Presentation of neonatal herpes simplex virus infections: implications for a change in therapeutic strategy.
Presentation of neonatal herpes simplex virus infections: implications for a change in therapeutic strategy.
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新生儿单纯疱疹病毒感染的表现：对治疗策略改变的影响。
DOI：
10.1097/00006454-198605000-00007
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发表时间：
1986
期刊：
影响因子：
--
通讯作者：
Corey,L
中科院分区：
文献类型：
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作者：
Sullivan-Bolyai,JZ;Hull,HF;Wilson,C;Smith,AL;Corey,L
为了确定疾病的临床症状，以便更快地识别治疗，我们回顾了1965年至1984年间连续42例新生儿单纯疱疹病毒（HSV）感染从发病到诊断的时间。首发症状包括14例皮肤粘膜病变，20例中枢神经系统症状，6例发热，2例婴儿呼吸功能不全。从发病到向医务人员报告的中位时间为1天。从向医务人员报告到获得病毒培养的中位时间为3天（范围，1至11天），在有和没有皮肤粘膜病变的婴儿中是相似的。1982年至1984年期间出生的13名非先天性感染婴儿中有8名在入院后24小时内进行了病毒培养，而1965年至1981年期间出生的24名婴儿中有5名进行了病毒培养（P< 0.03）。然而，在1965年至1977年、1978年至1981年和1982年至1984年出生的婴儿中，有33%、40%和14%的婴儿在向医务人员报告和获得病毒诊断研究之间延迟了72小时。从出现到医务人员和诊断之间，57%的婴儿被HSV累及其他器官系统。新生儿HSV感染往往是严重的时候，病人呈现给医务人员，疾病通常进展迅速。为了使新生儿疱疹患儿获得更好的治疗效果，应根据临床和流行病学的推测，考虑开始抗病毒治疗。未来治疗新生儿疱疹的策略应以预防疾病的获得为指导。
To identify clinical signs of disease that might lead to more rapid recognition in treatment, we reviewed the time from onset of illness to diagnosis of 42 consecutive cases of neonatal herpes simplex virus (HSV) infection seen between 1965 and 1984. The first signs of illness included mucocutaneous lesions in 14, central nervous system signs in 20, fever in 6 and respiratory insufficiency in 2 infants. The median time from onset of illness to presentation to medical personnel was 1 day. The median time from presentation to medical personnel to obtaining viral cultures was 3 days (range, 1 to 11) and was similar in infants who did and did not have mucocutaneous lesions. Viral cultures were performed within 24 hours of admission on 8 of 13 noncongenitally infected infants born between 1982 and 1984 compared to 5 of 24 seen between 1965 and 1981 (P< 0.03). However, a> 72-hour delay between presentation to medical personnel and obtaining viral diagnostic studies occurred in 33, 40 and 14% of infants born in the years 1965 to 1977, 1978 to 1981 and 1982 to 1984. Involvement of additional organ systems by HSV was noted in 57% of infants between the time from presentation to medical personnel and diagnosis. Neonatal HSV infection was often severe by the time patients presented to medical personnel, and the disease usually progressed rapidly. To achieve a better therapeutic outcome for infants with neonatal herpes, consideration should be given to the initiation of antiviral therapy on presumptive clinical and epidemiologic grounds. Future strategies for therapy of neonatal herpes should be directed at preventing the acquisition of disease.