CASE REPORT article
Front. Immunol.
Sec. Viral Immunology
This article is part of the Research TopicNew Discoveries and Challenges in Pediatric Infectious Diseases: Epidemiological, Clinical, and Pathogenic AdvancesView all 14 articles
Case Report: Multiple Challenges: A Rare Neonatal Case of Successful Management of HSV-2 with Disseminated Central Nervous System and Peripheral Organ Infections
Provisionally accepted
- 1Shandong Second Medical University, Weifang, China
- 2Gaomi Maternity and Child Health Hospital, Gaomi, China
- 3Shandong University of Traditional Chinese Medicine, Jinan, China
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Background:Neonatal cases of mixed infection with Herpes simplex virus (HSV) and Staphylococcus aureus, accompanied by disseminated infection involving the central nervous system and other systems, are rare. For neonatal HSV infection, the estimated case fatality rate is 60% if left untreated. In contrast, delayed diagnosis—leading to the lack of targeted treatment—can cause dissemination of the infection, resulting in approximately 75% mortality among affected infants and severe neurological dysfunction in the survivors.Here we report a neonate with mixed infection who was successfully treated despite delayed intervention. Case Presentation:The infant was born via vaginal delivery at a gestational age of 38+6 weeks, with a birth weight of 2900 g. Poor feeding was observed after birth. Abdominal distension developed at postnatal day (PND) 2–3. A small amount of blood-tinged fluid was noted from the nostrils during vomiting on PND 7. Before PND 9, mottling of the lower extremities was noted. On PND 13, the infant had one episode of hematemesis. Subsequent blood metagenomic next-generation sequencing (mNGS) confirmed a mixed infection complicated by HSV type 2 (HSV-2) and Staphylococcus aureus. Additionally, HSV-2 central nervous system (CNS) infection was diagnosed via cerebrospinal fluid (CSF) mNGS. The infant was also accompanied by liver failure and ascites. Acyclovir (20mg/kg, q8h) was administered for 36 days. Antibacterial therapy was sequentially adjusted from ampicillin combined with cefepime, to meropenem combined with vancomycin, and finally de-escalated to ampicillin monotherapy. Symptomatic treatments including paracentesis and liver protection were given. Infection markers normalized, ascites resolved, and liver function recovered. Repeat metagenomics showed clearance of Staphylococcus aureus, while HSV-2 remained detectable. Oral acyclovir was continued after discharge. Conclusion:Despite treatment delay, combined antiviral and antibacterial therapy successfully managed HSV-2 and Staphylococcus aureus mixed infection, providing insights for dual-infection therapy.
Keywords: HSV-21, Staphylococcus aureus2, Central Nervous System Infection3, Disseminated Infection4, Liver Failure5, Ascites6
Received: 05 Jul 2025; Accepted: 10 Oct 2025.
Copyright: © 2025 Xu, Zhuo, Sui, Sun, Yang and Shan. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Mingliang Shan
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