Midtrimester fetal herpes simplex-2 diagnosis by serology, culture and quantitative polymerase chain reaction.

Abstract

The acquisition of herpes simplex virus (HSV) in utero comprises a minority of neonatal herpes infections. Prenatal diagnosis is rare. We describe a midtrimester diagnosis of fetal HSV-2 infection. Ultrasound at 20 weeks for elevated maternal serum α-fetoprotein (MSAFP) showed lagging fetal growth, echogenic bowel, echogenic myocardium, and liver with a mottled pattern of echogenicity. Amniocentesis demonstrated normal karyotype, elevated AFP and positive acetylcholinesterase. Culture isolated HSV-2 with an aberrant growth pattern. Maternal serology was positive for HSV-2. Quantitative DNA polymerase chain reaction (PCR) showed 59 million copies/ml. Fetal autopsy demonstrated widespread tissue necrosis but only sparse HSV-2 inclusions. Fetal HSV-2 infection can be suspected when an elevated MSAFP accompanies ultrasound findings suggesting perinatal infection. Maternal HSV serology, amniotic fluid culture and quantitative PCR are recommended for diagnostic certainty and counseling.

• Authors: William M Curtin, Marilyn A Menegus, Maria-Magdalena Patru, C Jeanne Peterson, Leon A Metlay, Robert A Mooney, Nancy L Stanwood, Amy L Scheible, Angela Dorgan
• Journal: Fetal diagnosis and therapy (Fetal Diagn Ther) Vol. 33 Issue 2 Pg. 133-6 ( 2013) ISSN: 1421-9964 [Electronic] Switzerland
• PMID: 23075531 (Publication Type: Case Reports, Journal Article)
• Copyright: Copyright © 2012 S. Karger AG, Basel.

Chemical References

• AFP protein, human
• Antibodies, Viral
• alpha-Fetoproteins

Topics

• Abortion, Eugenic
• Adult
• Amniotic Fluid (virology)
• Antibodies, Viral (analysis)
• Female
• Herpes Simplex (diagnosis, embryology, immunology, virology)
• Herpesvirus 2, Human (classification, immunology, isolation & purification)
• Humans
• Molecular Typing
• Patient Education as Topic
• Pregnancy
• Pregnancy Trimester, Second
• Prenatal Diagnosis
• Young Adult
• alpha-Fetoproteins (analysis)