新生儿单纯疱疹病毒感染：现代时代的流行病学和结局。
Neonatal Herpes Simplex Virus Infection: Epidemiology and Outcomes in the Modern Era.
机构信息
Department of Pediatrics, Division of Pediatric Infectious Disease, University of Washington and Seattle Children's Research Institute, Seattle, Washington, USA.
Department of Laboratory Medicine & Pathology, University of Washington, Seattle, Washington, USA.
出版信息
J Pediatric Infect Dis Soc. 2022 Mar 24;11(3):94-101. doi: 10.1093/jpids/piab105.
BACKGROUND
Over the past several decades, there have been advances in diagnosis and treatment of neonatal herpes simplex virus (HSV) disease. There has been no recent comprehensive evaluation of the impact of these advances on the management and outcomes for neonates with HSV.
METHODS
Clinical data for initial presentation, treatment, and outcomes were abstracted from medical records of neonates with HSV treated at Seattle Children's Hospital between 1980 and 2016.
RESULTS
One hundred thirty infants with a diagnosis of neonatal HSV were identified. Between 1980 and 2016, high-dose acyclovir treatment for neonatal HSV infection increased from 0% to close to 95%, with subsequent decrease in overall HSV-related mortality from 20.9% to 5.6%. However, even among infants treated with high-dose acyclovir, mortality was 40.9% for infants with disseminated (DIS) disease, and only 55% of infants with central nervous system (CNS) disease were without obvious neurologic abnormalities at 24 months. Over the study period, the time between initial symptoms and diagnosis decreased. Skin recurrences were more common with HSV-2 than HSV-1 (80% vs 55%; P = .02) and in infants with lesions at initial diagnosis (76% vs 47%; P = .02).
CONCLUSION
Changes in the standard of care for management of neonatal HSV disease have led to improvements in timeliness of diagnosis and outcome but mortality in infants with DIS disease and neurologic morbidity in infants with CNS disease remain high. Future research should focus on prevention of perinatal infection and subsequent recurrences.
背景
在过去的几十年中，新生儿单纯疱疹病毒（HSV）疾病的诊断和治疗取得了进展。但是，最近没有对这些进展对患有 HSV 的新生儿的管理和结局的影响进行综合评估。
方法
从 1980 年至 2016 年在西雅图儿童医院接受治疗的患有 HSV 的新生儿的病历中提取了初始表现，治疗和结局的临床数据。
结果
确定了 130 例患有新生儿 HSV 的婴儿。在 1980 年至 2016 年期间，高剂量阿昔洛韦治疗新生儿 HSV 感染的比例从 0％增加到接近 95％，因此，HSV 相关死亡率从 20.9％下降到 5.6％。但是，即使在接受高剂量阿昔洛韦治疗的婴儿中，患有播散性（DIS）疾病的婴儿的死亡率仍为 40.9％，并且只有 55％的患有中枢神经系统（CNS）疾病的婴儿在 24 个月时没有明显的神经系统异常。在研究期间，从最初症状到诊断的时间减少了。与 HSV-1 相比，HSV-2 的皮肤复发更为常见（80％比 55％；P =.02），并且在最初诊断时出现病变的婴儿中更为常见（76％比 47％；P =.02）。
结论
管理新生儿 HSV 疾病的护理标准的变化导致诊断和结局的及时性得到了改善，但 DIS 疾病婴儿的死亡率和 CNS 疾病婴儿的神经发病率仍然很高。未来的研究应侧重于预防围产期感染和随后的复发。
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