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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">While rare&#44; neonatal herpes simplex virus &#40;HSV&#41; infection is one of the most severe perinatal infections&#46; Only 10&#37; of cases are acquired after birth&#46; The disease is classified according to clinical presentation as follows&#58; skin&#44; eye&#44; and mouth &#40;SEM&#41; disease &#40;prevalence of &#8776;45&#37;&#41;&#59; central nervous system &#40;CNS&#41; disease &#40;&#8776;30&#37;&#41;&#44; and disseminated disease &#40;&#8776;25&#37;&#41;&#44; which has the worst prognosis&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> No deaths have been reported for SEM disease&#44; but 2&#37; of those affected may develop some degree of impairment by the age of 12 years&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> Early recognition and treatment with high-dose acyclovir &#40;60<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;d&#41; reduces mortality and may improve long-term outcomes&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of a 10-day-old newborn female admitted to the hospital with generalized skin lesions that had appeared 5<span class="elsevierStyleHsp" style=""></span>h previously&#46; The lesions consisted of groups of vesicles and pustules overlying erythematous skin&#44; affecting the trunk and tongue &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The infant did not have fever or neurologic symptoms and was systemically well&#46; There had been no complications during the pregnancy&#44; vaginal delivery&#44; or immediate postpartum period&#46; The mother had had systemic lupus erythematous for the past 6 years&#44; but this was clinically stable&#46; She had had chickenpox during her childhood but had no genital lesions suggestive of herpes infection&#46; The father&#44; however&#44; had active herpes simplex labialis and admitted to having repeatedly kissed his baby while he had active lesions&#46; HSV type 1 was isolated from vesicular lesions in the neonate by real-time polymerase chain reaction &#40;PCR&#41;&#46; The rest of the tests were normal or negative&#44; and included biochemical analysis&#44; blood cell count&#44; coagulation studies&#44; blood culture&#44; PCR for varicella-zoster virus from the newborn&#39;s vesicles&#44; and culture and PCR for HSV&#44; enterovirus&#44; and varicella-zoster virus in cerebrospinal fluid&#46; The fundus of the eye and ultrasound imaging of the brain were also normal&#46; Due to the high suspicion of HSV infection&#44; high-dose intravenous acyclovir was administered empirically while awaiting the PCR test results&#46; Once the diagnosis had been confirmed&#44; acyclovir was continued to complete 14 days of treatment&#46; Contact isolation was also established&#46; The girl&#39;s condition gradually improved over the next few days&#44; and no sequelae were observed in the follow-up period&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">HSV is a common human pathogen&#46; Between 30&#37; and 100&#37; of adults have serologic evidence of the virus&#46; It has been shown that oral HSV excretion is episodic and may occur in the presence or absence of herpes labialis&#46; Importantly and contrary to general belief&#44; reactivation of HSV leads more frequently to asymptomatic viral shedding than to recurrence of mucocutaneous lesions&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">HSV infection in neonates typically presents within the first 4 weeks of life&#46; Skin lesions are an important diagnostic clue&#44; but they are absent in 39&#37; of cases of disseminated disease&#44; 32&#37; of cases of CNS disease&#44; and 17&#37; of cases of SEM disease&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a> The proportion of neonatal infections due to HSV type 1 has increased in the last decade&#44; possibly as a consequence of changing sexual habits among parents&#46; An early diagnosis is mandatory and the method of choice is detection of HSV DNA by PCR or virus culture&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Our findings led to a diagnosis of neonatal HSV type 1 infection &#40;SEM disease&#41;&#46; We believe that the most likely source of transmission was the father&#39;s herpes simplex labialis&#44; although we cannot be entirely certain because virus isolation was not performed&#46; We initiated early empirical treatment about 8<span class="elsevierStyleHsp" style=""></span>h after onset of the lesions&#44; and may&#44; therefore&#44; have prevented progression to CNS involvement&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The aim of this article is to alert dermatologists to the possibility of postnatally acquired HSV infection in newborns&#46; We emphasize the importance of establishing an early diagnosis and initiating empirical treatment upon the first suspicion&#46; Based on our case&#44; we strongly recommend separation of the newborn from any person with active HSV lesions &#40;mothers with herpes labialis should wear a mask&#41;&#46; We also recommend offering anticipatory guidance for parents&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interests</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest&#46;</p></span></span>"
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Case and Research Letter
Father-to-Newborn Transmission of Herpes Simplex Virus Infection: A Sweet but Bitter Kiss
Herpes neonatal tras contacto con herpes labial paterno: dulce y amargo beso
O. Guergué Diaz de Cerio
, M. Rubio Lombraña, A. Barrutia Borque, M.R. González Hermosa
Servicio de Dermatología del Hospital Universitario Cruces, Vizcaya, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">While rare&#44; neonatal herpes simplex virus &#40;HSV&#41; infection is one of the most severe perinatal infections&#46; Only 10&#37; of cases are acquired after birth&#46; The disease is classified according to clinical presentation as follows&#58; skin&#44; eye&#44; and mouth &#40;SEM&#41; disease &#40;prevalence of &#8776;45&#37;&#41;&#59; central nervous system &#40;CNS&#41; disease &#40;&#8776;30&#37;&#41;&#44; and disseminated disease &#40;&#8776;25&#37;&#41;&#44; which has the worst prognosis&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> No deaths have been reported for SEM disease&#44; but 2&#37; of those affected may develop some degree of impairment by the age of 12 years&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> Early recognition and treatment with high-dose acyclovir &#40;60<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;d&#41; reduces mortality and may improve long-term outcomes&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of a 10-day-old newborn female admitted to the hospital with generalized skin lesions that had appeared 5<span class="elsevierStyleHsp" style=""></span>h previously&#46; The lesions consisted of groups of vesicles and pustules overlying erythematous skin&#44; affecting the trunk and tongue &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The infant did not have fever or neurologic symptoms and was systemically well&#46; There had been no complications during the pregnancy&#44; vaginal delivery&#44; or immediate postpartum period&#46; The mother had had systemic lupus erythematous for the past 6 years&#44; but this was clinically stable&#46; She had had chickenpox during her childhood but had no genital lesions suggestive of herpes infection&#46; The father&#44; however&#44; had active herpes simplex labialis and admitted to having repeatedly kissed his baby while he had active lesions&#46; HSV type 1 was isolated from vesicular lesions in the neonate by real-time polymerase chain reaction &#40;PCR&#41;&#46; The rest of the tests were normal or negative&#44; and included biochemical analysis&#44; blood cell count&#44; coagulation studies&#44; blood culture&#44; PCR for varicella-zoster virus from the newborn&#39;s vesicles&#44; and culture and PCR for HSV&#44; enterovirus&#44; and varicella-zoster virus in cerebrospinal fluid&#46; The fundus of the eye and ultrasound imaging of the brain were also normal&#46; Due to the high suspicion of HSV infection&#44; high-dose intravenous acyclovir was administered empirically while awaiting the PCR test results&#46; Once the diagnosis had been confirmed&#44; acyclovir was continued to complete 14 days of treatment&#46; Contact isolation was also established&#46; The girl&#39;s condition gradually improved over the next few days&#44; and no sequelae were observed in the follow-up period&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">HSV is a common human pathogen&#46; Between 30&#37; and 100&#37; of adults have serologic evidence of the virus&#46; It has been shown that oral HSV excretion is episodic and may occur in the presence or absence of herpes labialis&#46; Importantly and contrary to general belief&#44; reactivation of HSV leads more frequently to asymptomatic viral shedding than to recurrence of mucocutaneous lesions&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">HSV infection in neonates typically presents within the first 4 weeks of life&#46; Skin lesions are an important diagnostic clue&#44; but they are absent in 39&#37; of cases of disseminated disease&#44; 32&#37; of cases of CNS disease&#44; and 17&#37; of cases of SEM disease&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a> The proportion of neonatal infections due to HSV type 1 has increased in the last decade&#44; possibly as a consequence of changing sexual habits among parents&#46; An early diagnosis is mandatory and the method of choice is detection of HSV DNA by PCR or virus culture&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Our findings led to a diagnosis of neonatal HSV type 1 infection &#40;SEM disease&#41;&#46; We believe that the most likely source of transmission was the father&#39;s herpes simplex labialis&#44; although we cannot be entirely certain because virus isolation was not performed&#46; We initiated early empirical treatment about 8<span class="elsevierStyleHsp" style=""></span>h after onset of the lesions&#44; and may&#44; therefore&#44; have prevented progression to CNS involvement&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The aim of this article is to alert dermatologists to the possibility of postnatally acquired HSV infection in newborns&#46; We emphasize the importance of establishing an early diagnosis and initiating empirical treatment upon the first suspicion&#46; Based on our case&#44; we strongly recommend separation of the newborn from any person with active HSV lesions &#40;mothers with herpes labialis should wear a mask&#41;&#46; We also recommend offering anticipatory guidance for parents&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interests</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest&#46;</p></span></span>"
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        "texto" => "<p id="par0040" class="elsevierStylePara elsevierViewall">We thank the patient&#39;s parents for providing the photographs used in this article and for authorizing their publication&#46; We would also like to thank Rabia Sofia Rashid for correcting the manuscript&#46;</p>"
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Article information
ISSN: 15782190
Original language: English
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Idiomas
Actas Dermo-Sifiliográficas
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