1.6 MTB Step 3 - The Newborn (TORCH Infections)

Question 1

TORCH INFECTIONS

SUMMARY

1. What are (4) General Features of the TORCH Infections?
2. What is (1) General Diagnostic Test Finding for the TORCH Infections?

Answer 1

General Features of TORCH Infections:

1. IUGR
2. Hepatosplenomegaly
3. Jaundice
4. Mental Retardation

General Diagnostic Test Finding for TORCH Infections:

1. Elevated Total Cord Blood IgM

Question 2

TORCH INFECTIONS

SUMMARY

1. What are (3) Classic Features of Toxoplasmosis?
2. What is (1) Diagnostic Test Finding for Toxoplasmosis?

Answer 2

Classic Features of Toxoplasmosis:

1. Hydrocephalus
2. Generalized Intracranial Calcifications
3. Chorioretinitis

Diagnostic Test Finding for Toxoplasmosis:

1. IgM against Toxoplasmosis

Question 3

TORCH INFECTIONS

SUMMARY

1. What are (4) Classic Features of Rubella?
2. What is (1) Diagnostic Test for Rubella if Maternal Rubella immune status Negative or Unknown?

Answer 3

Classic Features of Rubella:

1. Cataracts
2. Deafness
3. Heart Defects
4. Blueberry Muffin Spots (extramedullary hematopoiesis)

Diagnostic Test if Maternal immune status Negative or Unknown:

1. IgM against Rubella

Question 4

TORCH INFECTIONS

SUMMARY

1. What are (4) Classic Features of CMV?
2. What are (2) Diagnostic Tests in the Workup for CMV?

Answer 4

Classic Features of CMV:

1. Microcephaly with Periventricular Calcifications
2. Petechiae with Thrombocytopenia
3. Sensorineural Hearing Loss
4. Blueberry-type Rash

Diagnostic Tests for CMV:

1. Urine or Saliva CMV Culture - if Negative excludes CMV
2. Serum CMV IgM Antibody - if Positive in Newborn, suggests Congenital CMV

Question 5

TORCH INFECTIONS

SUMMARY

1. What are Classic Features of Herpes in the 1st Week, 2nd Week, and 3rd to 4th Week?
2. What are the Best INITIAL and Most SPECIFIC Tests for Herpes?

Answer 5

1. Classic Features of Herpes:
   
   • 1st Week = Pneumonia, Shock
   • 2nd Week = Skin Vesicles, Keratoconjunctivitis
   • 3rd to 4th Week = Acute Meningoencephalitis
2. Diagnostic Tests:
   
   • Best Initial = Tzank smear/culture (does not exclude disease if negative)
   • Most Specific = HSV PCR

Question 6

TORCH INFECTIONS

SUMMARY

1. What are (4) Classic Features of Syphilis?
2. What are the Best INITIAL and Most SPECIFIC Tests for Syphilis?

Answer 6

Classic Features of Syphilis:

1. Osteochondritis & Periostitis
2. Desquamating Skin Rash of Palms and Soles
3. Snuffles (mucopurulent rhinitis)
4. Hepatomegaly (most common finding)

Diagnostic Tests:

1. Best Initial = RPR or VDRL screening
2. Most Specific = IgM FTA-ABS

Question 7

TORCH INFECTIONS

SUMMARY

1. What are the Neonatal and Congenital Features of Varicella?
2. What are the Best INITIAL and Most SPECIFIC Tests for Varicella?

Answer 7

Classic Features of Varicella:

1. Neonatal:
   
   • Pneumonia
2. Congenital:
   
   • Limb Hypoplasia
   • Cutaneous Scars
   • Seizures
   • Mental Retardation

Diagnostic Tests:

1. Best Initial = IgM Serology
2. Most Specific = PCR of Amniotic Fluid