Background: 

Neonatal herpes simplex virus (HSV) infections can be challenging to diagnose and often occur without maternal history of infection. Routine initial pharmacologic management when a neonate presents with signs of sepsis in the first weeks of life typically targets antibiotic therapies. This case illustrates the importance of the addition of antiviral coverage, especially when a neonate demonstrates temperature instability and neurologic changes.

Clinical Findings: 

This case report describes the unique presentation of a 9-day old neonate with clinical findings significant for sepsis. This neonate was diagnosed with methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia with concomitant disseminated HSV-2 infection after presenting with temperature instability, lethargy, and signs of multisystem organ impairment.

Primary Diagnosis: 

This neonate was diagnosed with disseminated HSV infection, which occurs in 25% of neonatal HSV disease.

Interventions: 

Treatment was initiated with high-dose intravenous acyclovir at 20 mg/kg/dose every 8 hours along with broad-spectrum antibiotics. Management should include anticipating and monitoring for progressive multisystem organ failure in bacterial or viral infection.

Outcomes: 

This patient did not survive despite maximal intervention from the neonatal intensive care unit team. Disseminated HSV neonatal infections are associated with high mortality rates when they are present alone, and mortality is higher with concurrent bacteremia.

Practice Recommendations: 

Providers should have a high index of suspicion for HSV infection in neonates presenting in the first 1 to 3 weeks of life with signs of sepsis. Prophylactic treatment with high-dose acyclovir as an adjunct to broad-spectrum antibiotics while awaiting laboratory confirmation can be lifesaving.

中文翻译：

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一例新生儿播散性单纯疱疹病毒 (HSV) 伴有甲氧西林敏感金黄色葡萄球菌 (MSSA) 菌血症的罕见病例

背景： 

新生儿单纯疱疹病毒 (HSV) 感染的诊断具有挑战性，并且通常在没有母体感染史的情况下发生。当新生儿在出生后的头几周出现败血症迹象时，常规的初始药物管理通常以抗生素治疗为目标。这个案例说明了增加抗病毒覆盖的重要性，尤其是当新生儿表现出体温不稳定和神经系统变化时。

临床发现： 

本病例报告描述了一名 9 日龄新生儿的独特表现，其临床发现对败血症具有重要意义。这名新生儿在出现体温不稳定、嗜睡和多系统器官损伤迹象后，被诊断为甲氧西林敏感金黄色葡萄球菌(MSSA) 菌血症并伴有播散性 HSV-2 感染。

初步诊断： 

这名新生儿被诊断为播散性 HSV 感染，这种感染发生在 25% 的新生儿 HSV 疾病中。

干预措施： 

治疗以每 8 小时 20 mg/kg/剂量的高剂量静脉注射阿昔洛韦以及广谱抗生素开始。管理应包括预测和监测细菌或病毒感染引起的进行性多系统器官衰竭。

结果： 

尽管新生儿重症监护病房团队进行了最大限度的干预，但该患者仍未存活下来。播散性 HSV 新生儿感染在单独存在时与高死亡率相关，并发菌血症时死亡率更高。

实践建议： 

对于出生后 1 至 3 周内出现败血症迹象的新生儿，提供者应高度怀疑 HSV 感染。在等待实验室确认的同时，使用高剂量阿昔洛韦作为广谱抗生素的辅助预防性治疗可以挽救生命。