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High Yield Points and Vignettes on TORCH infections

Discussion in 'Pediatrics' started by neo_star, Jan 24, 2013.

  1. neo_star

    neo_star Moderator

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    [FONT=&amp]High Yield Points and Vignettes on TORCH infections[/FONT][FONT=&amp]

    frequently board tested and in the heat of the moment...u can miss out on something, which u otherwise could have answered in the middle of a sleep.

    I am making an attempt to highlight the key features in each of these infections that most commonly figure in the stem of the question.


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    1) A child born with microcephaly and chorioretinitis has seziures soon after birth.
    CT shows scattered calcification and hydrocephalus.

    Cause ”“ probably a mother fond of cats and changed kitty litter. These mothers are often asymptomatic during initial infection

    Rx ”“ For baby with risisng or stable ab titer to toxoplasma [/FONT]--> [FONT=&amp] Sulfadiazine + Pyrimethamine[/FONT][FONT=&amp]
    -- Falling ab titer (possibly aquired transplacentally from mother) [/FONT]à[FONT=&amp] no treatment[/FONT][FONT=&amp]

    Note [/FONT]à[FONT=&amp] In congenitally infected kids ocular disease is most common[/FONT][FONT=&amp]

    2) Child has fever and maculopapular rash on chest, palms and soles , rhinitis and hepatosplenomegaly.
    Nasal secretions placed under dark field microscope shows T pallidum

    Rx ”“ iv Penicillin G for 10 days

    3) 2 week old baby develops chorioretinitis , conjunctivitis & vesicular lesions of the mouth and skin.
    Mother had some new vaginal lesions prior to delivery.

    This child has skin, eye & mouth disease of HSV (which is transmitted during vaginal delivery) and is at high risk for developing
    a) HSV meningitis (sym include fever, irritability, lethargy, poor feeding and seizures)
    b) Additionally, the child could develop disseminated disease causing liver dysfunction and DIC

    So start Rx with Acyclovir immediately (without antiviral therapy, disseminated infection is ass with 90% mortality and 90% of those who survive will be mentally
    retarded)

    Note [/FONT]à[FONT=&amp] An infected mother should be counselled regarding the imp of good hand washing and hygeine in prventing transmission to her infant.[/FONT][FONT=&amp]

    4) Baby is born with cutaneous scars, CNS abnormalities, limb hypoplasia and growth retardation

    This infection has occurred during the first trimester & the baby is no more actively shedding varicell zoster. So no need to keep the baby in isolation.

    Take home point [/FONT]à[FONT=&amp] vaccinate all mothers considering pregnancy. [/FONT][FONT=&amp]

    Note [/FONT]à[FONT=&amp] Any infant whose mother develops varicella, 5 days prior to birth to 2 days after birth should receive Varicella Zoster Ig within 4 days after life.[/FONT][FONT=&amp]

    5) CMV vs Toxoplasmosis

    Both congenital lesions cause similar lesions i.e
    - chorioretinitis
    - IUGR
    - liver dysfunction
    - microcephaly
    - intracerebral calcification

    The distinguishing feature is the distribution of intracerebral calcification
    CMV ”“ periventricular (Hint CircuMVentricular)
    Toxoplasmosis ”“ basal ganglia or scattered in other locations of the brain.

    [/FONT][FONT=&amp]Note:[/FONT][FONT=&amp] Babies with congenital CMV continue to shed the virus after birth, so despite protective measures, pregnant (doctors, nurses and other health care staff) should not be exposed to the patients.[/FONT]



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  2. drchandoo

    drchandoo Active member

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    good discussion......made it very easy and informative
     

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