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2019

ANUÁRIO DO HOSPITAL
DONA ESTEFÂNIA

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NEONATAL HERPETIC KERATOCONJUNCTIVITIS – VERTICAL OR HORIZONTAL TRANSMISSION?

Mafalda Crisóstomo1, Cristina Brito2, João Neves1, Maria João Brito1, Catarina Gouveia1

1- Unidade Infecciologia Pediátrica, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central, EPE, Lisboa;
2- Departamento de Oftalmologia, Hospital Sto António dos Capuchos, Centro Hospitalar de Lisboa Central, EPE, Lisboa;

34th Annual Meeting of the European Society for Paediatric Infectious Diseases – Brighton, UK (May 10-14, 2016)

Introduction: Herpes Simplex Virus (HSV) disease of the newborn can be acquired in intrauterine period, peripartum or postpartum, being this last, the most common form. The disease results with infection of the central nervous system, disseminated disease or mucocutaneous infection, but two or more entities can coexist.
Case Report: A 47 days-old infant with lacrimation and ocular discharge of the right eye, followed by mattering, since the 2nd week of life, was admitted. On the 7th day of life, vesicular lesions were noticed in the upper right eyelid. A diagnosis of unilateral keratoconjunctivitis with extensive corneal ulcer was made and empirically treated with topical tobramycin and acyclovir. The patient was a full-term, delivered via an uncomplicated eutocic birth. In further observation, we found worsening of corneal lesions, extensive ulceration and stroma infiltration, and intravenous cefotaxime and acyclovir was started. HSV-1 polymerase chain reaction (PCR) was positive in corneal scrapings, but negative in blood and cerebrospinal fluid, excluding other forms of herpetic disease. She was discharged after 14 days of intravenous acyclovir and kept on prophylactic acyclovir. Her mother has no history of genital herpes, but was being treated with immunosuppressives for rheumatoid arthritis and has recurrent muco-cutaneous herpes, with lesions reported one week after giving birth.
Comments: A maternal immunosuppression cannot exclude the possibility of vertical transmission. However, the mother’s history, the infant’s age and the HSV1 suggest a horizontal transmission. Prophylactic acyclovir in mucocutaneous disease with keratoconjunctivitis is not consensual.

Palavras Chave: Herpes Simplex Virus; neonatal; keratoconjunctivitis.