Intrauterine herpes simplex virus infection.

Background: Early fetal herpes simplex virus (HSV) infection is rarely docu mented. Only the minority of affected fetuses survive this condition. Patient and methods: At 19 weeks of gestation the first episode of a genita l HSV-infection of a pregnant woman was treated with local interferon beta. At 34 weeks of gestation hydrocephalus with secondary microcephaly and mic rophthalmia of both eyes was detected by ultrasonography. In the amniotic f luid HSV type 2 (HSV-2) was isolated and HSV-2-DNA was detected by PCR. The serum of the mother proved positive for HSV-2 (glycoprotein G2)-specific I gG-antibodies. No other infectious causes were apparent on further testing. At 35+4 weeks gestation a small-for-gestational-age neonate (2130 g) with microcephaly (29 cm head circumference) was born by spontaneous vaginal del ivery. Scarce ulcerative skin lesions and vesicles, hepatosplenomegaly and microphthalmia were diagnosed. Furthermore, encephalomalacia with parenchym al destruction, cataract of both eyes and aplasia of the maculae and papill ae were found. HSV-2-PCR was tested positive in chorionic cells and an umbi lical segment of the placenta as well as in swabs from both eyes, throat, a nd a herpetic skin lesion collected during the first 5 days of life. HSV-Ig M-antibodies were found in the umbilical cord blood. Local and intravenous treatment with aciclovir was started. The infant exhibited signs of a sever ely malfunctioning central nervous system. At the age of 4 months the boy s ufferd from generalised cerebral seizures. He died at the age of 9 months a s a consequence of respiratory insufficiency with consecutive circulation f ailure. Results: The case of an intrauterine HSV-2-infection is presented. The time of onset of fetal infection was most probably at the time of the maternal disease (19 weeks of gestation), Inspite of the very early infection the fe tus did not die in utero. Conclusions: Especially, if a primary genital HSV-2-infection of a pregnant woman is suspected, which can be proven by serological means only several weeks after infection, systemic therapy of the mother with aciclovir should be considered since materno-fetal transmission may occur due to the risk o f maternal viraemia.