Febrile Infant Clinical Pathway – Emergency Department and Inpatient – Consider HSV and Other Diagnostic Testing

Febrile Infant Clinical Pathway – Emergency Department and Inpatient

Consider HSV and Other Diagnostic Testing

HSV Testing
  • Indicated for all infants ≤ 21 days; consider for infants 22–56 days old with any of the following risk factors:
    • Maternal vesicles and/or fever within 48 hrs before or after delivery
    • Postnatal oral HSV exposure
    • Vesicles or mucous membrane ulcers
    • Abnormal mental status, seizure
    • Hypothermia
    • Pleocytosis or RBCs in CSF
    • Leukopenia
    • Thrombocytopenia
  • 0–21 days
    • CSF and serum HSV PCR
    • Unroof vesicles for HSV PCR if present
  • 22–56 days
    • Consider testing if risk factors present
      • CSF and serum HSV PCR
      • Unroof vesicles for HSV PCR if present
Enterovirus Testing
  • Send CSF enterovirus PCR if CSF pleocytosis present
  • Consider also sending blood enterovirus PCR to increase diagnostic yield
  • Positive results may lead to decreased duration of antibiotics and length of stay
CSF Studies CSF gram stain and culture, save our specimen, protein, glucose, cell count and differential
Stool Studies
  • GI bacterial panel/stool culture: Mucous or gross blood in the stool
  • Consider GI virus PCR panel
CXR As indicated