Neonatal herpes diagnostic evaluation updated in 2012 Red Book

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Kimberlin, MD, said standard diagnostic evaluation of neonatal HSV should begin with surface cultures, which include swabs of the mouth, "/><meta id="metaKeywords" name="keywords" content="Infectious Disease News,Pediatrics,Infectious Disease,Emerging Diseases,Pediatric ID,Meeting News Coverage"/><meta id="Meta1" name="scID"/><meta id="scID" name="scID"/><meta name="robots" content="noindex, nofollow"/> <meta name="ModifiedDate" content="2013-05-03"/> <meta name="specialties" content="Pediatrics,Infectious Disease"/> <meta name="specialty" content="Pediatrics"/> <meta name="specialty" content="Infectious Disease"/> <meta name="primary_specialty" content="Pediatrics"/> <meta name="subspecialties" content="Emerging Diseases,Pediatric ID"/> <meta name="subspecialty" content="Emerging Diseases"/> <meta name="subspecialty" content="Pediatric ID"/> <meta name="primary_subspecialty" content="Emerging Diseases"/> <meta name="departments" content="Meeting News Coverage"/> <meta name="department" content="Meeting News Coverage"/> <meta name="content_type" content="News Article"/> <meta name="PostedDate" content="2012-12-01"/> <meta name="pageid" content="{2780042F-FB06-4A01-9FF4-65637B3F9A73}"/> <meta property="og:image" content="https://web.archive.org/web/20131030022504im_/http://213a1ca8842e5e699a80-05ce35571e92a3f7383a191aa5840bba.r66.cf1.rackcdn.com/healio_safe_image.png"/><meta name="authors" content=""/><meta name="articleid" content="{2780042F-FB06-4A01-9FF4-65637B3F9A73}"/><meta name="legacyarticleid" content=""/><meta name="article-title" content="Neonatal herpes diagnostic evaluation updated in 2012 Red Book"/><meta name="article-link" content="/pediatrics/emerging-diseases/news/print/infectious-disease-news/{2780042f-fb06-4a01-9ff4-65637b3f9a73}/neonatal-herpes-diagnostic-evaluation-updated-in-2012-red-book"/><meta name="pubname" content="Infectious Disease News"/><meta name="pubtype" content="print"/><meta name="issue-name" content="December 2012"/><meta name="issue-year" content="2012"/><meta name="source" content=""/><meta name="author" content=""/>  <link href="https://web.archive.org/web/20131030022504cs_/http://c341130.r30.cf1.rackcdn.com/styles.css" rel="stylesheet" type="text/css"/>  <link href="https://web.archive.org/web/20131030022504cs_/http://c341130.r30.cf1.rackcdn.com/styles2.css" rel="stylesheet" type="text/css"/><link href="https://web.archive.org/web/20131030022504cs_/http://c341130.r30.cf1.rackcdn.com/tb-ec-lb-min.css" rel="stylesheet" type="text/css" media="screen"/><link href="https://web.archive.org/web/20131030022504cs_/http://0043b493b06d545127da-d7c71b4c9ba1dd44e0cf6fa474e637d7.r99.cf1.rackcdn.com/healiojobs.css" rel="stylesheet" type="text/css"/><link href="https://web.archive.org/web/20131030022504cs_/http://6af4390358a281e0b439-028b17272c3ee5c2953a93a8c54187e2.r22.cf1.rackcdn.com/MediaKits.css" rel="stylesheet" type="text/css"/>  <link rel="shortcut icon" type="image/x-icon" href="https://web.archive.org/web/20131030022504im_/http://213a1ca8842e5e699a80-05ce35571e92a3f7383a191aa5840bba.r66.cf1.rackcdn.com/favicon.ico"/> <style type="text/css"> #wrap:before, #wrap:after { content: " "; display: table; } #wrap:after { clear: both; } </style> <script type="text/javascript" language="javascript" src="https://web.archive.org/web/20131030022504js_/http://ajax.googleapis.com/ajax/libs/jquery/1.8.2/jquery.min.js"></script> <script type="text/javascript" language="javascript" src="https://web.archive.org/web/20131030022504js_/http://cdn.jquerytools.org/1.2.7/full/jquery.tools.min.js"></script> <script type="text/javascript" language="javascript">$j = $.noConflict();</script> <script type="text/javascript" language="javascript" src="https://web.archive.org/web/20131030022504js_/http://c341136.r36.cf1.rackcdn.com/thickbox-compressed.js"></script> <script type="text/javascript">var globalUserID = 0;</script>  <script type="text/javascript" charset="utf-8"> var pd_tags = new Array; if (globalUserID !== undefined || globalUserID !== null) { pd_tags['customer_ID'] = globalUserID; } </script> <script type="text/javascript" charset="utf-8" src="https://web.archive.org/web/20131030022504js_/http://static.polldaddy.com/p/3191508.js"></script> <script type="text/javascript"> var googletag = googletag || {}; googletag.cmd = googletag.cmd || []; (function() { var gads = document.createElement('script'); gads.async = true; gads.type = 'text/javascript'; var useSSL = 'https:' == document.location.protocol; gads.src = (useSSL ? 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href="/web/20131030022504/http://www.healio.com/pediatrics/emerging-diseases"> Emerging Diseases</a> <span>›</span> <a href="/web/20131030022504/http://www.healio.com/pediatrics/emerging-diseases/news"> News</a> </p>   <div id="SeeAlso" class="related-links"><h3>See Also</h3><ul><li><a href="https://web.archive.org/web/20131030022504/http://www.healio.com/pediatrics/emerging-diseases/news/print/infectious-diseases-in-children/%7Bcaee697b-ca62-45cf-aed8-4db0e1c8c5ca%7D/neonatal-herpes-diagnostic-evaluation-updated-in-2012-red-book">Neonatal herpes diagnostic evaluation updated in 2012 Red ...</a></li><li><a href="https://web.archive.org/web/20131030022504/http://www.healio.com/pediatrics/emerging-diseases/news/online/%7Be75c1085-6562-42af-a9ad-06a992fb3410%7D/red-book-addresses-tstigra-debate">Red Book addresses TST/IGRA debate</a></li><li><a href="https://web.archive.org/web/20131030022504/http://www.healio.com/pediatrics/emerging-diseases/news/online/%7B995e2902-3f63-4a35-bc02-ae4b4e3dd1cc%7D/neonatal-viral-infections">Neonatal Viral Infections</a></li></ul></div> <input name="layout_0$maincontent_0$seeAlsoInsertUnderParagraph" type="hidden" id="layout_0_maincontent_0_seeAlsoInsertUnderParagraph" value="1"/>  <div class="content"> <h2> Neonatal herpes diagnostic evaluation updated in 2012 Red Book</h2> <h3 class="deck"> </h3> <p class="main-subtitle"> </p> <div class="social-links-top"> <ul class="share"> <li class="l1"><a href="javascript:void(0)" class="facebook-link" target="_new">Facebook</a></li> <li class="l2"><a href="javascript:void(0)" class="twitter-link" target="_new">Tweet</a></li> <li class="l3"><a href="javascript:void(0)" class="linkedin-link">Share</a></li> </ul> </div> <ul class="meta-info"> <li> Infectious Disease News, December 2012</li> </ul> <div class="wyContent"> <p class="BodyCxSpFirst">NEW YORK — Neonatal herpes simplex virus infection is rare, but it must be considered regularly in diagnostic evaluations, according to data presented here during the 25th Annual <em>Infectious Diseases in Children</em> Symposium.</p> <p style="margin: 0in 0in 10pt;" class="BodyCxSpLast">Course Director <strong>David W. Kimberlin, MD</strong>, said standard diagnostic evaluation of neonatal HSV has been updated slightly as per the 2012 edition of the AAP <em>Red Book</em>. In addition to the traditional workup of surface cultures and cerebrospinal PCR, the evaluation should now include whole blood for PCR for HSV DNA and blood alanine aminotransferase (ALT).</p> <div class="mug right"><img width="90" height="120" alt="David Kimberlin" src="/web/20131030022504im_/http://www.healio.com/~/media/Images/Mugs/IDC/K/Kimberlin_David2.jpg"/>  <p class="name"><strong><strong>David W. Kimberlin</strong></strong></p> </div> <p class="BodyCxSpMiddle"></p> <p class="BodyCxSpFirst">“The ALT levels indicate if the baby is sicker than you think because a baby may have neonatal HSV without looking extremely ill,” said Kimberlin, who was recently appointed editor of the AAP <em>Red Book</em> for the 30th edition to be published in 2015.</p> <p class="BodyCxSpMiddle">Sites from which surface cultures should be performed include swabs of the mouth, nasopharynx, conjunctivae and rectum; the 2012 <em>Red Book</em> also allows for PCR from these specimens, as long as it is in addition to the gold standard culture. Direct fluorescent antibody staining of vesicle scrapings also may aid in the diagnosis.</p> <p class="BodyCxSpMiddle">“It’s important to unroof the vesicle for the culture,” said Kimberlin, professor of pediatrics, Sergio Stagno Endowed Chair in Pediatric Infectious Diseases, co-director of the division of pediatric infectious diseases at the University of Alabama at Birmingham.</p> <p class="BodyCxSpMiddle">In addition, Kimberlin said, neonatal HSV infection should be considered even when the mother is receiving antiviral suppressive acyclovir or valacyclovir therapy.</p> <p class="BodyCxSpMiddle">Treatment of neonatal HSV should be initiated only after full diagnostic evaluation, including surface cultures and cerebrospinal fluid PCR. A 60-mg/kg per day dose of acyclovir should be administered in three divided doses for 21 days for central nervous system disease or disseminated disease and 14 days for skin, eyes and/or mouth disease, according to Kimberlin. </p> <p class="BodyCxSpMiddle">If the baby has central nervous sytem involvement, Kimberlin also said the lumbar puncture should be repeated for HSV PCR before cessation of parenteral antiviral therapy. Once parenteral therapy has ceased, oral acyclovir suppressive therapy should be initiated at a 300 mg/m2 dose given orally three times daily for 6 months.</p> <p style="margin: 0in 0in 10pt;" class="BodyCxSpLast">“[Absolute neutrophil counts] should be monitored at 2 and 4 weeks and then monthly,” Kimberlin said. </p> <p class="BodyCxSpMiddle"><b>For more information</b>:</p> <p class="BodyCxSpMiddle">Kimberlin DW. Neonatal viral infections. Presented at: 25th Annual <em>Infectious Diseases in Children</em> Symposium; Nov. 17-18; New York.</p> <p style="margin: 0in 0in 10pt;" class="BodyCxSpLast"><b>Disclosure: </b>Kimberlin reports his institution receives research funding from Cellex, Cubist Pharmaceuticals and GlaxoSmithKline.</p> </div>  <div class="fig left"> <p class="figcaption"> </p> </div> <div class="wyPagination">   </div>  <div class="follow"> <img src="/web/20131030022504im_/http://www.healio.com/~/media/Images/News/FollowUs.jpg" id="layout_0_maincontent_1_SocialFollow_socialfollow" name="socialfollow" alt="Follow us" usemap="#followus" border="0"/> <map id="followus" name="followus"> <area id="layout_0_maincontent_1_SocialFollow_followfb" shape="rect" coords="51,5,5,51" target="_blank" href="https://web.archive.org/web/20131030022504/http://www.facebook.com/InfectiousDiseasesInChildren" alt="Follow us on Facebook"></area> <area id="layout_0_maincontent_1_SocialFollow_followtw" shape="rect" coords="270,3,320,50" target="_blank" href="https://web.archive.org/web/20131030022504/https://twitter.com/PedSuperSite" alt="Follow us on Twitter"></area> </map> </div> </div>  <div class="social-links"> <div class="fb-like" data-send="false" data-width="300" data-show-faces="true" data-action="recommend"></div> <ul class="share"> <li><a href="javascript:void(0)" id="twitter" class="twitter-link" target="_new">Tweet</a></li> <li><a href="javascript:void(0)" id="facebook" class="facebook-link" target="_new">Share</a></li> <li class="linkedin"><a href="javascript:void(0)" id="linkedin" class="linkedin-link">Link</a></li> <li><span class="db-wrapper"><span class="g-plusone" data-size="tall" data-annotation="none"></span></span></li> <li><a href="javascript:void(0)" id="email">Email</a></li> <li class="last"><a href="javascript:void(0)" id="print">Print</a></li> </ul> <input name="layout_0$maincontent_1$SocialMedia$articleItemForTweet" type="hidden" id="layout_0_maincontent_1_SocialMedia_articleItemForTweet" value="{2780042F-FB06-4A01-9FF4-65637B3F9A73}"/> <input name="layout_0$maincontent_1$SocialMedia$tweettext" type="hidden" id="layout_0_maincontent_1_SocialMedia_tweettext" class="tweettext" value="Neonatal herpes diagnostic evaluation updated in 2012 Red Book "/> <input name="layout_0$maincontent_1$SocialMedia$tweeturl" type="hidden" id="layout_0_maincontent_1_SocialMedia_tweeturl" class="tweeturl" value="http://goo.gl/z39S2S"/> </div>  <div id="respond"> <h4> Comments</h4> <script language="javascript" type="text/javascript"> var idcomments_acct = 'aa6ff53f9870e40f92f83e1b5df3cddf'; var idcomments_post_id = '{2780042F-FB06-4A01-9FF4-65637B3F9A73}'; var idcomments_post_url; </script> <span id="IDCommentsPostTitle" style="display: none"></span> <script type="text/javascript" src="https://web.archive.org/web/20131030022504js_/http://www.intensedebate.com/js/genericCommentWrapperV2.js"></script> <p class="comment-notes"> Healio is intended for health care provider use and all comments will be posted at the discretion of the editors. 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