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Febrile infant (serious bacterial infection) — MCCQE Part 1 MCQ

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HardChild with FeverFebrile infant (serious bacterial infection)MCCQE Part 1

An 18-day-old infant has fever, lethargy, clustered scalp vesicles and a focal seizure. Bacterial cultures and lumbar puncture are being obtained, and empiric antibiotics have started. What additional treatment is most important while results are pending?

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Correct answer: A — Start intravenous acyclovir and send HSV PCR testing

Neonatal HSV can present as skin-eye-mouth disease, encephalitis or disseminated sepsis. Vesicles and a focal seizure are high-risk features, so intravenous acyclovir must begin immediately while CSF, blood and lesion specimens are sent for HSV PCR or culture. Oral or topical acyclovir does not achieve adequate acute neonatal treatment exposure, and negative bacterial studies must not be awaited before antiviral therapy.

Reference: https://cps.ca/en/documents/position/prevention-management-neonatal-herpes-simplex-virus-infections; https://www.canada.ca/en/public-health/services/infectious-diseases/sexual-health-sexually-transmitted-infections/canadian-guidelines/herpes-simplex-virus/treatment-follow-up.html