P35.2 Congenital herpesviral [herpes simplex] infection

Name of the Condition

• Congenital herpesviral [herpes simplex] infection
• ICD-10-CM Code: P35.2

Summary

This condition refers to herpes simplex virus (HSV) infection acquired by a newborn during pregnancy or delivery. It is a type of congenital viral infection that can affect multiple organ systems and may present with severe clinical manifestations in the neonate.

Causes

Congenital herpesviral infection is caused by vertical transmission of herpes simplex virus from an infected mother to the fetus. Transmission can occur transplacentally during pregnancy, intrapartum during delivery, or postnatally through close contact with an infected caregiver. The virus may infect the fetus or newborn, leading to systemic or localized disease.

Risk Factors

• Maternal primary or recurrent HSV infection during pregnancy
• Active genital HSV lesions at the time of delivery
• Prolonged rupture of membranes
• Invasive fetal monitoring or procedures during labor
• Lack of maternal antiviral prophylaxis

Symptoms

Symptoms may include skin vesicles or ulcers, eye inflammation (keratoconjunctivitis), central nervous system involvement (seizures, lethargy), respiratory distress, or disseminated disease with organ failure. Some infants may be asymptomatic initially but develop symptoms within the first few weeks of life.

Diagnosis

Diagnosis involves maternal history, newborn physical examination, and laboratory testing. Viral cultures, PCR, or serology from skin lesions, cerebrospinal fluid, or blood confirm HSV infection. Imaging (e.g., MRI) may assess central nervous system involvement. Prenatal or postnatal testing differentiates congenital from perinatal infection.

Treatment Options

Treatment typically includes intravenous antiviral therapy (e.g., acyclovir) for systemic or severe disease. Topical or oral antivirals may be used for localized infections. Supportive care addresses complications like seizures or organ dysfunction. Duration and regimen depend on disease severity and organ involvement.

Prognosis and Follow-Up

Prognosis varies based on disease extent and prompt treatment. Disseminated or central nervous system infection carries higher morbidity and mortality risks. Long-term follow-up monitors for neurodevelopmental delays, vision or hearing impairment, and recurrent HSV episodes. Early intervention improves outcomes.

Complications

Complications may include neurological sequelae (e.g., microcephaly, developmental delays), vision or hearing loss, skin scarring, or recurrent HSV infections. Severe cases can lead to multiorgan failure or death. Chronic HSV shedding may occur in some infants.

Lifestyle & Prevention

Prevention focuses on maternal HSV management during pregnancy, including antiviral prophylaxis for recurrent infection and cesarean delivery for active genital lesions at delivery. Avoiding close contact with active HSV lesions in caregivers reduces postnatal transmission risk.

When to Seek Professional Help

Seek immediate medical attention if a newborn shows signs of infection (e.g., skin lesions, fever, lethargy, poor feeding) or if maternal HSV status is unknown. Early evaluation is critical for timely diagnosis and treatment to reduce complications.

Tips for Medical Coders

Document the timing of infection (congenital vs. perinatal) and clinical manifestations (e.g., skin, CNS, disseminated) to support code assignment. Include maternal HSV history, delivery details, and laboratory confirmation. Ensure documentation aligns with the specificity of P35.2 for congenital herpes simplex infection.