CASE SCENARIO

A 14-day-old patient, who was born at 39 weeks’ gestation by spontaneous vaginal delivery, is brought to the clinic for a routine weight evaluation. Maternal medical history is benign with no pregnancy complications. Prenatal laboratory test results were within normal limits; however, the mother tested positive for group B streptococcus that was adequately treated with penicillin. The mother has no known history of herpes simplex virus (HSV), and there were no vaginal lesions noted at delivery. At this appointment, the patient has a rectal temperature of 96.5°F (35.8°C), appears well, is nursing on demand, and has gained weight appropriately. Due to the recorded hypothermia creating concern for infection, you refer the infant to the emergency department.

In the emergency department, an intravenous line is placed and a complete blood cell count; procalcitonin and C-reactive protein levels; and liver function tests are obtained. Empiric ampicillin, ceftazidime, and acyclovir are started. After multiple attempts at lumbar puncture, cerebrospinal fluid (CSF) is obtained. The fluid is bloody with 20,000 red blood cells/μL. Cultures are obtained from the blood, urine, and CSF, and HSV polymerase chain reaction testing of the skin, eye, mouth, serum, and CSF is performed.