Castillo Stephanie A, Pham Anh Khoa, Dinulos James G
aGeisel School of Medicine at Dartmouth, Hanover, NH bSection of Dermatology, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH cUniversity of Connecticut, Farmington, CT and Seacoast Dermatology, Portsmouth, NH, USA.
Curr Opin Pediatr. 2017 Apr;29(2):240-248. doi: 10.1097/MOP.0000000000000469.
Dermatologic findings may be the first signs of a neonatal viral infection. This review provides an update of the diagnostic features and therapies for selected viral illnesses [herpes simplex virus (HSV), varicella zoster virus, enterovirus, and Zika virus] that present with cutaneous manifestations in the neonate.
HSV DNA polymerase chain reaction of plasma and cerebrospinal fluid, routinely used in the diagnosis of neonatal HSV, may have expanded utility in assessing prognosis and acyclovir therapeutic efficacy. Maternal antiviral suppressive therapy may alter the clinical appearance of congenital HSV, resulting in delayed diagnosis and treatment. VariZIG, a varicella zoster immune globulin, is a US Food and Drug Administration approved form of prophylaxis for varicella. The Centers for Disease Control and Prevention has expanded the period of VariZIG eligibility for preterm infants, a group particularly susceptible to severe varicella infection. For severe neonatal enterovirus sepsis, the results of a randomized, double-blind, placebo-controlled trial of pleconaril, a viral capsid inhibitor, suggest that this compound is an effective therapy. Human Parechovirus type 3, a strain within a newly formed viral genus, has a similar, and potentially underestimated, clinical presentation to enterovirus sepsis. However, a distinctive erythematous palmoplantar rash may be specific to human Parechovirus type 3 infection. Perinatal Zika virus infection in the neonate may present with a nonspecific macular and papular rash. As this rash is not specific, obtaining a maternal travel history and, if appropriate, requesting additional diagnostic testing are critical for early diagnosis.
Neonatal rashes may be harmless and transient, whereas others may reflect the presence of a severe systemic illness. Recognizing key cutaneous features of viral-associated rashes may aid in the prompt and accurate diagnosis and treatment of neonatal viral illnesses.
皮肤表现可能是新生儿病毒感染的首发症状。本综述对新生儿期出现皮肤表现的特定病毒疾病（单纯疱疹病毒、水痘带状疱疹病毒、肠道病毒和寨卡病毒）的诊断特征及治疗方法进行了更新。
常用于新生儿单纯疱疹病毒诊断的血浆和脑脊液单纯疱疹病毒DNA聚合酶链反应，在评估预后和阿昔洛韦治疗效果方面可能具有更广泛的应用价值。母体抗病毒抑制治疗可能会改变先天性单纯疱疹病毒的临床表现，导致诊断和治疗延迟。水痘带状疱疹免疫球蛋白（VariZIG）是美国食品药品监督管理局批准的水痘预防用药。美国疾病控制与预防中心已延长了早产儿使用VariZIG的适用期限，早产儿是特别容易发生严重水痘感染的群体。对于严重的新生儿肠道病毒败血症，一项关于病毒衣壳抑制剂普来可那立的随机、双盲、安慰剂对照试验结果表明，该化合物是一种有效的治疗方法。人3型副埃可病毒是新形成的病毒属中的一个毒株，其临床表现与肠道病毒败血症相似，可能被低估。然而，特征性的手足红斑疹可能是人3型副埃可病毒感染所特有的。新生儿围产期寨卡病毒感染可能表现为非特异性的斑丘疹。由于这种皮疹不具有特异性，获取母亲的旅行史并在适当情况下要求进行额外的诊断检测对于早期诊断至关重要。
新生儿皮疹可能无害且短暂，而其他皮疹可能反映存在严重的全身性疾病。认识病毒相关皮疹的关键皮肤特征可能有助于新生儿病毒疾病的及时、准确诊断和治疗。
