DISSEMINATED HERPES-SIMPLEX VIRUS-INFECTION IN A NEONATE

The emergency department (ED) evaluation of the neonate with sepsis or symptoms suggesting sepsis usually includes a complete blood count, c atheterized urinalysis with culture, blood cultures, cerebrospinal flu id analysis and culture, and possibly a chest radiograph, Admission fo r observation for neonates at high risk for sepsis is universal. Depen ding on the patient's presentation and the preference of the admitting physician, intravenous antibiotics are started. Typically, ampicillin and either an aminoglycoside or cefotaxime are chosen because they co ver the likely pathogens in this age group, ie, group B streptococci, Escherichia coli and other gram-negative enterics, and Listeria monocy togenes. Coverage for viral infection, most notably herpes simplex vir us (HSV), is only rarely instituted in the ED and is usually considere d if the patient has obvious ulcerative lesions or if the mother has k nown HSV infection. Unfortunately, antiviral therapy with acyclovir or vidaribine has to be started in the early stages of infection to be e ffective. If antiviral therapy is started after viral entry into cells , morbidity is severe and mortality approaches 80%. Neonates who survi ve are usually severely disabled. Broadening the indications for initi ating antiviral therapy to include the neonate whose mother has any hi story of a sexually transmitted disease may prevent the sequelae of un treated or inadequately treated HSV infection. A case is reported of a n Il day-old girl who developed disseminated HSV infection and died as a result of hepatic failure. (Am J Emerg Med 1998;16:376-378. Copyrig ht (C) 1998 by W.B. Saunders Company).