TORCH Infections -Warren Flashcards
What are all of the TORCH infections?
- Toxoplasmosis
- Other (syphilis, Hep B, varicella zoster, HIV, parvovirus B19, enterovirus, lymphocytic choriomeningitic virus)
- Rubella
- CMV
- Herpes simplex virus
Hx: A 2-day-old baby is observed to have purpuric skin lesions. His mother recently emigrated from a developing country. Her pregnancy is notable for a flulike illness involving a maculopapular rash of her face and body several weeks after her last menstrual period.
Exam: low birth weight, cataracts, and a grade 2/6 harsh crescendo-decrescendo systolic murmur
Lab: low platelets – 70,000
What is the most likely diagnosis?
Rubella
When can a mother pass on Congenital Rubella Syndrome to her fetus? What are the neonatal manifestations of this?
-earlier in gestation=higher risk
- Sensorineural hearing loss (50-75%)
- Cataracts and glaucoma (20-50%)
- Cardiac malformations (20-50%)
- Neurologic (10-20%)
- Others to include growth retardation, bone disease (radiolucent bone lesions), HSM, thrombocytopenia, “blueberry muffin” lesions
What is the treatment for congenital rubella syndrome?
- Supportive
- Isolation
- Report to health department
- prevention with MMR
When should a non-immune pregnant woman receive a Rubella vaccine? Why?
after the baby is delivered
Rubella vaccine is live
Hx: You are at the delivery of an infant born to a 26 yo G5P4 mother with no prenatal care. No problems during pregnancy.
Exam: small for age, microcephaly, jaundice, hepatosplenomegaly, and petechiae.
Labs: anemic with hct 30%, low platelet count 50,000, SGOT 210 mU/mL and direct serum bilirubin of 8mg/dL.
What is the likely diagnosis?
CMV
What are the physical exam findings in a newborn with CMV? What is the normal treatment?
90%=asymptomatic
- hearing loss
- IUGR, low birth weight, petechiae, jaundice, hepatosplenomegaly, Chorioretinitis
- periventricular calcifications and ventriculomegaly –> may need a shunt
- ONLY treat for chorioretinitis
What is the most common cause of sensorineural hearing loss in the US?
CMV
What are the physical exam findings in a newborn with CMV? What is the normal treatment?
90%=asymptomatic
- hearing loss
- IUGR, low birth weight, petechiae, jaundice, hepatosplenomegaly, Chorioretinitis
- periventricular calcifications and ventriculomegaly –> may need a shunt
- ONLY treat for chorioretinitis =ganciclovir or CNS involvement
Hx: 2 hour old infant born to a 24 yo G3P3 mother, HIV neg, Hepatitis B neg, Gonorrhea/Chlamydia negative. No complications during pregnancy. Cat at home
Exam: small for age, microcephaly, jaundice, hepatosplenomegaly, and petechiae.
Labs: low platelet count 79,000
What is the likely diagnosis?
Toxoplasmosis
How is toxoplasma gondii transmitted?
Fecal-oral from infected cat feces/soil/unpasteurized milk
What is the classic triad of symptoms for Toxoplasmosis? How does this normally present at birth? How is it normally diagnosed?
-“CLASSIC TRIAD OF SYMPTOMS”: hydrocephalous,
intracranial calcifications (*diffuse),
Chorioretinitis
- most (70-90%) are asymptomatic at birth
- normally a diagnosis of clinical suspicion
What is the difference in the CT findings of Toxoplasmosis and CMV?
Toxoplasmosis=diffuse calcifications
CMV=periventricular calcifications
A 7 day old male is seen in the clinic for newborn follow-up appointment. Mother is concerned of a rash on his head.
He was born to a 25 yo G1 via forceps vaginal delivery. She had prolong rupture of membranes greater than 18 hours. Maternal serologies were negative.
On physical exam you note a vigorous infant with a fetal scalp probe with crusted lesions with an erythematous base.
What is the likely diagnosis?
Herpes simplex virus (HSV)
What factors can make a HSV infection of the newborn worse? When does this normally present?
- primary infection of the mother increases risk of transmission»_space; recurrent
- presents onset 1-4 weeks of age
How is HSV diagnosed?
High index of suspicion
- History ±
- Age (1-4 weeks)
- Sepsis Syndrome unresponsive to antibiotic therapy
PE - classic vesicular lesions
*PCR=diagnostic method of choice =best on CSF
What is the treatment for HSV?
- Acyclovir IV
- 21 days for disseminated or CNS
- 14 days for skin, eye and mouth
A full term infant is born to a mother without prenatal care or screening. You carefully examine the infant after birth and notice vesiculobullous lesions of the palms and soles.
What is the most likely diagnosis?
Syphilis
- Placental transmission as early as 6wks gestation
- Typically occurs during second half
- Mom with primary or secondary syphilis more likely to transmit than latent disease
How does congenital syphilis normally present?
- 2/3 of affected live-born infants are asymptomatic at birth
- Clinical symptoms split into early or late (2 years is cutoff)
3 major classifications:
- Fetal effects
- Early effects
- Late effects
What are the clinical manifestations of an early congenital syphilis infection?
1st 5 weeks
- Snuffles
- cutaneous lesions (palms/soles)
- HSM
- Jaundice
- Anemia
- Periostitis and metaphysial dystrophy
- Funisitis (umbilical cord vasculitis)
What are the clinical manifestation of late congenital syphilis?
- Frontal bossing
- Short maxilla
- High palatal arch
- Hutchinson teeth
- 8th nerve deafness
- Saddle nose
- Perioral fissures
How is syphilis diagnosed in pregnant women? When?
-RPR/VDRL: nontreponemal test
(Sensitive but NOT specific. Quantitative, so can follow to determine disease activity and treatment response)
MHA-TP/FTA-ABS: specific treponemal test
(Used for confirmatory testing. Qualitative, once positive always positive)
RPR/VRDL for pregnant women early in pregnancy AND at the time of birth**
**What is the treatment for syphilis?
Penicillin G
treat newborn if:
- meet CDC diagnostic criteria
- mom was treated
Which TORCH infection presents with snuffles?
syphilis
Which TORCH infection presents with chorioretinitis, hydrocephalus, and diffuse intracranial calcifications?
toxoplasmosis
Which TORCH infections (3) present with blueberry muffin lesions?
- Rubella
- CMV
- Toxoplasmosis
Which TORCH infection presents with periventricular calcifications?
CMV
Which TORCH infections can present as asymptomatic?
ALL OF THEM!
Which TORCH infections can absolutely be prevented? (2)
- Rubella
- Syphilis
The most common congenital infection is CMV. Of those babies infected, approximately what % are normal at birth and develop normally? A. 0% B. 10% C. 25% D. 50% E. 90%
90%
A term infant with microcephaly, jaundice and thrombocytopenia is thought to have congenital CMV infection. Your attending notes that 1.5% may be asymptomatic. Which of the following is the most commonly reported of such infections? A. Chorioretinitis B. Sensorineural hearing loss C. Thrombocytopenia D. Poor Growth E. Liver failure
B. Sensorineural hearing loss
You are consulting a primigravida woman who has been found to be rubella non immune on prenatal evaluation. She asks you if her fetus is at risk for malformations. When is maternal infection with rubella virus most commonly associated with congenital defects? A. 1st trimester B. 2nd trimester C. last trimester D. After delivery
A. 1st trimester
