Consider HSV as an etiology of fever in a neonate (0-30days) even without a maternal history of HSV or h/o active lesions.
In one study, only 12% of neonates dx’d with HSV infections had mothers with a known h/o HSV or active lesions.
Start Acyclovir empirically in these neonates, especially if the Gram Stain is negative. Send appropriate HSV PCR and Cx.
Only 29% of patients (pediatric and adult) ultimately diagnosed with HSV encephalitis were started on acyclovir in the ED.
Those who were not started on acyclovir in the ED, had a significant delay of appropriate therapy.
If you don’t think of it… the admitting team might not either.
References
Whitley R, Davis EA, Suppapanya N. Incidence of neonatal herpes simplex virus infections in a managed-care population. Sex Transm Dis. 2007 Sep;34(9):704-8.
Benson PC, Swadron SP. Empiric acyclovir is infrequently initiated in the emergency department to patients ultimately diagnosed with encephalitis. Ann Emerg Med. 2006 Jan;47(1):100-5. Epub 2005 Nov 8.
