OBJECTIVES: To determine the prevalence of central nervous system (CNS) herpes simplex virus (HSV) infection in neonates evaluated in the emergency department and to identify factors associated with cerebrospinal fluid (CSF) HSV polymerase chain reaction (PCR) testing. An existing testing paradigm was then applied to determine its potential impact on testing frequency. METHODS: This nested case-control study included infants aged 0 to 28 days who had lumbar puncture in the emergency department. Multivariate logistic regression was used to identify factors associated with CSF HSV PCR testing. RESULTS: The CSF HSV PCR testing was performed in 266 (47%) of 570 neonates. The prevalence of CNS HSV infection was 0.5% compared with 1.6% for bacterial meningitis. Performance of CSF HSV PCR testing was not associated with known HSV risk factors. Application of a known HSV testing paradigm would have reduced the proportion of infants tested by 21% without missing any of the cases of CNS HSV infection. CONCLUSIONS: The HSV testing remains common despite the low prevalence of HSV infection. The CSF HSV PCR testing is not well aligned with known risk factors. Future testing strategies should incorporate community HSV prevalence, known neonatal risk factors, and clinical judgment.
OBJECTIVES: To determine the prevalence of central nervous system (CNS) herpes simplex virus (HSV) infection in neonates evaluated in the emergency department and to identify factors associated with cerebrospinal fluid (CSF) HSV polymerase chain reaction (PCR) testing. An existing testing paradigm was then applied to determine its potential impact on testing frequency. METHODS: This nested case-control study included infants aged 0 to 28 days who had lumbar puncture in the emergency department. Multivariate logistic regression was used to identify factors associated with CSF HSV PCR testing. RESULTS: The CSF HSV PCR testing was performed in 266 (47%) of 570 neonates. The prevalence of CNS HSV infection was 0.5% compared with 1.6% for bacterial meningitis. Performance of CSF HSV PCR testing was not associated with known HSV risk factors. Application of a known HSV testing paradigm would have reduced the proportion of infants tested by 21% without missing any of the cases of CNS HSV infection. CONCLUSIONS: The HSV testing remains common despite the low prevalence of HSV infection. The CSF HSV PCR testing is not well aligned with known risk factors. Future testing strategies should incorporate community HSV prevalence, known neonatal risk factors, and clinical judgment.
Authors: Lise E Nigrovic; Nathan Kuppermann; Charles G Macias; Christopher R Cannavino; Donna M Moro-Sutherland; Robert D Schremmer; Sandra H Schwab; Dewesh Agrawal; Karim M Mansour; Jonathan E Bennett; Yiannis L Katsogridakis; Michael M Mohseni; Blake Bulloch; Dale W Steele; Ron L Kaplan; Martin I Herman; Subhankar Bandyopadhyay; Peter Dayan; Uyen T Truong; Vincent J Wang; Bema K Bonsu; Jennifer L Chapman; John T Kanegaye; Richard Malley Journal: JAMA Date: 2007-01-03 Impact factor: 56.272
Authors: Daniela M Cohen; Scott A Lorch; Rebecca L King; Richard L Hodinka; Keri A Cohn; Samir S Shah Journal: Pediatr Infect Dis J Date: 2007-12 Impact factor: 2.129
Authors: Joseph J Zorc; Deborah A Levine; Shari L Platt; Peter S Dayan; Charles G Macias; William Krief; Jeffrey Schor; David Bank; Kathy N Shaw; Nathan Kuppermann Journal: Pediatrics Date: 2005-09 Impact factor: 7.124
Authors: Laura H Brower; Paria M Wilson; Eileen Murtagh-Kurowski; Joshua D Courter; Samir S Shah; Amanda C Schondelmeyer Journal: Hosp Pediatr Date: 2020-05-08
Authors: Andrea T Cruz; Stephen B Freedman; Dina M Kulik; Pamela J Okada; Alesia H Fleming; Rakesh D Mistry; Joanna E Thomson; David Schnadower; Joseph L Arms; Prashant Mahajan; Aris C Garro; Christopher M Pruitt; Fran Balamuth; Neil G Uspal; Paul L Aronson; Todd W Lyons; Amy D Thompson; Sarah J Curtis; Paul T Ishimine; Suzanne M Schmidt; Stuart A Bradin; Kendra L Grether-Jones; Aaron S Miller; Jeffrey Louie; Samir S Shah; Lise E Nigrovic Journal: Pediatrics Date: 2018-01-03 Impact factor: 7.124