INAPPARENT INTRAUTERINE HSV INFECTION DETECTED BY IMMUNOHISTOCHEMISTRY

Abstract

We have used glucose oxidate-avidin-biotin (GAB) immunohistochemistry to detect herpes simplex virus (HSV) 1 & 2 virion antigen in fixed tissue. Cases were selected by placental or cord pathology &/or clinical findings in the fetus/neonate. Virus was detected in placenta, umbilical cord &/or fetal/infant organs from 17 pregnancies (1 set twins; 15 newborns & 3 stillborns). Antigen was found in single mesenchymal & epithelial cells without characteristic viral cytopathology. Viral cultures were positive in one case (skin vesicles). Five mothers had clinical or laboratory evidence of HSV 1/2 infections before or during pregnancy, but none had evidence of active infection at delivery. Thirteen pregnancies ended prematurely & 5 infants/fetuses were small for gestational age. Ten newborns were severely ill. Four infants died before 7-1/2 months of age. Of 11 survivors, 2 have severe CNS abnormalities, 1 persistent pulmonary disease & 2 remain hospitalized. Diagnoses associated with GAB positive herpes virus in specific organs include NEC, hepatitis with cholestatic jaundice, interstitial pneumonitis, aseptic meningitis, progressive cystic brain degeneration, & cardiac arrhythmias. We conclude that intrauterine HSV infection is more common than believed & that intrauterine HSV infection may persist in the fetus & neonate chronically without cytopathology or detectable virus & may be associated with prematurity, intrauterine & neonatal death, organ damage, & progressive neonatal disease.