Neonatal Herpes Simplex Virus Infections

Infections caused by herpes simplex viruses have been recognized since ancient Roman times, when Herodotus associated mouth ulcers and lip vesicles with fever. However, neonatal herpes simplex infection was not identified as a distinct disease until centuries later. Only 50 years ago, the first written descriptions of neonatal herpes were attributed nearly simultaneously to Hass, who described the histopathologic findings in a fatal case, and to Batingani who described a newborn child with herpes simplex virus (HSV) keratitis. For several decades our understanding of neonatal infections with herpes simplex virus was predicated upon histopathologic descriptions of the disease. These indicated a broad spectrum of involvement in infants. In the mid-1960s, Nahmias and Dowdle demonstrated two antigenic types of herpes simplex virus, HSV-1 and HSV-2. Recognition of these types prompted a rapid series of developments leading to a better characterization of the biochemical and molecular characteristics of the virus. One consequence of these advances has been the development of methods of typing of viruses which have been utilized to define the epidemiology of HSV infections. Herpes simplex viral infections "above-the-belt," primarily of the lip and oropharynx, have been found in most cases to be associated with HSV-1, whereas infections "below-the-belt" are usually caused by HSV-2.