Disseminated Herpes Infection

Female doctor examining newborn baby in incubator. Blend Images - ERproductions Ltd / Brand X Pictures / Getty Images

Most herpes infections only cause local problems. They cause sores by the mouth or the genitals that wax and wane with time.  In fact, the majority of herpes infections don't only cause a local infection, they cause a local infection with no noticeable symptoms. However, in rare, cases herpes can cause full body illness. This is referred to as disseminated herpes. In general, disseminated diseases are diseases that are spread throughout the body.

 

The Dangers of Disseminated Herpes

Disseminated herpes is most commonly seen as a complication of neonatal herpes. Neonatal herpes infections generally occur when a baby is exposed to the herpes virus during pregnancy or at the time of birth. However, disseminated infections can also occur in adults. A disseminated herpes infection may appear simply as lesions at multiple skin sites. That is not always an emergency. Such infections are considerably more severe when the infection spreads to the central nervous system. The central nervous system includes the spinal cord and the brain. 

When herpes infects the central nervous system (CNS), it can cause encephalitis or meningitis. Encephalitis is swelling of the brain. Meningitis is swelling of the protective layers of the brain and spinal cord. Left untreated, disseminated herpes infections that affect the CNS have high fatality rates. Fortunately, mortality and long term complications can be reduced by prompt treatment with acyclovir.

That drug may sound familiar, since it is also used to treat local herpes infections. 

Disseminated herpes infection can be detected by using PCR. This molecular test can look for herpes viruses in fluid from the spinal cord. However, this type of testing can lead to false negatives. Therefore, since a lack of prompt treatment can be fatal, many doctors will presumptively treat with acyclovir based on a patient's symptoms.

In other words, they'll treat whether or not the person tests positive, if they are known to have herpes and have symptoms of a CNS infection. This can be done, because acyclovir is a relatively safe drug. Therefore, the risks of treating a person who doesn't have disseminated herpes are much lower than the risks of not treating someone who does.

Symptoms of central nervous system herpes are quite different from the sores associated with the more common local infections. Symptoms of CNS herpes may include:

  • headache
  • vomiting
  • other neurological signs

When an Infant has Disseminated Herpes

Infants with disseminated herpes infections usually begin to show symptoms within 5-9 days after birth. These symptoms may include seizures, trouble breathing, irritability, and jaundice. Disseminated herpes in infants is very dangerous. It has a mortality rate of 85 percent if the infection remains untreated. Unfortunately, even prompt treatment is not a guarantee of symptom free survival. Many infants experience neurological problems after treatment. However, prompt and appropriate treatment makes a big difference in infants' outcomes after infection. It reduces both the death rate and the severity of symptoms.

Did You Know: Most cases of neonatal herpes infection occur at the time of delivery. Women are most at risk of passing on a herpes infection to their infant if they became infected during pregnancy or have active lesions at the time of delivery. That's why it's important to have safe sex - including safe oral sex - while pregnant. In addition, if you become infected, suppressive treatment near the time of delivery may be recommended. Many doctors also recommend a c-section when women have vaginal lesions at the time she is giving birth. 

What Herpes Types Cause Disseminated Herpes?

Disseminated herpes infections can be caused by varicella zoster virus and other human herpes viruses.

(Varicella zoster virus , or VZV, is the virus that causes chicken pox.) It's not only caused by the herpes simplex viruses that cause genital and oral infections. In all cases, disseminated infections may be more likely to occur in immunocompromised individuals, such as those with advanced AIDS.

A Word from Verywell - Varicella Vaccination and Pregnancy

If you are planning to become pregnant, and have not had the chicken pox, talk to your doctor about whether getting the VZV vaccine makes sense for you. In general, vaccines for varicella are not recommended during or immediately before pregnancy because they contain live virus. However, if you are waiting to get pregnant, the vaccine may be something you want to explore. If you are already pregnant and have not had chicken pox, the VZV vaccine is recommended during the postpartum period -- after you've given birth. 

Sources:

Knezevic A, Martic J, Stanojevic M, Jankovic S, Nedeljkovic J, Nikolic L, Pasic S, Jankovic B, Jovanovic T. Disseminated neonatal herpes caused by herpes simplex virus types 1 and 2. Emerg Infect Dis. 2007 Feb;13(2):302-4.

Pinninti SG, Kimberlin DW. Preventing herpes simplex virus in the newborn. Clin Perinatol. 2014 Dec;41(4):945-55. doi: 10.1016/j.clp.2014.08.012.

Swamy GK, Heine RP. Vaccinations for pregnant women. Obstet Gynecol. 2015 Jan;125(1):212-26. doi: 10.1097/AOG.0000000000000581. 

Tyler KL. Herpes simplex virus infections of the central nervous system: encephalitis and meningitis, including Mollaret's. Herpes. 2004 Jun;11 Suppl 2:57A-64A.

Watanabe D, Kuhara T, Ishida N, Takeo T, Tamada Y, Matsumoto Y. Disseminated mucocutaneous herpes simplex virus infection in an immunocompetent woman. Int J STD AIDS. 2010 Mar;21(3):213-4.

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