Very important documents related health

4. The "other" now also includes:
HIV
VZV
Zika virus
Parvovirus B19
Enteroviruses,
Listeria monocytogenes and
Others

5.  In any case of torch complex
interpretation of results may be
complicated by such factors as:-
1. prior immunization,
2. blood transfusions and
3. the possible acquisition of antibodies
either transplacentally or from a
postnatal infection

6.  Causative Organism-Toxoplasma gondii
 Transmission:-
 Transplacental
 Fecal-oral route
 Oocysts excreted in cat feces
 Found in undercooked meat, contaminated
water/soil, and unpasteurized goat milk
 Risk of fetal infection increases with gestational
age
 Severity of fetal infection decreases with
gestational age

8.  First Trimester-
often results in
death
 Second Trimester-
classic triad
a. Hydrocephalus
b. Intracranial
calcifications
c. Chorioretinitis

11.  Third Trimester- often asymptomatic at birth
 Symptoms may also include:
 Fever
 IUGR,
 Microcephaly
 Seizure
 Hearing loss
 Maculopapular rash
 Jaundice,
 Hepatosplenomegaly
 Anemia, and
 Lymphadenopathy

12.  Definitive - Isolating organism from
placenta, serum, or CSF
 Also available – PCR and lgM titer (lgG will
be elevated if mother is infected
regardless of transmission)

13. 1. Pyrimethamine 2 mg/kg (maximum 50 mg/dose)
once daily for two days; then 1 mg/kg (maximum 25
mg/dose) once daily for six months; then 1 mg/kg
(maximum 25 mg/dose) every other day to complete
one year of therapy, plus
2. Sulfadiazine 100 mg/kg per day divided in two doses
every day for one year, plus
3. Leucovorin 10 mg three times per week during and
once a week after pyrimethamine therapy
4. Infants should be weighed weekly and dosages
adjusted accordingly.
5. Glucocorticoids (Prednisone 0.5 mg twice per day)
are added if CSF protein is> 1 g/dL or when active
chorioretinitis threatens vision.

14.  Causative Organism - Treponema pallidum
 Transmission:-
 Transplacental
 Sexual activity

15.  Majority are symptomatic at birth
 Early Congenital Syphilis (symptoms at 1-2 months of
age)
 Maculopapular rash,
 “Snuffles,"
 Lymphadenopathy,
 Hepatomegaly,
 Thrombocytopenia,
 Anemia,
 Meningitis,
 Chorioretinitis,
 Osteochondritis
 Late congenital Syphilis (symptoms after 2 years of
age)

16.  Hutchinson Teeth
 Mulberry Molars
 Perforated hard palate
 Rhagades (cracks or fissures in the skin
around the mouth)
 Saber Shins
 Sensorineural hearing loss (CN VIII)
 Interstitial Keratitis
 Saddle Nose

22.  Dark field microscopy
 FTA-Abs, RPR, VDRL

23.  Penicillin
 For Infants less than one month, either as a
single dose of benzathine penicillin G (50,000
units/kg, intramuscularly (IM) or as a ten day
course (aqueous penicillin G 50,000 units/kg
intravenously (V) every 12 hours (for
infants<7 days of age) and every 8 hours (for
infants >7 days of age) for a total of 10 days,
or
 Procaine penicillin G 50,000 units/kg
intramuscularly (IM) as a single daily dose for
10 days

24.  For children diagnosed with congenital
syphilis after one month of age (including
those with late congenital syphilis) and
children with acquired syphilis should be
treated with aqueous penicillin G (50,000
units/kg intravenously every four to six hours
for 10 days) however some experts suggest
that the 10-day course of aqueous penicillin
be followed with a single dose of benzathine
penicillin (50,000 units/kg intramuscularly).

25.  Single-dose therapy is contraindicated for
asymptomatic infants born to women with
inadequate/suboptimal treatment unless the
infant has undergone appropriate evaluation
(CSF quantitative VDRL, cell count, and
protein; CBC with differential and platelet
count; and long-bone radiographs) and has
completely normal results

26.  Causative Organism - Togavirus
 Transmission
 Transplacental
 Respiratory secretions

27. “Blueberry Muffin” rash due to extramedullary hematopoiesis

31.  Diagnosis
 Culture from blood, urine, CSF, oral/nasal
secretions
 IgM titer
 Treatment
 Supportive care

32.  Causative Organism-Human herpesvirus 5
 Transmission
 Transplacental
 Perinatal (contact with vagina during delivery or
breast milk after delivery)
 Contact with bodily fluids (urine/saliva)
 Transmission is possible through reactivation of
latent virus (decreased risk of transmission)
 Clinical Manifestations
 Majority are asymptomatic at birth
 Periventricular calcifications

34.  IUGR
 Developmental delay
 Microcephaly,
 Sensorineural hearing loss,
 Retinitis,
 Jaundice,
 Hepatosplenomegaly,
 Thrombocytopenia,
 Hypotonia,
 Lethargy,
 Poor suck
 Preterm infants may appear septic - apnea, bradycardia,
intestinal distension)
 N.B. Postnatal infections are generally asymptomatic

35.  Diagnosis
 Culture (urine or pharyngeal secretions)
 PCR
 Treatment
 Gancyclovir can improve hearing loss and
neurodevelopmental outcomes. 6 mg/kg per
dose administered IV for six weeks
 Supportive care

36.  Causative Organism - Human herpesvirus 1&2
 Transmission
 Perinatal (contact with vagina during
delivery)
 Contact after rupture of membranes
 Direct contact with affected areas

37.  SEM disease (Localized to skin, eyes, and
mucosal)
 Vesicular lesions on an erythematous base

38.  Keratoconjunctivitis, cataracts, chorioretinitis
 Ulcerative lesions of the mouth, palate, and tongue
 CNS disease
 Seizure, lethargy, irritability, tremor, poor feeding.
 temperature instability, full anterior fontanelle
 Disseminated disease
 Multiple organ involvement (CNS, skin, eye, mouth,
lung, liver, adrenal glands)
 May appear septic- fever/hypothermia, apnea,
irritability, lethargy, respiratory distress
 Hepatitis, ascites, direct hyperbilirubinemia,
neutropenia, DIC, pneumonia, hemorrhagic
pneumonitis, necrotizing enterocolitis,
meningoencephalitis, skin vesicles

39.  Seizures
 Psychomotor retardation
 Spasticity
 Blindness
 Learning disabilities
 Autism ????
 Death

40.  Diagnosis
 PCR of CSF, IgM titers, HSV culture of a lesion
 Treatment
 Acyclovir IV at a dose of 60 mg/kg per day IV
divided every eight hours.