Neonatologia
Infezioni herpetiche invasive neonatali
Neonatal invasive herpes infections. Inborn errors of immunity and phenocopies as predisposing factors
Ian Valencic1, Mattia Moratti1,2, Francesca Conti3, Francesca Nanni4, Gina Ancora4
1Scuola di Specializzazione in Pediatria, “Alma Mater Studiorum”, Università di Bologna
2Dipartimento di Biomedicina e Prevenzione, Università “Tor Vergata” di Roma
3Unità di Pediatria, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Dipartimento di Scienze Mediche e Chirurgiche, “Alma Mater Studiorum”, Università di Bologna
4UO di Terapia Intensiva Neonatale, Ospedale degli Infermi di Rimini
Marzo 2025 - pagg. 171 -175 | DOI: 10.53126/MEB44171
Abstract
Herpetic infection is a condition with high rates of neonatal morbidity and mortality; to date, there is no universally recognized strategy for the perinatal management of the risk of Herpes Simplex Virus (HSV) transmission based on the prognostic value attributed to maternal risk factors. Starting from the analysis of a clinical case of neonatal herpes meningoencephalitis, a literature review was conducted concerning the management of herpetic infection during pregnancy and in the neonatal period in terms of prevention and early diagnosis. The paper describes a case of a newborn with neonatal herpes meningoencephalitis transmitted by a mother with recurrent herpetic infection without clinically evident genital lesions at birth, despite the correct application of gynecological-neonatal protocols stratified by risk categories. An integrative model to the current guidelines should consider the following prophylactic strategies: performance of serological screening for HSV between the 24th and 28th week of pregnancy; provision of counseling regarding the main maternal-fetal and neonatal transmission risk factors for HSV; administration of antiviral prophylaxis with acyclovir to seropositive pregnant women starting from the 36th week of gestation; expansion of neonatal HSV-related screening tests even in cases where primary or recurrent genital lesions are present within ninety days before delivery. The diagnosis of neonatal herpetic meningoencephalitis suggests an underlying congenital error in innate immunity, related to an alteration in the TLR3/IFNα-β-λ axis, which presents with minimal/absent alterations in the immunological balance of I/II level, associated with infectious susceptibility to a restricted spectrum of viral pathogens, and deserves early immunological specialist evaluation.
Riassunto
L’infezione herpetica è una patologia con alti tassi di morbilità e mortalità neonatale; a oggi non esiste una strategia universalmente riconosciuta sulla gestione perinatale del rischio di trasmissione di herpes simplex virus (HSV) sulla base del valore prognostico attribuito agli elementi di rischio materno. Si propone un nuovo approccio all’infezione da HSV neonatale al fine di estendere lo screening profilattico a categorie di rischio non incluse nelle attuali linee guida italiane relative alla gestione del rischio infettivo perinatale da HSV. A partire dall’analisi di un caso clinico di meningo-encefalite herpetica neonatale è stata effettuata una revisione della letteratura inerente al management dell’infezione herpetica in gravidanza e nel periodo neonatale in termini di prevenzione e diagnosi precoce. Una diagnosi di meningo-encefalite herpetica neonatale è suggestiva di un sottostante errore congenito dell’immunità innata, correlato ad alterazione dell’asse TLR3/IFNα-β-λ, che si presenta con minime/assenti alterazioni ai bilanci immunologici di I/II livello, associate a suscettibilità infettiva nei confronti di uno spettro ristretto di patogeni virali, meritevole di una precoce valutazione specialistica immunologica.
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Corrispondenza: mattia.moratti@studio.unibo.it