Early Second Trimester HSV-2 Infection detection in an 18 weeks fetus; Case Report

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Also, Maternal HSV-2 infections during pregnancy pose increased risks, particularly when diagnosed in the third trimester, leading to unfavorable outcomes for the fetus and rarly detected in early second trimester of pregnancy. Case Presenation: We present a case of HSV-2 infection in an 18-week fetus in previously healthy mother, the patient's ultrasound findings, diagnostic evaluations, and subsequent management and oucome. Conclusion: This case underscores the challenges associated with mid-trimester intrauterine infections and prompts diagnosis based on ultrasound and echocardiography findings. Herpes Simplex Virus 2 Prenatal Diagnosis Second Trimester Vertical Transmission Fetal echocardiography Figures Figure 1 Figure 2 Background We present a case of mid trimester herpes simplex virus type 2 (HSV-2) infection in an 18-week fetus, highlighting the importance of early clinical suspicious, detection and timely management of this infection in pregnancy and childbirth.Herpes Simplex Virus type 2 (HSV-2) is a significant viral pathogen known for its role in genital herpes infections. While primary maternal HSV-2 infections during pregnancy pose certain risks, the potential implications for fetal health become particularly pronounced when infections occur during the mid-trimester [1]. HSV-2 belongs to the TORCH group of infections, which includes Toxoplasmosis, Other (syphilis, varicella-zoster, parvovirus B19), Rubella, Cytomegalovirus, and Herpes Simplex. Each of these pathogens has the potential to cause congenital infections, affecting the developing fetus and resulting in diverse clinical manifestations [2].In the context of HSV-2, the virus can be transmitted to the fetus through vertical transmission, especially during primary maternal infections. The mid-trimester, spanning weeks 14 to 26 of pregnancy, is a crucial period for fetal development, and infections during this time can lead to severe consequences. Fetal involvement in HSV-2 infections can result in conditions such as disseminated infection, encephalitis, and intrauterine growth restriction [3].TORCH infections, including HSV-2, highlight the intricate interplay between maternal health and fetal outcomes. Maternal immunity plays a crucial role in protecting the developing fetus, and any compromise in this defense mechanism increases the risk of transplacental transmission [4]. In the case of HSV-2, understanding the dynamics of viral shedding and its correlation with the risk of fetal infection is essential for clinical management. Diagnosis of mid-trimester HSV-2 infection in the fetus typically involves a combination of maternal serological testing, amniocentesis, and advanced imaging techniques. The TORCH panel is often employed in routine prenatal screenings to identify potential infections and guide appropriate interventions. While advancements in diagnostic tools have improved our ability to detect fetal infections, challenges remain in differentiating between active and latent infections and predicting the severity of fetal outcomes[5].HSV-2 infections during pregnancy can have implications for fetal health, necessitating careful monitoring through ultrasound examinations, particularly during routine anomaly scans. Ultrasound findings in cases of HSV-2 infection may reveal specific abnormalities that can guide clinical management. During anomaly scans in pregnancies with HSV-2 infection, ultrasound may detect signs such as intrauterine growth restriction (IUGR), central nervous system abnormalities, and evidence of disseminated infection [6]. IUGR is a concerning manifestation, emphasizing the need for close monitoring of fetal growth and development. In cases of central nervous system involvement, ultrasound imaging may reveal abnormalities such as ventriculomegaly, microcephaly, or intracranial calcifications [7]. The timing of anomaly scans is crucial, and mid-trimester scans (around 18-22 weeks) are particularly significant for identifying structural abnormalities. The ultrasound findings in HSV-2-infected pregnancies underscore the importance of integrating imaging with other diagnostic modalities and clinical assessments. This comprehensive approach is essential for timely and accurate diagnosis, allowing for appropriate management strategies to optimize outcomes for both the mother and the developing fetus. While most cases are identified in the third trimester or late in the second trimester [8], the case introduced during the anomaly scan was diagnosed in the early second trimester. This underscores the importance of early detection during routine screenings, such as anomaly scans conducted in the second trimester, to promptly address and manage potential complications associated with HSV-2 infections in pregnant individuals. Managing mid-trimester HSV-2 infections requires a multidisciplinary approach involving obstetricians, neonatologists, and infectious disease specialists. Antiviral therapy may be considered to reduce viral shedding and minimize the risk of fetal transmission. Additionally, close monitoring of fetal growth and development through regular ultrasounds is crucial for early detection of potential complications. Case Presentation The mother, is a 26-year-old previously healthy woman without any history of genital and skin chronic ulcer who had a four year old boy before. She was presented to our antenatal screening imaging clinic with an 18 weeks fetus, who was referred for fetal echocardiography and second anomaly scan due to physician suggestion for better evaluation of possible cardiac anomalies and patient concerns of fetal anomalies. In pervious history of first trimester ultrasound and anomaly scan no pathologic findings were seen. Although, triple blood test revealed no obvious abnormal findings. Second anomaly scan showed no skeletal, abdominal and CNS pathology,except thymic hypoplasia and thymic hypoplasia with thymic ratio of 0.4 (Figure 1) is noted. In fetal echocardiography during anomaly scan, mild pericardial effusion with maximum diameter of 3.3 mm and mild increased myocardial echogenicity (Figure 2) is seen. Otherwise, the exam for rhythm, cardiac defects and functional assessment were normal. According to this findings, amniocentesis is suggested with high suspicious of TORCH infection or chromosome 22 microdeletion. Further investigations revealed evidence of active herpes simplex virus type 2 infection in the amniotic fluid in TORCH panel molecular qualitative analysis. Diagnostic tests, including polymerase chain reaction and viral culture, confirmed the presence of herpes simplex virus type 2 in both the amniotic fluid, confirming the vertical transmission of the virus to the fetus. Amniocentesis results included a 46,XX karyotype, with positive acetylcholinesterase and negative cytomegalovirus, toxoplasma, and Parvovirus B19 polymerase chain reaction (PCR) tests. The viral culture unexpectedly isolated HSV-2. Maternal serology for HSV at 20 weeks gestation was positive for HSV-2 IgG, negative for HSV-1 IgG, and positive for HSV-1/2 IgM. The treatments included antiviral therapy with acyclovir initiated promptly after the diagnosis of HSV-2 vertical transmission in the second trimester. Maternal counselling and education on the risks and management of neonatal herpes infection were also provided. In follow-up, due to the prompt diagnosis and treatment of the mother, the child was born without any significant pathology or sequelae of HSV-2 infection. Close monitoring and follow-up care were recommended to ensure the long-term health and well-being of the infant. Discussion and Conclusions The detection of herpes simplex virus type 2 infection in the mid trimester is rare and highlights the potential risks and complications associated with this viral infection during pregnancy. Previous case reports have shown that such infections can lead to severe fetal complications, including central nervous system abnormalities, growth restrictions, and even fetal demise[9]. It is necessary to consider the infections that can be transmitted from mother to fetus and maintain clinical suspicion, even in times when the likelihood of fetal involvement may appear low based on past cases. Immunological assessments were conducted on the mother to determine the risk of viral transmission to the fetus and evaluate the potential need for antiviral prophylaxis during pregnancy [10]. The results of the immunological assessments indicated that the mother had high levels of IgG antibodies against herpes simplex virus type 2, suggesting prior exposure to the virus and a lower risk of transmission to the fetus [11]. Early detection and timely intervention play a crucial role in managing mid-trimester herpes simplex virus type 2 infection in fetuses. As demonstrated in this case report, the detection of herpes simplex virus type 2 infection in the mid trimester allowed for appropriate interventions to be implemented, potentially reducing the risk of severe complications and improving the outcome for the fetus. The case report highlights the importance of early detection and timely intervention in cases of mid-trimester herpes simplex virus type 2 infection in fetuses. Additionally, previous studies have emphasized the significance of conducting diagnostic tests, such as polymerase chain reaction and viral culture, to confirm the presence of herpes simplex virus type 2 infection in the amniotic fluid and fetal tissues [12]. These diagnostic tests are essential in confirming the vertical transmission of the virus and guiding appropriate management strategies, including antiviral prophylaxis during pregnancy. In conclusion, the mid-trimester detection of herpes simplex virus type 2 infection in an 18-week fetus underscores the need for careful monitoring and management of pregnant individuals with a history of herpes simplex virus type 2 infection. It also emphasizes the importance of conducting immunological assessments to evaluate the risk of viral transmission and the potential need for antiviral prophylaxis. Early detection of mid-trimester herpes simplex virus type 2 infection in an 18-week fetus is crucial for implementing appropriate interventions and improving outcomes for both the fetus and the pregnant individual. List of abbreviations HSV-2;Herpes Simplex Virus Type 2- TORCH; Toxoplasmosis, others (syphilis, hepatitis B), Rubella, Cytomegalovirus, Herpes simplex -IUGR; Intrauterine Growth Restriction - CNS; Central Nervous System Declarations Ethical approval and consent to participate Consent to participate statement Written informed consent was taken from the patient. Consent For publication Written informed consent was obtained from participant for publication of the details of the medical case and any accompanying images. Availability of data and materials The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions. Competing Interest The authors have no conflicts of interest to declare. Funding This study was not supported by any sponsor or funder. Author Contributions M.BS and R.G participated in study conception and design, data collection, analysis and interpretation of results, and manuscript preparation. Acknowledgement None References Westhoff GL, Little SE, Caughey AB. Herpes simplex virus and pregnancy: a review of the management of antenatal and peripartum herpes infections. Obstetrical & gynecological survey. 2011 Oct 1;66(10):629-38. Pradhan J, Mallick S, Mishra N, Tiwari A, Negi VD. Pregnancy, infection, and epigenetic regulation: A complex scenario. Biochimica et Biophysica Acta (BBA)-Molecular Basis of Disease. 2023 Oct 1;1869(7):166768. Sappenfield E, Jamieson DJ, Kourtis AP. Pregnancy and susceptibility to infectious diseases. Infectious diseases in obstetrics and gynecology. 2013 Oct;2013. Hussain T, Murtaza G, Kalhoro DH, Kalhoro MS, Yin Y, Chughtai MI, Tan B, Yaseen A, Rehman ZU. Understanding the immune system in fetal protection and maternal infections during pregnancy. Journal of Immunology Research. 2022 Jun 24;2022. Fitzpatrick D, Holmes NE, Hui L. A systematic review of maternal TORCH serology as a screen for suspected fetal infection. Prenatal diagnosis. 2022 Jan;42(1):87-96. Aly GS, Abdel-Hady H, Ibrahim MZ. Congenital viral infections. Viral Infections in Children, Volume I. 2017:1-46. Sharma D, Shastri S, Sharma P. Intrauterine growth restriction: antenatal and postnatal aspects. Clinical medicine insights: pediatrics. 2016 Jan;10:CMPed-S40070. Fa F, Laup L, Mandelbrot L, Sibiude J, Picone O. Fetal and neonatal abnormalities due to congenital herpes simplex virus infection: a literature review. Prenatal diagnosis. 2020 Mar;40(4):408-14. Jash S, Sharma S. Pathogenic infections during pregnancy and the consequences for fetal brain development. Pathogens. 2022 Jan 31;11(2):193. Yu W, Hu X, Cao B. Viral infections during pregnancy: the big challenge threatening maternal and fetal health. Maternal-Fetal Medicine. 2022 Jan 25;4(01):72-86. De Rose DU, Bompard S, Maddaloni C, Bersani I, Martini L, Santisi A, Longo D, Ronchetti MP, Dotta A, Auriti C. Neonatal herpes simplex virus infection: From the maternal infection to the child outcome. Journal of Medical Virology. 2023 Aug;95(8):e29024. Bougioukas L, Psoinos RB, Jones DC, Morris EA, Hale AJ. Disseminated herpes simplex virus 2 as a complication of pregnancy. IDCases. 2021 Jan 1;24:e01107. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4222968","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":289854942,"identity":"856e239c-35ed-46ca-8d60-4a81b33efefe","order_by":0,"name":"Melika Boroomand-Saboor","email":"","orcid":"","institution":"Shahid Beheshti University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Melika","middleName":"","lastName":"Boroomand-Saboor","suffix":""},{"id":289854943,"identity":"f161b8a9-9a67-4c87-8868-abe2d198011a","order_by":1,"name":"Reza Gerami","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9klEQVRIiWNgGAWjYFADZuYDBh+ANBs78VrYEgpngLQwE28Nj8JnHrBeAurM29sffvxScU9et52HcbPNr23yfMwMjB8+5uDWInPmQLK0zJliw22HeQ8b5/bdNmxjZmCWnLkNtxYJiYQD0pJtCYzbDvOlGef23GYEamFj5sWnRf5h82/Jfwn22w7zmP+27LltT1iLBDOb5MeGhESgFgNjhh+3Ewlr4Uljs2Y4lpC87TBbgmFvw+3kNmbGZvx+YT/++OaPmgTbbecPHzD48ee27fz25oMfPuLRAgLMPDAWYxuYbMCvHqTkB5z5h6DiUTAKRsEoGIEAAHDzUC0jEN4eAAAAAElFTkSuQmCC","orcid":"","institution":"AJA University of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Reza","middleName":"","lastName":"Gerami","suffix":""}],"badges":[],"createdAt":"2024-04-05 12:27:02","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4222968/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4222968/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":54519184,"identity":"1ee3c7e0-e26f-487c-9060-50fc7432c4e9","added_by":"auto","created_at":"2024-04-11 17:41:09","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":84566,"visible":true,"origin":"","legend":"\u003cp\u003eThymic hypoplasia with thymic ratio of 0.4 in second trimester anomaly scan\u003c/p\u003e","description":"","filename":"Fig1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4222968/v1/4ef29b2a20eaaac2a84c73fa.jpg"},{"id":54519185,"identity":"c47ee0db-ae08-4b8e-8dbd-37abc55aa1d3","added_by":"auto","created_at":"2024-04-11 17:41:09","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":56547,"visible":true,"origin":"","legend":"\u003cp\u003ePericardial effusion and mild increased echogenicity of myocardium in fetal echocardiography in an 18 weeks fetus\u003c/p\u003e","description":"","filename":"Fig2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4222968/v1/9b32eeedfc2dff418c6b0c52.jpg"},{"id":64299927,"identity":"9490aadb-646d-4386-901e-efba26022759","added_by":"auto","created_at":"2024-09-11 11:29:37","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":369518,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4222968/v1/8eb6ecae-cc2d-4e96-adec-64ecbd3e70b5.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Early Second Trimester HSV-2 Infection detection in an 18 weeks fetus; Case Report","fulltext":[{"header":"Background ","content":"\u003cp\u003eWe present a case of mid trimester herpes simplex virus type 2 (HSV-2) infection in an 18-week fetus, highlighting the importance of early clinical suspicious, detection and timely management of this infection in pregnancy and childbirth.Herpes Simplex Virus type 2 (HSV-2) is a significant viral pathogen known for its role in genital herpes infections. While primary maternal HSV-2 infections during pregnancy pose certain risks, the potential implications for fetal health become particularly pronounced when infections occur during the mid-trimester [1]. HSV-2 belongs to the TORCH group of infections, which includes Toxoplasmosis, Other (syphilis, varicella-zoster, parvovirus B19), Rubella, Cytomegalovirus, and Herpes Simplex. Each of these pathogens has the potential to cause congenital infections, affecting the developing fetus and resulting in diverse clinical manifestations [2].In the context of HSV-2, the virus can be transmitted to the fetus through vertical transmission, especially during primary maternal infections. The mid-trimester, spanning weeks 14 to 26 of pregnancy, is a crucial period for fetal development, and infections during this time can lead to severe consequences. Fetal involvement in HSV-2 infections can result in conditions such as disseminated infection, encephalitis, and intrauterine growth restriction [3].TORCH infections, including HSV-2, highlight the intricate interplay between maternal health and fetal outcomes. Maternal immunity plays a crucial role in protecting the developing fetus, and any compromise in this defense mechanism increases the risk of transplacental transmission [4]. In the case of HSV-2, understanding the dynamics of viral shedding and its correlation with the risk of fetal infection is essential for clinical management.\u003c/p\u003e\n\u003cp\u003eDiagnosis of mid-trimester HSV-2 infection in the fetus typically involves a combination of maternal serological testing, amniocentesis, and advanced imaging techniques. The TORCH panel is often employed in routine prenatal screenings to identify potential infections and guide appropriate interventions. While advancements in diagnostic tools have improved our ability to detect fetal infections, challenges remain in differentiating between active and latent infections and predicting the severity of fetal outcomes[5].HSV-2 infections during pregnancy can have implications for fetal health, necessitating careful monitoring through ultrasound examinations, particularly during routine anomaly scans. Ultrasound findings in cases of HSV-2 infection may reveal specific abnormalities that can guide clinical management.\u003c/p\u003e\n\u003cp\u003eDuring anomaly scans in pregnancies with HSV-2 infection, ultrasound may detect signs such as intrauterine growth restriction (IUGR), central nervous system abnormalities, and evidence of disseminated infection [6]. IUGR is a concerning manifestation, emphasizing the need for close monitoring of fetal growth and development. In cases of central nervous system involvement, ultrasound imaging may reveal abnormalities such as ventriculomegaly, microcephaly, or intracranial calcifications [7].\u003c/p\u003e\n\u003cp\u003eThe timing of anomaly scans is crucial, and mid-trimester scans (around 18-22 weeks) are particularly significant for identifying structural abnormalities.\u003c/p\u003e\n\u003cp\u003eThe ultrasound findings in HSV-2-infected pregnancies underscore the importance of integrating imaging with other diagnostic modalities and clinical assessments. This comprehensive approach is essential for timely and accurate diagnosis, allowing for appropriate management strategies to optimize outcomes for both the mother and the developing fetus.\u003c/p\u003e\n\u003cp\u003eWhile most cases are identified in the third trimester or late in the second trimester [8], the case introduced during the anomaly scan was diagnosed in the early second trimester. This underscores the importance of early detection during routine screenings, such as anomaly scans conducted in the second trimester, to promptly address and manage potential complications associated with HSV-2 infections in pregnant individuals.\u003c/p\u003e\n\u003cp\u003eManaging mid-trimester HSV-2 infections requires a multidisciplinary approach involving obstetricians, neonatologists, and infectious disease specialists. Antiviral therapy may be considered to reduce viral shedding and minimize the risk of fetal transmission. Additionally, close monitoring of fetal growth and development through regular ultrasounds is crucial for early detection of potential complications.\u003c/p\u003e"},{"header":"Case Presentation","content":"\u003cp\u003eThe mother, is a 26-year-old previously healthy woman without any history of genital and skin chronic ulcer who had a four year old boy before. She was presented to our antenatal screening imaging clinic with an 18 weeks fetus, who was referred for fetal echocardiography and second anomaly scan due to physician suggestion for better evaluation of possible cardiac anomalies and patient concerns of fetal anomalies.\u003c/p\u003e\n\u003cp\u003eIn pervious history of first trimester ultrasound and anomaly scan no pathologic findings were seen. Although, triple blood test revealed no obvious abnormal findings.\u003c/p\u003e\n\u003cp\u003eSecond anomaly scan showed no skeletal, abdominal and CNS pathology,except thymic hypoplasia and thymic hypoplasia with thymic ratio of 0.4 (Figure 1) is noted.\u003c/p\u003e\n\u003cp\u003eIn fetal echocardiography during anomaly scan, mild pericardial effusion with maximum diameter of 3.3 mm and mild increased myocardial echogenicity (Figure 2) is seen. Otherwise, the exam for rhythm, cardiac defects and functional assessment were normal.\u003c/p\u003e\n\u003cp\u003eAccording to this findings, amniocentesis is suggested with high suspicious of TORCH infection or chromosome 22 microdeletion. \u003c/p\u003e\n\u003cp\u003eFurther investigations revealed evidence of active herpes simplex virus type 2 infection in the amniotic fluid in TORCH panel molecular qualitative analysis. Diagnostic tests, including polymerase chain reaction and viral culture, confirmed the presence of herpes simplex virus type 2 in both the amniotic fluid, confirming the vertical transmission of the virus to the fetus.\u003c/p\u003e\n\u003cp\u003eAmniocentesis results included a 46,XX karyotype, with positive acetylcholinesterase and negative cytomegalovirus, toxoplasma, and Parvovirus B19 polymerase chain reaction (PCR) tests. The viral culture unexpectedly isolated HSV-2.\u003c/p\u003e\n\u003cp\u003eMaternal serology for HSV at 20 weeks gestation was positive for HSV-2 IgG, negative for HSV-1 IgG, and positive for HSV-1/2 IgM.\u003c/p\u003e\n\u003cp\u003eThe treatments included antiviral therapy with acyclovir initiated promptly after the diagnosis of HSV-2 vertical transmission in the second trimester. Maternal counselling and education on the risks and management of neonatal herpes infection were also provided.\u003c/p\u003e\n\u003cp\u003eIn follow-up, due to the prompt diagnosis and treatment of the mother, the child was born without any significant pathology or sequelae of HSV-2 infection. Close monitoring and follow-up care were recommended to ensure the long-term health and well-being of the infant.\u003c/p\u003e"},{"header":"Discussion and Conclusions","content":"\u003cp\u003eThe detection of herpes simplex virus type 2 infection in the mid trimester is rare and highlights the potential risks and complications associated with this viral infection during pregnancy. Previous case reports have shown that such infections can lead to severe fetal complications, including central nervous system abnormalities, growth restrictions, and even fetal demise[9]. It is necessary to consider the infections that can be transmitted from mother to fetus and maintain clinical suspicion, even in times when the likelihood of fetal involvement may appear low based on past cases.\u003c/p\u003e\n\u003cp\u003eImmunological assessments were conducted on the mother to determine the risk of viral transmission to the fetus and evaluate the potential need for antiviral prophylaxis during pregnancy [10]. The results of the immunological assessments indicated that the mother had high levels of IgG antibodies against herpes simplex virus type 2, suggesting prior exposure to the virus and a lower risk of transmission to the fetus [11].\u003c/p\u003e\n\u003cp\u003eEarly detection and timely intervention play a crucial role in managing mid-trimester herpes simplex virus type 2 infection in fetuses. As demonstrated in this case report, the detection of herpes simplex virus type 2 infection in the mid trimester allowed for appropriate interventions to be implemented, potentially reducing the risk of severe complications and improving the outcome for the fetus. The case report highlights the importance of early detection and timely intervention in cases of mid-trimester herpes simplex virus type 2 infection in fetuses.\u003c/p\u003e\n\u003cp\u003eAdditionally, previous studies have emphasized the significance of conducting diagnostic tests, such as polymerase chain reaction and viral culture, to confirm the presence of herpes simplex virus type 2 infection in the amniotic fluid and fetal tissues [12]. These diagnostic tests are essential in confirming the vertical transmission of the virus and guiding appropriate management strategies, including antiviral prophylaxis during pregnancy.\u003c/p\u003e\n\u003cp\u003eIn conclusion, the mid-trimester detection of herpes simplex virus type 2 infection in an 18-week fetus underscores the need for careful monitoring and management of pregnant individuals with a history of herpes simplex virus type 2 infection. It also emphasizes the importance of conducting immunological assessments to evaluate the risk of viral transmission and the potential need for antiviral prophylaxis. Early detection of mid-trimester herpes simplex virus type 2 infection in an 18-week fetus is crucial for implementing appropriate interventions and improving outcomes for both the fetus and the pregnant individual.\u003c/p\u003e"},{"header":"List of abbreviations","content":"\u003cp\u003eHSV-2;Herpes Simplex Virus Type 2- TORCH; Toxoplasmosis, others (syphilis, hepatitis B), Rubella, Cytomegalovirus, Herpes simplex -IUGR; Intrauterine Growth Restriction - CNS; Central Nervous System\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was taken from the patient.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent For publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from participant for publication of the details of the medical case and any accompanying images.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no conflicts of interest to declare.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was not supported by any sponsor or funder.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eM.BS and R.G participated in study conception and design, data collection, analysis and interpretation of results, and manuscript preparation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eWesthoff GL, Little SE, Caughey AB. Herpes simplex virus and pregnancy: a review of the management of antenatal and peripartum herpes infections. Obstetrical \u0026amp; gynecological survey. 2011 Oct 1;66(10):629-38.\u003c/li\u003e\n \u003cli\u003ePradhan J, Mallick S, Mishra N, Tiwari A, Negi VD. Pregnancy, infection, and epigenetic regulation: A complex scenario. Biochimica et Biophysica Acta (BBA)-Molecular Basis of Disease. 2023 Oct 1;1869(7):166768.\u003c/li\u003e\n \u003cli\u003eSappenfield E, Jamieson DJ, Kourtis AP. Pregnancy and susceptibility to infectious diseases. Infectious diseases in obstetrics and gynecology. 2013 Oct;2013.\u003c/li\u003e\n \u003cli\u003eHussain T, Murtaza G, Kalhoro DH, Kalhoro MS, Yin Y, Chughtai MI, Tan B, Yaseen A, Rehman ZU. Understanding the immune system in fetal protection and maternal infections during pregnancy. Journal of Immunology Research. 2022 Jun 24;2022.\u003c/li\u003e\n \u003cli\u003eFitzpatrick D, Holmes NE, Hui L. A systematic review of maternal TORCH serology as a screen for suspected fetal infection. Prenatal diagnosis. 2022 Jan;42(1):87-96.\u003c/li\u003e\n \u003cli\u003eAly GS, Abdel-Hady H, Ibrahim MZ. Congenital viral infections. Viral Infections in Children, Volume I. 2017:1-46.\u003c/li\u003e\n \u003cli\u003eSharma D, Shastri S, Sharma P. Intrauterine growth restriction: antenatal and postnatal aspects. Clinical medicine insights: pediatrics. 2016 Jan;10:CMPed-S40070.\u003c/li\u003e\n \u003cli\u003eFa F, Laup L, Mandelbrot L, Sibiude J, Picone O. Fetal and neonatal abnormalities due to congenital herpes simplex virus infection: a literature review. Prenatal diagnosis. 2020 Mar;40(4):408-14.\u003c/li\u003e\n \u003cli\u003eJash S, Sharma S. Pathogenic infections during pregnancy and the consequences for fetal brain development. Pathogens. 2022 Jan 31;11(2):193.\u003c/li\u003e\n \u003cli\u003eYu W, Hu X, Cao B. Viral infections during pregnancy: the big challenge threatening maternal and fetal health. Maternal-Fetal Medicine. 2022 Jan 25;4(01):72-86.\u003c/li\u003e\n \u003cli\u003eDe Rose DU, Bompard S, Maddaloni C, Bersani I, Martini L, Santisi A, Longo D, Ronchetti MP, Dotta A, Auriti C. Neonatal herpes simplex virus infection: From the maternal infection to the child outcome. Journal of Medical Virology. 2023 Aug;95(8):e29024.\u003c/li\u003e\n \u003cli\u003eBougioukas L, Psoinos RB, Jones DC, Morris EA, Hale AJ. Disseminated herpes simplex virus 2 as a complication of pregnancy. IDCases. 2021 Jan 1;24:e01107.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Herpes Simplex Virus 2, Prenatal Diagnosis, Second Trimester, Vertical Transmission, Fetal echocardiography","lastPublishedDoi":"10.21203/rs.3.rs-4222968/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4222968/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground: Herpes Simplex Virus type 2 (HSV-2), is mainly linked to genital herpes infections. Also, Maternal HSV-2 infections during pregnancy pose increased risks, particularly when diagnosed in the third trimester, leading to unfavorable outcomes for the fetus and rarly detected in early second trimester of pregnancy.\u003c/p\u003e\n\u003cp\u003eCase Presenation: We present a case of HSV-2 infection in an 18-week fetus in previously healthy mother, the patient's ultrasound findings, diagnostic evaluations, and subsequent management and oucome.\u003c/p\u003e\n\u003cp\u003eConclusion: This case underscores the challenges associated with mid-trimester intrauterine infections and prompts diagnosis based on ultrasound and echocardiography findings.\u003c/p\u003e","manuscriptTitle":"Early Second Trimester HSV-2 Infection detection in an 18 weeks fetus; Case Report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-11 17:41:04","doi":"10.21203/rs.3.rs-4222968/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4799a62e-58b3-4542-b0c2-07ea4ab581ae","owner":[],"postedDate":"April 11th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-09-11T11:21:31+00:00","versionOfRecord":[],"versionCreatedAt":"2024-04-11 17:41:04","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4222968","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4222968","identity":"rs-4222968","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}