新生儿单纯疱疹病毒中枢神经系统感染病例报告并文献复习

Herpes simplex virus central nervous system infection in neonate:a case report and literature review

目的报道1例新生儿单纯疱疹病毒中枢神经系统感染病例,并通过文献回顾和复习,提高临床上对此类少见病的认识,减少该病的误诊、漏诊。方法回顾性分析1例新生儿单纯疱疹病毒中枢神经系统感染患儿的发病、诊断和治疗过程,结合以往的文献报道,总结该病的临床表现和诊治要点。结果回顾文献显示:新生儿单纯疱疹病毒中枢神经系统感染非常少见。病死率高,存活者大多存在神经系统不良结局。本例为14天大新生儿,因发热入院,原因未明,入院即予阿昔洛韦抗病毒治疗取得良好疗效,随访至今(3月大),未见神经系统异常表现。提示及早有效的抗病毒治疗是影响预后的关键因素。结论新生儿单纯疱疹病毒中枢神经系统感染临床无特异性表现,此病少见。尽早、足程的抗病毒治疗,可明显改善患儿的预后。对于不明原因发热的新生儿(特别是社区获得者),早期经验性予以阿昔洛韦抗病毒治疗,利大于弊。

Objective To report a case of herpes simplex virus central nervous system infection in a neonate and to review literatures about this disease,and to improve clinical understanding of this rare disease and reduce misdiagnosis and missed diagnosis.Methods The clinical manifestation,diagnosis and treatment of the patient with herpes simplex virus central nervous system infection were analyzed.The epidemiology,clinical manifestation and key points of diagnosis were summarized from literature review.Results Literature review showed that:neonatal herpes simplex virus central nervous system infection is very rare.The mortality rate is high,and most of the survivors have adverse neurological outcomes.This case is a fourteen days newborn who was admitted to the hospital due to fever for unknown reasons.He was given acyclovir antiviral therapy immediately after admission and achieved good results.Follow-up of 3 months showed no neurological abnormalities.It suggested that early and effective antiviral therapy is a key factor affecting the prognosis.Conclusion Neonatal herpes simplex virus central nervous system infection has no specific clinical manifestations,and this disease is rare.Early,full-course of antiviral therapy can greatly improve the prognosis of children.For newborns with unexplained fever(especially those obtained in the community),early empirical antiviral treatment with acyclovir is more beneficial than harmful.