RC TORCH Flashcards
Clinical features
System Clinical features
General: IUGR, prematurity
Skin: Petechiae, purpura, echymoses, jaundice
Hematopoietic: Thrombocytopenia,anemia,splenomegaly
Hepatobiliary: Hyperbilirubinemia, elevated ALT, hepatomegaly
CNS: Microcephaly, seizures, periventricular calcifications
Eye: Chorioretinitis, strabismus, optic atrophy, microphthalmia
Ear: Sensorineural hearing loss
CMV
Tx for positive urine CMV with hearing loss on screen?
Valgancyclovir x 6 months
Early onset manifestations
System Manifestations
General: Prematurity, IUGR, FTT
Mucocutaneous: Snuffles, maculopapular rash followed by desquamation, blistering and crusting, condyloma lata
Reticuloendothelial: Hepatosplenomegaly, lymphadenopathy
Hematologic: Coomb’s negative hemolytic anemia, thrombocytopenia
Skeletal: Pseudoparalysis, osteochondritis, diaphyseal periostitis, deminiralization/destruction of proximal
tibia metaphysis, osteitis
Neurologic: Aseptic meningitis, hydrocephalus, cranial nerve palsies
Ophthalmologic: Salt and pepper chorioretinitis, glaucoma, uveitis
Syphillis
Late onset manifestations
System Clinical features
CNS: Global developmental delay, hydrocephalus, cranial nerve palsies, seizures, juvenile paresis
Eye: Interstitial keratitis, healed chorioretinitis, corneal scarring, glaucoma, optic atrophy
Ears: Sensorineural hearing loss
Face: Saddle nose, frontal bossing, protuberant mandible, high arch palate
Teeth: Hutchinson’s teeth, mulberry molars
Skin: Ragades (linear scars), gummas
MSK: Saber shins, clutton joints, Higoumenakis’ sign
Syphillis
Mom diagnosed with syphilis week 32 of pregnancy, RPR 1:128. Given single dose IM penicillin after
which RPR drops to 1:64. Infant has normal physical exam; RPR 1:32. Management?
a. No treatment as mom was appropriately treated
b. Full workup including LP; give 10 days of IV penicillin regardless of workup findings
c. Full workup including LP; 10 days of IV penicillin if workup abnormal
d. Full workup including LP; single dose IM penicillin if workup abnormal
B
No 4 fold drop in titres - would have wanted to see her drop from at least 1:32 or lower. If doesn’t happen - full work up in baby, doesn’t matter if normal or not, treat
When to evaluate an infant for congenital syphillis?
- Infant has signs and symptoms of congenital syphilis
- Mother not treated or treatment not adequately documented
- Mother treated with non-penicillin regimen
- Mother treated within 30 days of child’s birth
- Less than 4-fold drop in mothers non-treponemal titer or not assessed or documented
- Mother had relapse or re-infection after treatment
How to do full evaluation for infant with suspected congenital syphillis?
• Physical exam
▫ Stigmata
▫ Ophthalmology,audiology
assessments
• CBC, (LFT’s)
• Lumbar puncture
▫ CSFWBCcount
▫ CSFprotein
▫ Treponemal&non- treponemal serologic tests
• Skeletal survey
• Syphilis serology
▫ Non-treponemal
▫ Treponemal
• Direct detection ▫ Darkfield microscopy ▫ DirectfluourescentAb ▫ Placentaltissue,umbilical cord, lesion exudate
Treatment of congenital syphillis during neonatal period?
Clinical status Recommended treatment
Proven, probable disease §–> Intravenous crystalline penicillin G for 10 days
Asymptomatic, but at risk based on maternal history ‡ –>Intravenous crystalline penicillin G for 10 days
Asymptomatic, mother adequately treated–> Close clinical follow-up
§ Abnormal physical examination or investigation findings, infants RPR >/= 4-fold that of mothers, detection of organism in infant samples
‡ Mother’s treatment or serologic response inadequate
• The syndrome (major features)
▫ Severe microcephaly with partially collapsed skull
▫ Thin cerebral cortices, subcortical calcifications
▫ Macular scarring, focal pigmentary retinal mottling
▫ Congenital contractures (arthrogryposis, club foot etc)
• Selected important facts
▫ Infection in pregnancy can be asymptomatic
▫ Full disease spectrum not clearly defined
▫ Antenatal diagnosis – fetal US, amniotic fluid PCR ▫ Postnatal diagnosis – serology and PCR
Zika
Well appearing newborn infant of mother whose husband resided in Brazil until 2 months prior to conception. What testing on baby?
a. Zika PCR in blood and urine and head ultrasound b. BrainMRI
c. Zika serology
d. No testing of baby
D
first step maternal testing - if mom sero neg then no need to poke baby
IUGR, hepatosplenomegaly, anemia, thrombocytopenia, cardiomyopathy, anasarca, meningoencephalitis
Chagas
IUGR, hepatosplenomegaly, thrombocytopenia, microcephaly, periventricular calcifications, SNHL, chorioretinitis
CMV
IUGR, blueberry muffin rash, hepatosplenomegaly, cataract, bony lucencies, cardiac anomalies (PDA), SNHL
Rubella
IUGR, snuffles, variable rashes (including palms & soles), osteitis/perichondritis, chorioretinitis, aseptic meningitis
Syphillis
Macrocephaly, hydrocephalus, parenchymal calcifications, chorioretinitis
Toxoplasmosis
Microcephaly, cicatricial scars, limb hypoplasia, microphthalmia, GERD
Varicella
Microcephaly, brain malformations, subcortical calcifications, macular scars, contractures
Zika
Classic triad of hydrocephalus, cerebral calcifications and chorioretinitis
Toxoplasmosis
CSF findings in congenital toxoplasmosis?
- Lymphocytic pleocytosis
- Elevated protein (often very high)
Triad of cataracts, sensorineural hearing loss, PDA
Rubella
