Congenital herpes – the herpetic infection which is found at newborns at antenatalny or intranatalny infection from the infected mother. It is characterized by specific skin manifestations in the form of vesicular rash which can also settle down on mucous membranes of eyes, a mouth, internals. Often herpetic encephalitis with focal symptomatology and spasms develops. Pathological changes are noted in a liver, a spleen, lungs, kidneys and other bodies. Congenital herpes is diagnosed on the basis of results of serological, histologic researches, and also identification of particles of a virus. Treatment – antiviral medicines, immunomodulators, immunoglobulins, vitamin therapy.
Congenital herpetic infection
Congenital herpes is one of a set of options of a herpetic infection to which the cytomegalic inclusion disease, chicken pox, a sudden ekzantema of children and others of a nosology also belong. Frequency of occurrence of a disease – 1 case on 2,5-60 thousand newborns. Presumably, such dispersion of statistical data is connected with low detectability in developing countries. Congenital herpes has the high importance in pediatrics in connection with the incidence growth, and also increase in cases of a recidivous current. It is caused by the fact that the virus of simple herpes infected practically all population of the planet, and the virus constantly undergoes considerable mutations. Besides, low specificity of symptoms often is the reason of overdue diagnostics that, in turn, poses hazard to life of the child.
Reasons and classification of congenital herpes
The causative agent of a disease – a virus of simple herpes of the person. The set of types of this virus is known, however congenital herpes in 80% of cases is caused by a virus 2 types which is also known as genital herpes. The remained 20% in structure of incidence fall to the share of a virus of simple herpes of 1 type. Infection most often occurs intranatalno, when passing a fruit on the infected patrimonial ways. Less often congenital herpes develops in a womb, getting to an organism of the kid through a placenta. In this case it is about the heaviest course of a disease what the abortion or the child's birth with different degree of prematurity and heavy malformations usually is result of.
The disease can proceed in several forms which reflect the dominating clinical manifestations. Allocate 3 forms of congenital herpes: localized, cerebral and generalized. The first of them is presented by characteristic skin rashes, and this symptom is the leader. The cerebral form is, as a rule, shown by meningitis and encephalitis of the herpetic nature. Generalized congenital herpes at newborns rather often develops owing to imperfection of the immune answer and is followed by symptoms from internals. Brain violations and skin elements are also present.
Symptoms of congenital herpes
As it was already told above, the symptomatology differs depending on a disease form. Most often congenital herpes debuts for 7-14 day of life. Time of emergence of the first clinical signs depends on many factors: terms of the gestation, term of infection accompanying pathology etc. Approximately in half of cases congenital herpes is shown by vesicular rash, specific to this nosology. Small bubbles with serous contents can be localized on any part of a body, at the same time elements settle down groups, forming congestions and sometimes merging. Vesicles are surrounded with a ring of hyperaemia and hypostasis at the expense of what they slightly rise over skin. Damage of a mucous membrane of eyes in the form of keratit and conjunctivitis is characteristic.
Contents of skin elements in short terms hemorrhagic or purulent become frequent. After opening on the place of bubbles there are erosion healing by formation of a crust. The general condition of the kid can slightly worsen, temperature increases to subfebrilny values. The exception is made by cases of the so-called primary congenital herpes representing the localized form of a disease and which is shown plentiful rash which elements often merge, leaving after opening extensive erosion. High temperature, rashes are present not only at skin, but also at mucous. For lack of timely therapy generalization happens in 50% of cases.
The cerebral form of congenital herpes is shown by meningealny symptomatology in the absence of damage of skin. Sometimes vesicular rash arises later, about a week later after a debut of brain violations, but rash elements in this case always a little. To the forefront there are symptoms of meningitis and encephalitis: consciousness violations, epileptiformny, tonic and toniko-clonic spasms. Symptoms are not specific therefore it is easy to confuse herpetic encephalitis with encephalitis of any other nature. Considerable intoxication worsens a state, however at newborns fever can be not expressed. Also there are symptoms of hypostasis of a brain that it is shown by stem violations: dysphagy, disorders of breath and so forth.
The generalized form of congenital herpes is the most dangerous. It includes both elements of rash, and the cerebral symptomatology described above. In addition, the disease is shown by damage of internals: gepatosplenomegaliya, pneumonia, specific changes in kidneys and adrenal glands. The phenomena of toxicosis are expressed substantially. Mortality at a generalized form of congenital herpes makes more than 50%, and according to some information reaches 80-90% of cases, at the same time a half of the survived children remain deep disabled people. Slow regress of all-brain and focal frustration and their frequent irreversibility are feature of a herpetic infection.
Diagnosis of congenital herpes
Detection of a disease is accompanied for the pediatrician by considerable difficulties. First, if there are no skin manifestations, then congenital herpes can be suspected with the same probability, as many other pathologies of the neonatal period, in particular, pre-natal infections, a hypoxemic trauma etc. Besides, often identification of the activator is not the proof of a herpetic infection as population bulk in the world had contact with this virus. Nevertheless, a basis of diagnostics is detection of the virus or its anti-genes in different environments, for example, in contents of vesicles, blood, dabs from noso-and rotoglotka, tserebrospinalny liquid, etc.
The method is highly specific, but takes a lot of time. For this reason serological researches for the purpose of definition of specific antibodies of the class IgM are conducted that is confirmation of a sharp phase of congenital herpes. Confirmation of the diagnosis is possible also on the basis of detection of antibodies of the class IgG, at the same time the crucial role is played by not the fact of their existence, and increase of a caption in dynamics not less than by 4 times (in the absence of increase of an antibody are maternal). In diagnosis of herpetic encephalitis doctors are based on the data of a serological research. Congenital herpes is also confirmed, proceeding from the anamnesis of mother and results of histologic inspection of an afterbirth.
Treatment and forecast of congenital herpes
Etiotropny therapy of a disease is carried out, the forecast for life and health of the child in many respects depends on terms of its beginning. Antiviral medicines, vysokotropny are applied to a virus of simple herpes. The parenteral way of introduction is used. Also means of external action for treatment of vesicular rash are appointed. Besides, immunoglobulins and immunomodulators are always connected to therapy of congenital herpes, a vitamin therapy course is conducted. According to indications oxygen support and IVL is carried out, anticonvulsive drugs are injected, dehydration is carried out.
The forecast is adverse. Congenital herpes often proceeds in a generalized form, consequences of herpetic encephalitis are irreversible. The survived children very seldom do not lag behind in development peers. Most of them remain disabled people or perish in the period of a heat of clinical manifestations. Even if therapy is begun in due time, the disease can repeatedly recur with the same symptomatology. For prevention of a recurrence use of a herpetic vaccine is possible. Now there are several its types, but owing to frequent mutations of a virus efficiency of vaccination remains undecided.