Perinatale HSV-Infektionen

R. Roos

doi:10.1055/s-0038-1629379

Kinder- und Jugendmedizin, Table of Contents

Kinder- und Jugendmedizin 2014; 14(02): 80-84
DOI: 10.1055/s-0038-1629379

Infektiologie

Schattauer GmbH

Perinatale HSV-Infektionen

Perinatal HSV-infections

R. Roos

Abstract

Zusammenfassung

Perinatale HSV-Infektionen sind zwar selten, führen unbehandelt zu einer sehr hohen Letalität und erheblichen Spätmorbidität. Leitsymptome sind Herpesbläschen vorwiegend an Haut oder Augen, eine Sepsis verbunden mit Symptomen einer Hepatitis oder eine Enzephalitis mit oder ohne typische Herpesbläs-chen der Haut. Die Übertragung von HSV erfolgt in der Regel durch eine infizierte Schwangere, selten postnatal durch eine Kontaktperson. Je später die HSV-Infektion einer Schwangeren erfolgt, desto höher ist das Risiko der perinatalen Übertragung und desto gravierender sind Symptome und Spätmorbidität.

Das HSV wird mittels PCR aus Bläschen, Liquor, Schleimhautabstrichen oder Blut nachgewiesen. Therapeutisch entscheidend sind die frühe Verdachtsdiagnose und sofort beginnende antivirale Therapie vor mikrobiologischer Bestätigung. Bei Neugeborenen wird mit Aciclovir 60 mg/kg KG/Tag in 3 ED (Dosisreduktion bei Frühgeborenen mit eingeschränkter Nierenfunktion) für drei Wochen behandelt. Foscarnet ist eine Alternative.

Präventiv entscheidend ist, infizierte Mütter zu erkennen. Bei perinataler Primärinfektion ohne Blasensprung wirkt eine Sectio präventiv. Bei der asymptomatischen HSV-Ausschei-dung kann eine perinatale Aciclovirtherapie der Mutter das Risiko der perinatalen Übertragung aufs Kind reduzieren.

Summary

Perinatal HSV infections are rare, however they led to a very high mortality and late morbidity if not treated early. HSV may be confined to the skin or eyes or may led to HSV-sepsis frequently combined with symptoms of hepatitis or encephalitis with or without the typical HSV-blisters on the skin. Perinatal infections usually are due to maternal infections, rarely by transmission of a third person. The later a pregnant women is infected by HSV the higher is the risk of perinatal transmission and the more severe are symptoms and late morbidity.

PCR is the most sensitive and rapid method to prove HSV infections. Swabs of blisters, mucous membranes (conjunctiva), CSF or blood are are suitable specimen.

Therapy with acyclovir 60 mg/kg/day in 3 doses (reduced dose in prematures with renal impairment) is recommended. Foscarnet is an alternative.

For prevention of perinatal HSV transmission it is crucial to recognize infected pregnant women. In case of perinatal primary infection a cesarean section, in perinatal asymptomatic HSV-excretion acyclovir is preventive.

Schlüsselwörter

Perinatale Infektion - HSV - Aciclovir

Keywords

Perinatal infection - HSV - acyclovir

Full Text

References

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