HERPES-SIMPLEX VIREMIA - REPORT OF 8 PEDIATRIC CASES AND REVIEW OF THE LITERATURE

Bloodstream infection due to herpes simplex virus (HSV) is rare in the immunocompetent host but may be important in the pathogenesis of diss eminated HSV infection in the immuno-compromised patient. Using a simp le blood-culture method, we detected herpes simplex viremia in eight i mmunologically compromised or immature children: two neonates, two onc ology patients, and four transplant recipients. Only two patients init ially exhibited evidence of mucocutaneous HSV infection. Blood was cul tured for HSV because of perinatal exposure, for routine surveillance, or for the evaluation of fever, esophagitis, or oral lesions in immun ocompromised patients. In five cases HSV was recovered only from the b lood; in two other instances blood cultures for HSV were the first pos itive cultures. The time required for the detection of HSV by blood cu lture ranged from 1 day to 12 days. In one case viremia was transient and cleared without specific therapy. The other seven cases were treat ed with intravenous acyclovir; in four of these cases, therapy was ini tiated because of the positive blood culture. The detection of HSV in blood may promote early initiation of antiviral therapy and thereby im prove prognosis.