Congenital Disseminated HSV-1 Infection in Preterm Twins after Primary Gingivostomatitis of the Mother: Case Report and Review of the Literature

Abstract

Transplacental transmission of HSV infection is rare, typically associated with Herpes Simplex Virus 2 (HSV-2) and often reported in term infants, whereas only a few cases of preterm infants with Herpes Simplex Virus 1 (HSV-1) infection are found in the literature. We report the case of a transplacental HSV-1 infection in preterm twins born at 27 weeks gestation. At 23 weeks gestation the mother had experienced primary gingivostomatitis and “flu-like” symptoms, which healed without specific treatment. At birth both infants presented disseminated ulcerated skin lesions at the head, trunk and extremities. Soon after birth, the infants required mechanical ventilation and showed multiple organ involvement. On the basis of the mother’s positive HSV-1 serology, treatment was established before the Tzanck test, serological findings and polymerase chain reaction of the skin and blood had confirmed the neonatal infection. In spite of the early diagnosis within hours after birth and immediate treatment, the extensive skin involvement associated with rapidly progressing multiorgan failure resulted in death of both infants within 3 days. Although a primary HSV-1 infection during pregnancy is extremely rare, gingivostomatitis with general symptoms can lead to transplacental infection and should therefore be taken seriously. Prompt recognition and treatment in the mother are paramount and might be life-saving for the infants.

Zusammenfassung

Die diaplazentare Übertragung von HSV ist selten, häufig mit Herpes Simplex Virus Typ 2 (HSV-2) vergesellschaftet und vorwiegend in Termingeborenen beschrieben. Demgegenüber gibt es in der Literatur nur vereinzelte Berichte über HSV-1 Infektionen bei Frühgeborenen. Wir beschreiben die diaplazentare HSV-1 Infektion in Zwillingen der 27. SSW. In der 23. SSW manifestierte die Mutter eine primäre Gingivostomatitis und allgemeine Erkältungssymptome, die ohne spezifische Behandlung abheilten. Bei Geburt zeigten die Neugeborenen disseminierte ulzerierte Hautläsionen im Kopf- und Stamm­bereich sowie an beiden Extremitäten. Kurz nach Geburt benötigten beide Zwillinge mechanische Beatmung und entwickelten zunehmend Zeichen einer multiplen Organbeteiligung. Aufgrund der Symptomatik und der positiven mütterlichen Serologie für HSV-1 wurde die antivirale Therapie begonnen. Die Diagnose wurde mittels Tzanck-Test, positiver Serologie und der Polymerasekettenreaktion aus Haut und Blut beider Frühgeborener bestätigt. Trotz unverzüglicher Behandlung und Diagnose verstarben beide Zwillinge innerhalb von 3 Tagen infolge der ausgedehnten Hautläsionen und dem rasch voranschreitenden Multiorganversagen. Obwohl eine primäre HSV-1 Infektion in der Schwangerschaft extrem selten ist, kann eine Gingivostomatitis mit generalisierten Erkältungssymptomen zur diplazentaren Infektion führen. Die prompte Diagnose und Therapie der Mutter sind von überragender Bedeutung, das sie für die Neugeborenen lebensrettend sein könnten.

Key words

Herpes simplex - transplacental transmission - preterm infants - skin lesions

Schlüsselwörter

Herpes simplex - diaplazentare Übertragung - Frühgeborene - Hautläsionen

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