TORCH

Question 1

Characteristics of

Congenital Toxoplasmosis:

what are complications?

Answer 1

symptomatic at birth

hydrocephalus

horioretinitis

intracerebral calcifications (calcifications throughout the cerebrum)

Complications: severe neurodevelopmental sequelae (seizures, mental retardation, paralysis, blindness)

Question 2

Congenital Syphilis

organism:

characteristic features:

Answer 2

Treponema pallidum

most are asymptomatic at birth but manifest symptoms if untreated

papulosquamous lesions (anywhere including palms and soles)

perioral fissures and scarring (rhagades)

lymphadenopathy, hepatosplenomegaly (HSM)

Rhinitis and snuffles

Anemia and jaundice

Osteochondritis

May also show: sensorineural ddddeafness, sabre shin, saddle nose deformity, hutchinson teath (notched teeth) and mulberry molars (rounded molars)

Question 3

Rubella:

Classic Traid

Answer 3

Cataracts

deafness

heart malformations

pt. may also have a blueberry muffin rash

Question 4

Congenital CMV

characteristics

Answer 4

the majority of infants are asymptomatic at birth

symptomatic infants may have:
HSM/jaundice

IUGR (intrauterine growth retardation)

Periventricular calcificaitons

Chorioretinitis and optic nerve atrophy

** CMV is transmitted transplacentally late in the pregnancy. Dx is often made prior to delivery by ultrasound, microcephaly, and calcifications. Infants usually die <2 mo. Those that do survive have severe disabilities

Question 5

Congenital Herpes

organism

Characteristics:

Answer 5

HSV 1 or 2

three distinct diseases:

1. Cutaneous disease
   
   1. third week of life
   2. localised mucocutaneous lesions
   3. may progress if untreated
2. Disseminated disease
   
   1. 4th-8th day of life
   2. baby is very sick
   3. respiratory distress, hepatitis, DIC (purpura, hemorrhagic bullae, and focal gangrene) shock
   4. CNS involvement (lethargy, focal seizures- a hand twitching)
3. Encephalitic disease
   
   1. 2nd-4th week of life
   2. isolated CNS involvement- dx. w/ bloody lumbar puncture

Question 6

rxn to a viral illness (commonly HSV or EBC)

symmetrical, fixed, erythematous eruption that evolves into target lesions with violaceous centers

What is the most likely diagnosis?

what type of hypersensitivity?

characteristics

Answer 6

Erythema Multiforme

self limited hypersensitivity (Type IV) syndrome

on biopsy: focal liquefaction degeneration of epidermas. The mucosal involvement is limited

no prodrome

Question 7

High fever

involvement of the mucosus membranes (2 or more)

epidermal detatchment

1-14 day prodrome period of fever, malaise, and URI symptoms

Nikolsky sign

What is the most likely diagnosis?

Answer 7

SJS/TEN

TEN= more advanced SJS (>30% of the body is involved)

SJS (<10% of the body is involved)

the skin layers slough off at the dermal epidermal junction

Tx like you would for burns

Some drugs can cause this- sulfa, PCN, NSAIDS< and anticonvulsants

Question 8

non-painful and superficial peeling

begins with a sandpaper-like rash in the axillae, trunk, and legs

What is the most likely diagnosis?

Where does the sloughing of skin occur?

etiology:

Answer 8

Scalded Skin Syndrome

Sloughing of the skin occurs within the granular layer of the epidermis and results in no scarring

Exfoliative toxins A and B from S aureus

Question 9

Sudden onset fever, rash, hypotension, and toxic appearance

s/s of multisystem organ failure including: respiratory distress, vomiting, oliguria

What is the most likely diagnosis?

Answer 9

Toxic Shock Syndrome

TSST-1 are superantigens that allow bypass of normal antigen presentation and allow for a robust activation of T cells