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Midtrimester Fetal Herpes Simplex-2 Diagnosis by Serology, Culture and Quantitative Polymerase Chain Reaction

Curtin W.M.a, b · Menegus M.A.c · Patru M.-M.c · Peterson C.J.b · Metlay L.A.c · Mooney R.A.c · Stanwood N.L.d, e · Scheible A.L.b · Dorgan A.b
aDivision of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Pathology, Penn State University Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pa., and bDivision of Maternal-Fetal Medicine, and Departments of cPathology and Laboratory Medicine and dObstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, Rochester, N.Y., and eDepartment of Obstetrics, Gynecology and Reproductive Science, Yale School of Medicine, New Haven, Conn., USA Fetal Diagn Ther 2013;33:133-136 (DOI:10.1159/000342756)

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.

 

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