DERMATOLOGY

ResponseDiagnosis = Neonatal HSV

HSV transmission to neonate
- Intrauterine via placenta (Rare)
- Perinatal via genital tract - Maternal gential herpes (Esp. if active at time of birth, NVD, PROM, scalp PH monitor, maternal fever
- Postnatal from somoene shedding the virus postnatal contact with someone with cold sore (kissing etc)

Complications
Herpes meningioencephalitis

• Seizures, lethargy, irritibulity, tremors, poor feeding, fever, full anterior fontanelle

Herpetic mouth ulcers
Keratoconjunctivitis
Pneumonitis - SOB, poor feeding
Painful skin lesions
Disseminated herpes causing organ failure

• Sepsis like shock, multi organ failure, bleeding from thrombocytopaeina/liver dysfunction, abdo distension, ascites

Electrolyte abnormalities

ResponseDescription:
Multiple Vescicles with ertythematous base. Vescicular monomorphic rash
Coalescing around right cheek
Crusted
Lower lip involved, some lesions close to eye

Diagnosis: Eczema Herpeticum (HSV, occasionally coxsackie or vaccina virus)
Eczema herpeticum with possible secondary bacterial infection (impetigo)
DDx Impetigo, chicken pox, hand, foot, and mouth with secondary bacterial infection, SJS


-RCH

ResponseInvestigations:
Viral swab from blisters - HSV
Bacterial swab - ?Staph/strep

Mgmt
Aciclovir 10 mg/kg IV BD
Flucloxacillin 50 mg/kg IV QID
Look for complications - shock, hypovolaemia, sepsis, eye, meningitis/encephalitis
Analgesia
Admit for treatment, analgesia +/- rehydration

ResponseHerpes encephalitis
Herpes hepatitis
Herpes opthalmicus
Bacteraemia, sepsis, organ failure
ARDS
DIC
Death