Herpes simplex virus infection in infants undergoing meningitis evaluation

Andrea T. Cruz, Stephen B. Freedman, Dina M. Kulik, Pamela J. Okada, Alesia H. Fleming, Rakesh D. Mistry, Joanna E. Thomson, David Schnadower, Joseph L. Arms, Prashant Mahajan, Aris C. Garro, Christopher M. Pruitt, Fran Balamuth, Neil G. Uspal, Paul L. Aronson, Todd W. Lyons, Amy D. Thompson, Sarah J. Curtis, Paul T. Ishimine, Suzanne M. SchmidtStuart A. Bradin, Kendra L Grether-Jones, Aaron S. Miller, Jeffrey Louie, Samir S. Shah, Lise E. Nigrovic

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

BACKGROUND: Although neonatal herpes simplex virus (HSV) is a potentially devastating infection requiring prompt evaluation and treatment, large-scale assessments of the frequency in potentially infected infants have not been performed. METHODS: We performed a retrospective cross-sectional study of infants .60 days old who had cerebrospinal fluid culture testing performed in 1 of 23 participating North American emergency departments. HSV infection was defined by a positive HSV polymerase chain reaction or viral culture. The primary outcome was the proportion of encounters in which HSV infection was identified. Secondary outcomes included frequency of central nervous system (CNS) and disseminated HSV, and HSV testing and treatment patterns. RESULTS: Of 26 533 eligible encounters, 112 infants had HSV identified (0.42%, 95% confidence interval [CI]: 0.35%.0.51%). Of these, 90 (80.4%) occurred in weeks 1 to 4, 10 (8.9%) in weeks 5 to 6, and 12 (10.7%) in weeks 7 to 9. The median age of HSV-infected infants was 14 days (interquartile range: 9.24 days). HSV infection was more common in 0 to 28-day-old infants compared with 29- to 60-day-old infants (odds ratio 3.9; 95% CI: 2.4.6.2). Sixty-eight (0.26%, 95% CI: 0.21%.0.33%) had CNS or disseminated HSV. The proportion of infants tested for HSV (35%; range 14%.72%) and to whom acyclovir was administered (23%; range 4%.53%) varied widely across sites. CONCLUSIONS: An HSV infection was uncommon in young infants evaluated for CNS infection, particularly in the second month of life. Evidence-based approaches to the evaluation for HSV in young infants are needed.

Original languageEnglish (US)
Article numbere20171688
JournalPediatrics
Volume141
Issue number2
DOIs
StatePublished - Feb 1 2018

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Virus Diseases
Simplexvirus
Meningitis
Confidence Intervals
Central Nervous System
Central Nervous System Infections
Acyclovir
Cerebrospinal Fluid
Hospital Emergency Service
Cross-Sectional Studies
Odds Ratio

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Cruz, A. T., Freedman, S. B., Kulik, D. M., Okada, P. J., Fleming, A. H., Mistry, R. D., ... Nigrovic, L. E. (2018). Herpes simplex virus infection in infants undergoing meningitis evaluation. Pediatrics, 141(2), [e20171688]. https://doi.org/10.1542/peds.2017-1688

Herpes simplex virus infection in infants undergoing meningitis evaluation. / Cruz, Andrea T.; Freedman, Stephen B.; Kulik, Dina M.; Okada, Pamela J.; Fleming, Alesia H.; Mistry, Rakesh D.; Thomson, Joanna E.; Schnadower, David; Arms, Joseph L.; Mahajan, Prashant; Garro, Aris C.; Pruitt, Christopher M.; Balamuth, Fran; Uspal, Neil G.; Aronson, Paul L.; Lyons, Todd W.; Thompson, Amy D.; Curtis, Sarah J.; Ishimine, Paul T.; Schmidt, Suzanne M.; Bradin, Stuart A.; Grether-Jones, Kendra L; Miller, Aaron S.; Louie, Jeffrey; Shah, Samir S.; Nigrovic, Lise E.

In: Pediatrics, Vol. 141, No. 2, e20171688, 01.02.2018.

Research output: Contribution to journalArticle

Cruz, AT, Freedman, SB, Kulik, DM, Okada, PJ, Fleming, AH, Mistry, RD, Thomson, JE, Schnadower, D, Arms, JL, Mahajan, P, Garro, AC, Pruitt, CM, Balamuth, F, Uspal, NG, Aronson, PL, Lyons, TW, Thompson, AD, Curtis, SJ, Ishimine, PT, Schmidt, SM, Bradin, SA, Grether-Jones, KL, Miller, AS, Louie, J, Shah, SS & Nigrovic, LE 2018, 'Herpes simplex virus infection in infants undergoing meningitis evaluation', Pediatrics, vol. 141, no. 2, e20171688. https://doi.org/10.1542/peds.2017-1688
Cruz AT, Freedman SB, Kulik DM, Okada PJ, Fleming AH, Mistry RD et al. Herpes simplex virus infection in infants undergoing meningitis evaluation. Pediatrics. 2018 Feb 1;141(2). e20171688. https://doi.org/10.1542/peds.2017-1688
Cruz, Andrea T. ; Freedman, Stephen B. ; Kulik, Dina M. ; Okada, Pamela J. ; Fleming, Alesia H. ; Mistry, Rakesh D. ; Thomson, Joanna E. ; Schnadower, David ; Arms, Joseph L. ; Mahajan, Prashant ; Garro, Aris C. ; Pruitt, Christopher M. ; Balamuth, Fran ; Uspal, Neil G. ; Aronson, Paul L. ; Lyons, Todd W. ; Thompson, Amy D. ; Curtis, Sarah J. ; Ishimine, Paul T. ; Schmidt, Suzanne M. ; Bradin, Stuart A. ; Grether-Jones, Kendra L ; Miller, Aaron S. ; Louie, Jeffrey ; Shah, Samir S. ; Nigrovic, Lise E. / Herpes simplex virus infection in infants undergoing meningitis evaluation. In: Pediatrics. 2018 ; Vol. 141, No. 2.
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abstract = "BACKGROUND: Although neonatal herpes simplex virus (HSV) is a potentially devastating infection requiring prompt evaluation and treatment, large-scale assessments of the frequency in potentially infected infants have not been performed. METHODS: We performed a retrospective cross-sectional study of infants .60 days old who had cerebrospinal fluid culture testing performed in 1 of 23 participating North American emergency departments. HSV infection was defined by a positive HSV polymerase chain reaction or viral culture. The primary outcome was the proportion of encounters in which HSV infection was identified. Secondary outcomes included frequency of central nervous system (CNS) and disseminated HSV, and HSV testing and treatment patterns. RESULTS: Of 26 533 eligible encounters, 112 infants had HSV identified (0.42{\%}, 95{\%} confidence interval [CI]: 0.35{\%}.0.51{\%}). Of these, 90 (80.4{\%}) occurred in weeks 1 to 4, 10 (8.9{\%}) in weeks 5 to 6, and 12 (10.7{\%}) in weeks 7 to 9. The median age of HSV-infected infants was 14 days (interquartile range: 9.24 days). HSV infection was more common in 0 to 28-day-old infants compared with 29- to 60-day-old infants (odds ratio 3.9; 95{\%} CI: 2.4.6.2). Sixty-eight (0.26{\%}, 95{\%} CI: 0.21{\%}.0.33{\%}) had CNS or disseminated HSV. The proportion of infants tested for HSV (35{\%}; range 14{\%}.72{\%}) and to whom acyclovir was administered (23{\%}; range 4{\%}.53{\%}) varied widely across sites. CONCLUSIONS: An HSV infection was uncommon in young infants evaluated for CNS infection, particularly in the second month of life. Evidence-based approaches to the evaluation for HSV in young infants are needed.",
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T1 - Herpes simplex virus infection in infants undergoing meningitis evaluation

AU - Cruz, Andrea T.

AU - Freedman, Stephen B.

AU - Kulik, Dina M.

AU - Okada, Pamela J.

AU - Fleming, Alesia H.

AU - Mistry, Rakesh D.

AU - Thomson, Joanna E.

AU - Schnadower, David

AU - Arms, Joseph L.

AU - Mahajan, Prashant

AU - Garro, Aris C.

AU - Pruitt, Christopher M.

AU - Balamuth, Fran

AU - Uspal, Neil G.

AU - Aronson, Paul L.

AU - Lyons, Todd W.

AU - Thompson, Amy D.

AU - Curtis, Sarah J.

AU - Ishimine, Paul T.

AU - Schmidt, Suzanne M.

AU - Bradin, Stuart A.

AU - Grether-Jones, Kendra L

AU - Miller, Aaron S.

AU - Louie, Jeffrey

AU - Shah, Samir S.

AU - Nigrovic, Lise E.

PY - 2018/2/1

Y1 - 2018/2/1

N2 - BACKGROUND: Although neonatal herpes simplex virus (HSV) is a potentially devastating infection requiring prompt evaluation and treatment, large-scale assessments of the frequency in potentially infected infants have not been performed. METHODS: We performed a retrospective cross-sectional study of infants .60 days old who had cerebrospinal fluid culture testing performed in 1 of 23 participating North American emergency departments. HSV infection was defined by a positive HSV polymerase chain reaction or viral culture. The primary outcome was the proportion of encounters in which HSV infection was identified. Secondary outcomes included frequency of central nervous system (CNS) and disseminated HSV, and HSV testing and treatment patterns. RESULTS: Of 26 533 eligible encounters, 112 infants had HSV identified (0.42%, 95% confidence interval [CI]: 0.35%.0.51%). Of these, 90 (80.4%) occurred in weeks 1 to 4, 10 (8.9%) in weeks 5 to 6, and 12 (10.7%) in weeks 7 to 9. The median age of HSV-infected infants was 14 days (interquartile range: 9.24 days). HSV infection was more common in 0 to 28-day-old infants compared with 29- to 60-day-old infants (odds ratio 3.9; 95% CI: 2.4.6.2). Sixty-eight (0.26%, 95% CI: 0.21%.0.33%) had CNS or disseminated HSV. The proportion of infants tested for HSV (35%; range 14%.72%) and to whom acyclovir was administered (23%; range 4%.53%) varied widely across sites. CONCLUSIONS: An HSV infection was uncommon in young infants evaluated for CNS infection, particularly in the second month of life. Evidence-based approaches to the evaluation for HSV in young infants are needed.

AB - BACKGROUND: Although neonatal herpes simplex virus (HSV) is a potentially devastating infection requiring prompt evaluation and treatment, large-scale assessments of the frequency in potentially infected infants have not been performed. METHODS: We performed a retrospective cross-sectional study of infants .60 days old who had cerebrospinal fluid culture testing performed in 1 of 23 participating North American emergency departments. HSV infection was defined by a positive HSV polymerase chain reaction or viral culture. The primary outcome was the proportion of encounters in which HSV infection was identified. Secondary outcomes included frequency of central nervous system (CNS) and disseminated HSV, and HSV testing and treatment patterns. RESULTS: Of 26 533 eligible encounters, 112 infants had HSV identified (0.42%, 95% confidence interval [CI]: 0.35%.0.51%). Of these, 90 (80.4%) occurred in weeks 1 to 4, 10 (8.9%) in weeks 5 to 6, and 12 (10.7%) in weeks 7 to 9. The median age of HSV-infected infants was 14 days (interquartile range: 9.24 days). HSV infection was more common in 0 to 28-day-old infants compared with 29- to 60-day-old infants (odds ratio 3.9; 95% CI: 2.4.6.2). Sixty-eight (0.26%, 95% CI: 0.21%.0.33%) had CNS or disseminated HSV. The proportion of infants tested for HSV (35%; range 14%.72%) and to whom acyclovir was administered (23%; range 4%.53%) varied widely across sites. CONCLUSIONS: An HSV infection was uncommon in young infants evaluated for CNS infection, particularly in the second month of life. Evidence-based approaches to the evaluation for HSV in young infants are needed.

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