Clinical Evaluation Of The Infant

Many different conditions may mimic HSV disease. In the infant with disseminated infection and its associated multiorgan involvement, other conditions that must be considered include hyaline membrane disease, intraventricular hemorrhage, necrotizing enterocolitis, and overwhelming bacterial sepsis caused by, among others, group B streptococcus, Staphylococcus aureus, Listeria monocytogenes, and Gram-negative bacteria.

The vesicular rash that occurs with HSV infection may be confused with the cutaneous manifestations of other infectious diseases, such as varicella-zoster virus infection, postnatally acquired enteroviral disease, and disseminated cytomegalovirus infection. Such distinctions are especially difficult when HSV assumes an atypical cutaneous presentation. Definitive confirmation of HSV disease can be achieved by culture of the skin vesicles. Noninfectious cutaneous conditions such as incontinentia pigmenti, acrodermatitis enteropathica, erythema toxicum, and neonatal melanosis should also be considered. Lesions associated with these diseases can often be distinguished rapidly from those caused by HSV by the presence of eosinophils on staining of a tissue scraping, by peripheral eosinophilia, and by appropriate viral cultures.

The most difficult clinical diagnosis to make is that of HSV encephalitis, in large part because nearly 40% of infants with CNS infection do not have skin lesions at the time of clinical presentation (11,12). Clinical diagnosis under these conditions is based on a high index of suspicion. This is especially true if the patient's bacterial cultures are negative at 48-72 hours. Infection of the CNS should be suspected in the neonate who has evidence of acute neurological deterioration with the onset of seizures, especially when this occurs in the absence of intraventricular hemorrhage or metabolic imbalances. Serial increases in cerebrospinal fluid (CSF) cell counts and protein concentrations also suggest the possibility of HSV disease. An electroencephalogram, and to a lesser degree a computed tomographic scan of the head, may be of benefit in this situation (12).

Bacterial Vaginosis Facts

Bacterial Vaginosis Facts

This fact sheet is designed to provide you with information on Bacterial Vaginosis. Bacterial vaginosis is an abnormal vaginal condition that is characterized by vaginal discharge and results from an overgrowth of atypical bacteria in the vagina.

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