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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.