Smith Amanda E, McKenney Amy, Rabinowitz Laura, Das Anirudha
Department of Neonatology, Cleveland Clinic Children's Hospital, Cleveland, OH, USA.
Department of Pathology, Cleveland Clinic Foundation, Cleveland, OH, USA.
Case Rep Pediatr. 2020 Nov 20;2020:8898612. doi: 10.1155/2020/8898612. eCollection 2020.
Due to a high rate of fetal demise and premature birth in intrauterine HSV infection, the outcome in neonates is usually adverse. A female preterm infant with a gestational age of 25 1/7 weeks with expected early clinical course tested positive for neonatal herpes simplex virus (HSV) 2 after the neonatologist was informed of positive immunohistochemistry for the virus on the fifth day of life by the pathologist. Pathological examination of the placenta had revealed subacute necrotizing inflammation with stromal cell necrosis suggestive of intrauterine infection, possibly ascending due to prolonged rupture of membranes. To the best of our knowledge, this is the first case wherein placental pathology indicated exposure to HSV before the infant presented with signs or symptoms of neonatal HSV resulting in a favorable outcome for the infant. Due to the variability of presentation of intrauterine HSV infection, pathological examination of the placenta in the first 2-5 days of life in premature infants can provide clues to the diagnosis of neonatal HSV which may significantly impact the outcome.
由于宫内单纯疱疹病毒（HSV）感染时胎儿死亡和早产的发生率很高，新生儿的预后通常较差。一名孕25又1/7周的早产女婴，预计临床病程早期，在病理学家告知新生儿科医生其出生后第5天病毒免疫组化呈阳性后，检测出新生儿单纯疱疹病毒2型（HSV）阳性。胎盘的病理检查显示有亚急性坏死性炎症伴基质细胞坏死，提示宫内感染，可能因胎膜长时间破裂上行感染。据我们所知，这是第一例胎盘病理显示在婴儿出现新生儿HSV体征或症状之前已接触HSV，而婴儿预后良好的病例。由于宫内HSV感染的表现具有变异性，对早产儿出生后前2至5天的胎盘进行病理检查可为新生儿HSV的诊断提供线索，这可能会显著影响预后。
