Consider HSV

• Consider HSV as an etiology of fever in a neonate (0-30days) even without a maternal history of HSV or h/o active lesions.
  • In one study, only 12% of neonates dx’d with HSV infections had mothers with a known h/o HSV or active lesions.
• Start Acyclovir empirically in these neonates, especially if the Gram Stain is negative.  Send appropriate HSV PCR and Cx.
  • Only 29% of patients (pediatric and adult) ultimately diagnosed with HSV encephalitis were started on acyclovir in the ED. 
  • Those who were not started on acyclovir in the ED, had a significant delay of appropriate therapy.
  • If you don’t think of it… the admitting team might not either.
     

References

Whitley R, Davis EA, Suppapanya N. Incidence of neonatal herpes simplex virus infections in a managed-care population.  Sex Transm Dis. 2007 Sep;34(9):704-8.

Benson PC, Swadron SP. Empiric acyclovir is infrequently initiated in the emergency department to patients ultimately diagnosed with encephalitis.  Ann Emerg Med. 2006 Jan;47(1):100-5.  Epub 2005 Nov 8.