Electron microscopy in the routine screening of newborns with congenital cytomegalovirus infection.

The pseudoreplica method of electron microscopy (EM) was evaluated as a rapid screening technique for the detection of cytomegaloviruria in 3056 neonates in a predominantly lower socioeconomic population. Virus isolation methods detected 49 (1.6%) CMV-positive individuals. When pools of three to five urines were tested, 26 (54%) of the culture-positive neonates were identified by EM; however, testing of individual urines increased EM detection to 33 (67%). Almost all of these urines, as well as urine or oral specimens obtained on follow-up visits, which had infectivity titers greater than or equal to 10(4)/ml were EM-positive, whereas only half of the specimens with titers less than 10(4)/ml were EM-positive. All the symptomatic neonates were detected by EM, suggesting that electron microscopy would be most valuable as a diagnostic aid in this group of CMV-infected neonates.

The natural history of herpes simplex virus infection of mother and newborn.

The controlled evaluation of vidarabine as therapy of neonatal herpes implex virus (HSV) infection provided an opportunity to collect data to further assess the natural history of maternal and newborn infections. Women delivering infected babies were young, nulliprous, and infrequent aborters. Nearly 50% of the gestations ended in premature labor. Maternal infection was asymptomatic in 39 of 56 (70%) of the mothers, at the time of delivery. However, risk factors included a past history of genital herpes at any time and exposure to a sexual partner with presumed HSV lesions. Associated diseases in children born to these women were common. Premature infants had an incidence of respiratory distress of 52% (14 of 27). Eight of 29 (28%) term newborns had a bacterial infection, antedating the onset of neonatal HSV infection. Virologic studies on infected newborns confirmed that skin lesions were the most frequent site for virus retrieval. Progression of disease from isolated skin lesions was common, occurring in 70% of babies whose presenting sign was skin vesicles. CSF was virus-positive from 14 babies and more frequently in those with localized CNS disease. Importantly, brain biopsy was necessary for diagnosis in four cases. Finally, neither the presence or absence of antibodies to HSV was useful in predicting either presentation or outcome of infection. These studies further emphasize the complex nature of HSV infections of the newborn and need for tertiary care.

Infection in infants and children.

Infection with Listeria monocytogenes is demonstrated over a 141/2 year period in 24 newborns, three infants 1 to 2 months of age, and two children. Comparison of the 22 cases of Listeria meningitis in newborns with 118 cases of neonatal meningitis due to other bacteria indicates a later onset of symptoms in cases of Listeria meningitis with a more favorable outcome than with most other agents. Treatment with ampicillin sodium appears effective. Monocytic cell increases in peripheral blood or CSF may be helpful in suspecting this diagnosis. The cases of Listeria meningitis in the older children were unusual. In one child it occurred as a concomitant infection with Staphylococcus epidermidis of a ventricular shunt. In the second case in an otherwise healthy child the acquisition of the bacteria from gerbils was suggested, but could not be confirmed.

Leukocyte transforming agent (Epstein-Barr virus) in newborn infants and older individuals.

The lymphocyte transforming agent, associated with Epstein-Barr virus, was sought in the oropharynx and other clinical sites of 443 individuals in the following groups: premature and term neonates; infants with congenital malformations or with suspected TORCH syndrome; children with various illnesses; pregnant and postpartum women; healthy adults; and patients with infectious mononucleosis. Evidence of intrauterine infection was found in one newborn infant and LTA was demonstrated in a 16-day-old infant who developed transient hepatosplenomegaly. LTA was not detected in 96 other newborn infants and 57 infants with various anomalies or illnesses; nor was it found in the cervix of 125 pregnant or postpartum women. LTA was demonstrated in varying frequency in ill children, healthy adults, and those with infectious mononucleosis. It is suggested that the clinicoepidemiologic patterns of EBV infection in newborn infants and children will best be established by prospective studies.

Eye infections with herpes simplex viruses in neonates.

A newborn with severe ocular herpes simplex virus (HSV) type 2 infection acquired in utero is presented to exemplify problems in diagnosis and management. A review of 297 newborns with HSV type 1 or type 2 infection reveals that about one-fifth demonstrate ocular involvement including one or more of the following: microphatalmia, conjunctivitis, keratitis, chorioretinitis, optic neuritis and cataracts.

Type 2 herpes simplex virus infections.

The problems related to herpes simplex virus (HSV) type 2 infections include: (1) the clinical diseases produced primarily at urogenital sites, but also in extragenital areas, and the frequent recurrences of such infections; (2) the severity of the diseases produced in immunocompromised hosts and in newborns, including a varity of ocular manifestations; and (3) the possible role of the virus in human cancers. The usually sexually transmitted mode of spread of this virus has increased current medical concern with this virus. Although laboratory diagnosis of HSV-2 infection is currently available, we still lack effective preventive or therapeutic means for most clinical forms of the infection. However, the great progress made over the past decade in the molecular, virological, immunological and clinicoepidemiological aspects of HSV are providing the necessary tools to attain this goal.

Effects of immunostimulants on resistance of newborn mice to herpes simplex type 2 infection.

Since age-dependent diminished macrophage function has been related to the increased susceptibility of newborn mice to herpes simplex virus (HSV) infection, the effect of several agents which might activate macrophages or other cells involved in immunity was investigated. BCG, typhoid vaccine, brucella vaccine, levamisole, or staphage lysate were administered to newborn mice prior to challenge with HSV-2. Of these agents, only BCG, administered ip or id 6 days prior to challenge, was found to increase the survival rate of newborn mice. The possible use of BCG, alone or in combination with other modalities, for the prevention or treatment of neonatal HSV infections is discussed.