Herpes Simplex Virus Infection: Dissemination in Association with Malnutrition.

Eight cases of disseminated herpes simplex infection unassociated with infantile eczema have been found at autopsy during the period September, 1957, to April, 1958. All but two of these were grossly malnourished. Herpetic stomatitis is very much more common than is generally appreciated. Routine studies carried out in our virus laboratory have revealed that many of the more severe and atypical forms of stomatitis are due to the herpes simplex virus, and in the past must have been diagnosed as stomatitis due to Vincent's angina or moniliasis. While herpes simplex infection usually manifests itself as a lesion localized to the epithelial surfaces of the lips, face and mouth, widespread systemic involvement does from time to time occur. Dissemination in association with infantile eczema (eczema herpeticum or Kaposi's varicelliform eruption) is well known, but in recent years a fulminating illness due to widespread dissemination of the herpes simplex virus, quite unassociated with eczema, has been reported by several investigators. On histopathological grounds, Hass (1935) suggested that the necrotic liver and adrenal lesions found in a premature infant at autopsy were due to systemic dissemination of the herpes simplex virus. Encephalitis in the newborn due to herpes simplex virus has been recorded by several authors (Smith, Lennette and Reames, 1941; Wildi, 1951; Florman and Mindlin, 1952; France and Wilmers, 1953), hepatic necroses due to the same agent have been described (Quilligan and Wilson, 1951; Zuelzer and Stulberg, 1952; France and Wilmers, 1953; Pugh, Newns and Dudgeon, 1954; Brain, Pugh and Dudgeon, 1957) while necrotic adrenal lesions have been noted in association with eczema herpeticum (Zuelzer and Stulberg, 1952; Brain et al., 1957). With the exception of two cases in Group II of Zuelzer and Stulberg (1952) and one case of Brain et al. (1957), all cases recorded have occurred in the neonatal period. Of interest in our series is that all the children were between 9 and 16 months of age.