Neonatal HSV Encephalitis — RACP Paediatrics MCQ

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HardInfectious DiseaseNeonatal HSV EncephalitisRACP Paediatrics

A 3-week-old neonate presents with vesicular lesions on the scalp, fever, lethargy, and seizures. CSF shows lymphocytic pleocytosis with elevated protein and normal glucose. What is the most important empirical treatment to add?

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Correct answer: B — IV aciclovir

Neonatal HSV encephalitis presents with vesicles, seizures, and CSF pleocytosis. IV aciclovir (20 mg/kg/dose TDS) should be started immediately on clinical suspicion - do not wait for PCR results. Mortality is high without treatment. HSV PCR of CSF and vesicle swab should be sent.

Reference: RCH Melbourne – 2024 – Clinical Practice Guidelines: Neonatal Herpes Simplex