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Annales de Dermatologie et de Vénéréologie
Vol 129, N° 4-C2  - avril 2002
pp. 655-661
Doi : DERM-04-2002-129-4-C2-0151-9638-101019-ART21
Modalités des traitements locaux et généraux, médicamenteux ou non, dans la prise en charge du nouveau-né suspect d'être infecté/contaminé par HSV1 ou HSV2
Modalities for local and general drug and non-drug treatments of neonates with suspected infection/contamination by HSV1 or HSV2
 

Y. AUJARD
[1]  Service de Néonatologie, Hôpital Robert-Debré — Paris.

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L'infection herpétique néonatale est rare en France ; son incidence est proche de 3/100 000 naissances, soit environ 20 cas par an. Elle est secondaire à une contamination virale par le virus herpès (HSV) de type 2 dans 70 p. 100 des cas ou de type 1 dans 30 p. 100. Le risque de transmission virale est surtout élevé en cas de primo-infection herpétique génitale, 30 p. 100, et est de 3 p. 100 dans les récurrences. Toutefois, dans 70 p. 100 des cas l'anamnèse maternelle est négative. Trois formes cliniques principales sont décrites

Le traitement utilise l'acyclovir à forte posologie – 60 mg/kg/j – pendant 14 jours dans les formes localisées et 21 jours dans les autres formes. Il entraîne une réduction nette de la mortalité par rapport au traitement à dose conventionnelle, mais qui reste élevée – 31 p. 100 – dans les formes disséminées et est de 6 à 11 p. 100 dans les formes neurologiques. La morbidité reste importante avec un taux de séquelles sévères qui est de 17 p. 100 et 31 p. 100 respectivement.

L'efficacité d'une décontamination virale prophylactique à la naissance — collyre anti-herpétique et bain à la polyvidone – très largement utilisée en France, n'a jamais été évaluée.

Abstract
Antiviral and non-antiviral local and general treatments for herpes in the pregnant woman (including prevention of mother-infant transmission) : alternative propositions

Neonatal herpes infection is secondary to pre/pernatal viral contamination from mother by HSV2 (70 p. 100) or HSV1 (30 p. 100). Incidence in French population is closed to 3/100,000 live births corresponding to 20 cases per year. Risk for maternal viral transmission to the neonate is 30 p. 100 with genital herpetic primo infection and 3 p. 100 in recurrence. However, in 70 p. 100 of cases, maternal history is not contributive.

Three main clinical presentations are described

  • localized (skin/eye/mouth) (30-40 p. 100 of the cases),
  • neurological (CNS) (30-40 p. 100)
  • and disseminated (20 to 60 p. 100) infections.
However atypical symptoms – as isolated fever – can be a telltale sign. Mean clinical delay from birth to first clinical symptoms is 6 to 12 days and neonate is usually symptom – free at birth. Viral cultures from pharynx, stools, cutaneous lesions and specific PCR in blood and cerebrospinal fluid confirm the diagnosis. Curative treatment is acyclovir at high dosage – 60 mg/kg/d – during 14 days for localized forms and 21 days for neurological and disseminated diseases.

Compared to conventional dosages, this treatment leads to a reduction in mortality which however remains high in disseminated forms, 31 p. 100 and 6 to 11 p. 100 in CNS infection. Morbidity is also high in survived patients, 17 p. 100 and 31 p. 100 respectively.

Efficacy of prophylactic viral decontamination by anti-herpetic eye drops and cutaneous polyvidone iodine bath, which is largely used at birth in France, has never been evaluated.






© 2002 Elsevier Masson SAS. Tous droits réservés.
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