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Background: Herpes simplex virus (HSV) is one of the main causes of neonatal meningitis; nonetheless, it usually goes unreported. A lumbar puncture is needed to accurately differentiate between viral and bacterial meningitis. The cerebrospinal fluid can be analyzed to exclude bacterial meningitis; nevertheless, the identification of the specific viral cause may be beneficial. Viral diagnosis determines prognosis, improves the care of the patient, decreases hospitalization duration, and reduces unnecessary use of antibiotics. In young infants, the herpes simplex virus infection is responsible for serious complications leading to morbidity, mortality, and permanent sequelae in survivors. The clinical findings of this infection usually include tremors, seizures, lethargy, irritability, poor feeding, temperature instability, and a bulging anterior fontanel, which are common in almost all forms of meningitis. These similarities make the differential diagnosis rather difficult. Case report: We report and discuss the case of an an11-day-old neonate girl who presented with fever and negative test results, as well as our challenges that finally led to the diagnosis of HSV-related meningitis and its management. Conclusion: It could be managed to reach a firm diagnosis confirming the initial differential diagnosis through additional and repetitive testing. Therefore, it is concluded that clinical judgments may be more reliable than paraclinical results in the individual approach for each patient. Furthermore, HSV infection should also be considered for patients with a persistent fever of unknown origin. It is also recommended to adopt separate procedures for the suspicion of HSV type 1 and HSV type 2. Keywords: Herpes simplex virus, Infantile fever, Meningitis

Background: Herpes simplex virus (HSV) is one of the main causes of neonatal meningitis; nonetheless, it usually goes unreported. A lumbar puncture is needed to accurately differentiate between viral and bacterial meningitis. The cerebrospinal fluid can be analyzed to exclude bacterial meningitis; nevertheless, the identification of the specific viral cause may be beneficial. Viral diagnosis determines prognosis, improves the care of the patient, decreases hospitalization duration, and reduces unnecessary use of antibiotics. In young infants, the herpes simplex virus infection is responsible for serious complications leading to morbidity, mortality, and permanent sequelae in survivors. The clinical findings of this infection usually include tremors, seizures, lethargy, irritability, poor feeding, temperature instability, and a bulging anterior fontanel, which are common in almost all forms of meningitis. These similarities make the differential diagnosis rather difficult. Case report: We report and discuss the case of an an11-day-old neonate girl who presented with fever and negative test results, as well as our challenges that finally led to the diagnosis of HSV-related meningitis and its management. Conclusion: It could be managed to reach a firm diagnosis confirming the initial differential diagnosis through additional and repetitive testing. Therefore, it is concluded that clinical judgments may be more reliable than paraclinical results in the individual approach for each patient. Furthermore, HSV infection should also be considered for patients with a persistent fever of unknown origin. It is also recommended to adopt separate procedures for the suspicion of HSV type 1 and HSV type 2. [ABSTRACT FROM AUTHOR]

From October 2013 through February 2014, human parechovirus genotype 3 infection was identified in 183 infants in New South Wales, Australia. Of those infants, 57% were male and 95% required hospitalization. Common signs and symptoms were fever >38°C (86%), irritability (80%), tachycardia (68%), and rash (62%). Compared with affected infants in the Northern Hemisphere, infants in New South Wales were slightly older, both sexes were affected more equally, and rash occurred with considerably higher frequency. The New South Wales syndromic surveillance system, which uses near real-time emergency department and ambulance data, was useful for monitoring the outbreak. An alert distributed to clinicians reduced unnecessary hospitalization for patients with suspected sepsis.

This case report presents an interesting and rare cause of meningitis in young infants, Pasteurella multocida . Not only is the organism unusual but the well appearance of the infant made this diagnosis surprising. The 2021 American Academy of Pediatrics (AAP) clinical practice guidelines on well-appearing febrile infants brought a national guideline on the evaluation and management of fever in infants. However, providers should be aware that there is room for shared decision-making and that the guideline will miss a very small percentage of well-appearing infants with invasive bacterial infections., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Cahn et al.)

Background The incidence of severe bacterial infections (SBIs) in infants aged ≤90 days is thought to have decreased because of widespread vaccination programs. However, relevant epidemiological data in Japan are scarce. Materials and methods This observational, single-center study investigated the epidemiology of fever in infants aged ≤90 days. SBI was defined as the presence of meningitis, urinary tract infections (UTIs), or bacteremia. Invasive bacterial infection (IBI) was defined as the presence of meningitis, bacteremic UTI, or bacteremia. We determined the incidence of UTIs, bacteremia, meningitis, SBIs, and IBIs in the following three age groups: 0-28, 29-60, and 61-90 days. We subsequently calculated the relative incidence for the groups aged 29-60 and 61-90 days, using the group aged 0-28 days as the reference group.  Results Herein, 58, 124, and 166 infants were included in the 0-28 days, 29-60 days, and 61-90 days age groups, respectively. Of the total number of patients, 15.5%, 8.9%, and 16.9% in the 0-28 days, 29-60 days, and 61-90 days age groups, respectively, were diagnosed with SBI. The relative incidences were 1 for the 0-28 days group (reference group), 0.67 for the 29-60 days group (95% confidence interval [CI], 0.39-1.15), and 1.08 for the 61-90 days group (95% CI, 0.58-2.00). Of the total number of patients, 10.3%, 3.2%, and 0.6% in the 0-28 days, 29-60 days, and 61-90 days age groups, respectively, were diagnosed with IBI. Relative incidences were 1 (reference group), 0.50 (95% CI, 0.29-0.88), and 0.28 (95% CI, 0.19-0.41) for the 0-28 days, 29-60 days, and 61-90 days age groups, respectively. All cases of IBI were caused by Group B streptococcus (GBS), except for two cases of bacteremia, which were caused by Haemophilus influenzae .  Conclusion The incidence of SBI was similar in the 0-28 days and 61-90 days age groups. However, the incidence of IBI decreased with increasing age. The incidence of UTIs was highest in the 61-90 days age group, and that of meningitis and bacteremia decreased with increasing age., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Yoshitake et al.)