1/3ofneonatalHSVHERPESENCEPHALITISHERPESENCEPHALITIS?ofHSVdiseaseisinthedisseminatedform PresentinthefirstweekoflifeAffects:liver,lungs,adrenals,CNS,skin,eyes,andmouth,DICDisseminatedDiseaseDisseminatedDisease單純皰疹病毒課件DiagnosisofNeonatalHSVInfectionGoldstandard=Positivecultureof:lesion,nasopharynx,conjunctiva,rectum,orCSFRapiddiagnosticmethodsPolymerasechainreactiononCSFandbloodFluorescentantibodystainonvesiclescrapingDiagnosisofNeonatalHSVInfeEEGBrainImagingChestRadiographMaydemonstratebilateral,diffusepneumoniaAbdominalUSMaydemonstrateascitesand/orenlargedliverinneonateswithHSVhepatitisandacuteliverfailureEEGTREATMENTAcycloviristhetreatmentofchoiceDose-skineyemouthinfection60mg/kg/daydividedq8hfor14daysMaybelengthenedto21daysinthenearfutureDissiminatedandCNSHSVinfections60mg/k