ToRCHeS Infections

Question 1

what are ToRCHeS infections? what is their transmission?

Answer 1

• microbes that may pass from mother to fetus
• transmission is transplacental in most cases
  
  • OR via delivery (especially HSV-2)

Question 2

nonspecific signs common to many ToRCHeS infections

Answer 2

• hepatosplenomegaly
• jaundice
• thrombocytopenia
• growth retardation

Question 3

what are the causes of meningitis in neonates?

Answer 3

• Streptococcus agalactiae (group B streptococci)
• E. coli
• Listeria monocytogenes

Question 4

what causes hydrops fetalis?

Answer 4

Parvovirus B19

Question 5

name the ToRCHeS agents of infection

Answer 5

• Toxoplasma gondii
• Rubella
• Cytomegalovirus
• HIV
• Herpes simplex virus-2
• Syphilis

Question 6

Toxoplasma gondii–modes of maternal transmission

Answer 6

• cat feces
• ingestion of undercooked meal

Question 7

Toxoplasma gondii–maternal manifestations

Answer 7

• usually asymptomatic
• lymphadenopathy–rarely

Question 8

Toxoplasma gondii–neonatal manifestations

Answer 8

• classic triad:
  
  • chorioretinitis
  • hydrocephalus
  • intracranial calcifications
• +/- bluberry muffin rash (A)

Question 9

Rubella–modes of maternal transmission

Answer 9

• respiratory droplets

Question 10

Rubella–maternal manifestations

Answer 10

• rash
• lymphadenopathy
• polyarthritis
• polyarthralgia

Question 11

rubella–neonatal manifestations

Answer 11

• classic triad
  
  • abnormalities of eye (cataract)
  • abnormalities of ear (deafness)
  • congenital heart disease (PDA)
• +/- “blueberry muffin” rash
  
  • “I (eye) heart ruby (rubella) earrings.”

Question 12

cytomegalovirus–modes of maternal transmission

Answer 12

• sexual contact
• organ transplants

Question 13

cytomegalovirus–maternal manifestations

Answer 13

• usually asymptomatic
• mononucleosis like illness

Question 14

cytomegalovirus–neonatal manifestations

Answer 14

• hearing loss
• seizures
• petechial rash
• “blueberry muffin” rash
• periventricular calcifications

Question 15

HIV–modes of maternal transmission

Answer 15

• sexual contact
• needlestick

Question 16

HIV–maternal manifestations

Answer 16

• variable presentation depending on CD4+ cell count

Question 17

HIV–neonatal manifestations

Answer 17

• recurrent infections
• chronic diarrhea

Question 18

Herpes simplex virus-2–modes of maternal transmission

Answer 18

• skin or mucous membrane contact

Question 19

Herpes simplex virus-2–maternal manifestations

Answer 19

• usually asymptomatic
• herpetic (vesicular) lesions

Question 20

Herpes simplex virus-2–neonatal manifestations

Answer 20

• encephalitis
• herpetic (vesicular) lesions

Question 21

syphilis–modes of maternal transmission

Answer 21

• sexual contact

Question 22

syphilis–maternal manifestations

Answer 22

• chancre (primary)
• disseminated rash (2ndary)
  
  • 2 stages likely to result in fetal infection

Question 23

syphilis–neonatal manifestations

Answer 23

• often results in stillbirth, hydrops fetalis
• if child survives, presents with:
  
  • facial abnormalities–notched teeth, saddle nose, short maxilla
  • saber shins
  • CN VIII deafness