In newborn infants, herpes simplex virus (HSV) infection can
manifest as the following: (1) disseminated disease involving
multiple organs, most prominently liver and lungs, but in 60% to
75% of cases also involving the central nervous system; (2)
localized central nervous system (CNS) disease, with or without
skin involvement (CNS disease); or (3) disease localized to the
skin, eyes, and mouth (SEM disease). Approximately 20% of cases
of neonatal HSV manifest as disseminated disease, one third
manifest as CNS disease, and 40% to 45% manifest as SEM disease.
Approximately 60% of neonates with disseminated disease or CNS
disease have skin lesions, and approximately 80% to 85% of
neonates with SEM disease will have skin involvement. In the
absence of skin lesions, the diagnosis of neonatal HSV infection
is difficult. Disseminated infection should be considered in
neonates with sepsis syndrome, negative bacteriologic culture
results, and severe liver dysfunction. HSV also should be
considered as a causative agen