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Which of the following is NOT a component of Hutchinson's triad?
Saber shin refers to the bowing of the tibia.
True
What is the primary vector for Congenital Zika Virus Infection?
Aedes aegypti
A 4-fold increase in titres of __________ is diagnostic in the diagnosis of Torch infections.
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Match the clinical feature with its description related to Congenital Zika Virus Infection:
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What is the causative agent of Erythema Infectiosum?
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Erythema Infectiosum typically affects children younger than 5 years.
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What is a common clinical feature seen during the prodromal stage of Erythema Infectiosum?
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The rash in Erythema Infectiosum has a __________ appearance in its central clearing stage.
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Match the following complications of Erythema Infectiosum with their descriptions:
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What is the period of highest risk for congenital varicella syndrome?
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Congenital syphilis is most commonly associated with recurrent abortion.
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Name one clinical feature of congenital varicella syndrome.
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The first feature of congenital syphilis in early onset is __________.
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Match the following features with their corresponding condition:
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Which of the following is NOT a clinical feature of Roseola Infantum?
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Chicken pox is caused by Coxsackie A16.
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What is the most common complication associated with Hand, Foot and Mouth Disease?
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The main causative agent of Roseola Infantum is ________.
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Match the disease with its key feature:
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What is the classical appearance of a varicella rash?
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Secondary attack rate of varicella is approximately 80%.
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What antiviral medication is recommended for treating varicella?
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The ______ vaccine is a live attenuated Oka strain used for prevention of varicella.
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Match the complications of varicella with their descriptions:
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Which of the following infections is part of the TORCH complex?
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Congenital Rubella Syndrome (CRS) often leads to sensorineural hearing loss.
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What is the most common antenatal manifestation of TORCH infections?
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TORCH infections include Toxoplasmosis, Rubella, __________, Cytomegalovirus, and Herpes simplex.
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Match the congenital defects with their association to Congenital Rubella Syndrome:
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What is the most common ocular finding associated with rubella infection?
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Congenital cytomegalic inclusion disease is most commonly associated with infection during the first trimester.
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What chronic manifestation can develop in children after a rubella infection?
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Fetal IgM antibodies against rubella are used for ________ diagnosis.
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Match the following features with their descriptions:
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What is the most sensitive period for transmission of Congenital Parvovirus B19?
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Microcephaly is a potential limb manifestation associated with childhood infections.
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What severe condition can arise due to severe anemia during a Congenital Parvovirus B19 infection?
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The flow of B19 originates from the bone marrow, passes through the liver, and then affects the __________.
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Match the conditions with their respective characteristics:
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Which of the following is NOT a clinical feature of congenital toxoplasmosis?
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Ganciclovir treatment for TORCH infections lasts for a total of 6 months.
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What is the most common long-term sequelae associated with TORCH infections?
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The triad of clinical features for congenital toxoplasmosis includes hydrocephalus, chorioretinitis, and __________.
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Match the following clinical features with their associated infections:
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Which of the following is a complication of post streptococcal infections?
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Rubella is caused by a bacteria.
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What mode of spread is associated with Rubella?
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The infectivity period for rubella is ____ days before to ____ days after the onset of rash.
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Match the following clinical features of Rubella with their descriptions:
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Study Notes
Late Onset Torch Infections
- Hutchinson's Triad: Syphilis infection after 2 years of age, characterized by Sensorineural Hearing Loss (SNHL), Interstitial Keratitis, and Hutchinson's Teeth.
- Mulberry Molars: Irregular surface of molars with rudimentary cups, typically affecting the first molar.
- Deformed Nose: Saddle nose deformity precedes notching of incisors, peg-shaped incisors, perforations, and deformed nose caused by bony deformities.
- Rhagodes: Fissures around the mouth and nose.
- Saber Shin: Bowing of the tibia.
- Clutton's Joint: Bilateral knee effusion caused by Syphilis.
Management of Torch Infections
- Diagnosis: VDRL (Venereal Disease Research Laboratory) test for both baby and mother.
- Diagnostic Criteria: A four-fold increase in VDRL titres confirms a diagnosis of Syphilis.
- Treatment: Aqueous crystalline penicillin or Penicillin G is the preferred treatment, followed by 3rd generation cephalosporins such as Ceftriaxone.
Congenital Zika Virus Infection
- Transmission: Occurs through the Aedes aegypti mosquito.
- Period of Risk: The first trimester of pregnancy.
- Transmission: Infected mothers transmit the virus to their unborn babies.
Congenital Zika Virus Infection: Skull Manifestations
- Skull Abnormalities: Partial collapse of the skull and internal abnormalities like overlapping of sutures.
- Brain Damage: Microcephaly, Hypertonia/Spasticity, and Extrapyramidal manifestations including choreoathetosis.
- Other Features: Damage to the basal ganglia and occipital prominence.
Erythema Infectiosum (Fifth Disease)
- Etiology: Parvovirus B19 (single-stranded DNA virus).
- Incubation Period: 4 to 28 days.
- Age Group: Primarily affects children over 5 years old
Erythema Infectiosum: Clinical Features
- Prodromal Stage: Fever lasting for 1-2 days.
- Exanthematous Phase: Slapped-cheek appearance facial flushing (Stage 1), followed by diffuse macular erythema spreading to the trunk and extremities (Stage 2). The rash then develops central clearing giving a lacy/reticulated appearance (Stage 3).
Erythema Infectiosum: Associations
- Arthralgia: Affects older children.
- Transient Aplastic Crisis: Occurs in individuals with pre-existing hemolytic anemia and parvovirus B19 infection. Presents with pancytopenia.
- Infection in the Mother (During Pregnancy): Associated with fetal hydrops and fetal death.
Erythema Infectiosum: Complications
- Post-Infectious Thrombocytopenia (PRP): Develops 2-3 weeks after infection and is usually self-limiting.
- Arthritis: Common in older children.
- Progressive Rubella Panencephalitis (PRP): Most severe complication, presents with features similar to subacute sclerosing panencephalitis (SSPE).
Erythema Infectiosum: Management
- Good Prognosis: Supportive management with good prognosis.
Congenital Varicella Syndrome (Congenital Chickenpox)
- Transmission: Intrauterine transmission of varicella zoster virus.
- Period of Risk: Occurs during the third trimester (13 to 20 weeks of gestation), with the highest risk period being 5 days before to 2 days after delivery.
- Clinical Features: Cerebral atrophy, Microcephaly, Limb hypoplasia, and scarring (irregular scarring similar to burn scars).
- Management: IV immunoglobulin (Ig) is administered immediately after birth for prevention, and acyclovir is given if lesions are present.
Congenital Syphilis (Congenital Treponema Pallidum Infection)
- Unique Feature: Recurrent abortion.
- Period of Risk: Greater than 4 months of gestation (2nd and 3rd trimesters).
- Clinical Features:
- Early Onset (< 2 years): Rhinitis (Snuffles) is the first feature, followed by bone metaphysis, osteochondritis, and periostitis.
- Severe Syphilis: Bone pain and edema of affected limb, pseudo paralysis.
- Vesiculobullous rash seen in palms and soles.
- Pemphigus syphiliticus (blistering rash).
Roseola Infantum (Exanthema Subitum, Sixth Disease)
- Etiology: Human herpes virus (HHV) 6 and 7, and echovirus 16.
- Age Group: Affects children between 6 months and 3 years old.
- Clinical Features:
- Prodromal Stage (1-4 days): Fever, Cough, and Running nose.
- Exanthematous Phase (On day 4): Maculopapular rash starting in the trunk, fever intensity decreases after the rash appears, no residual pigmentation.
- Exanthem: Nagayama spots (erythematous macules in the soft palate and uvula) can be observed.
Roseola Infantum: Treatment and Prognosis
- Treatment: Supportive care.
- Prognosis: Good prognosis.
Hand, Foot, and Mouth Disease (HFMD)
- Age Group: Preschoolers (< 5 years old).
- Causative Agent: Coxsackie A16 and Enterovirus 71.
- Mode of Spread: Direct contact or through infected fomites (e.g., used towels).
- Clinical Features: Fever, Vesicles that resolve within 4-5 days.
- Treatment: Supportive care.
- Common Complication: Temporary loss of nails 4 weeks after initial infection.
Varicella (Chickenpox)
- Causative Agent: Varicella-zoster virus (double-stranded DNA virus).
- Incubation Period: 10-21 days.
- Mode of Spread: Droplet spread.
- Infective Period: 24-48 hours before the onset of the rash.
- Secondary Attack Rate: 80%.
Varicella: Clinical Features
- Fever: Fever on day 2, lasting for 3-5 days.
- Rash: Macule to papule to vesicle (classical rash) that is pruritic and starts in the trunk, spreading to other areas. Leaves behind hypo/hyperpigmented macules. Pleomorphic appearance ("dew drop on a rose petal" appearance).
Varicella: Complications
- Secondary Bacterial Infection of Skin Lesion: Staphylococcus aureus and Streptococcus pyogenes.
- Neurological: Cerebellar ataxia, meningo-encephalitis.
- Reye's Syndrome: Associated with aspirin usage during varicella infection.
- Hepatic Encephalopathy.
Varicella: Diagnosis
- Primarily clinical.
- Tzanck Smear: Lesion is scrapped and examined microscopically, revealing multinucleated giant cells, but this method has poor sensitivity.
- Serology: Anti-IgM antibodies against varicella.
Varicella: Treatment
- Antipyretics: Paracetamol.
- Antiviral: Acyclovir (20 mg/kg/dose x 4 times/day). Start within 48 hours of onset. Ibuprofen should be avoided due to an increased risk of necrotizing fasciitis.
Varicella: Prevention
- Varicella Vaccine: Live attenuated Oka strain. Two doses are given subcutaneously. The first dose is administered at 15-18 months of age and the second dose at 4-6 years of age.
- Post-Exposure Prophylaxis (VZIG): For high-risk contacts, including:
- Immunocompromised children.
- Pregnant women.
- Neonate born to a mother who was affected (5 days before to 2 days after delivery).
TORCH Infections
- Transmitted intrauterine infections from mother to baby.
- Includes: Toxoplasmosis, Other (Syphilis, Zika virus, Parvo B19 virus), Rubella, Cytomegalovirus (CMV), Herpes simplex.
General Aspects of TORCH Infections
- Primary Infection: The mother is infected during pregnancy, leading to mother-to-child transmission.
- Time of Gestation: First trimester infections are most common due to increased risk of congenital anomalies and the highest risk of transmission.
General Aspects of TORCH Infections (Continued)
- Secondary/Reactivation: Latent infection reactivation in the mother during pregnancy.
- Transmission: Transmission of syphilis and CMV.
Common Manifestations of TORCH Infections
- Antenatal: Intrauterine growth restriction (IUGR) is the most common, followed by Intrauterine death (IUD), preterm delivery, and abortions.
Congenital Rubella Syndrome (CRS)
- Severe maturation infection.
Congenital Rubella Syndrome: Clinical Manifestations
- Clinical Triad:
- Heart Defects: Patent ductus arteriosus (PDA), Pulmonary artery stenosis (PS), Ventricular septal defect (VSD).
- Sensorineural hearing loss (SNHL) (most common).
- Cataract.
Congenital Rubella Syndrome: Postnatal Manifestations
- Bone Marrow Suppression: Anemia, thrombocytopenia.
- Hepatosplenomegaly.
- Lymphadenopathy.
- Jaundice or abnormal Liver function Tests (LFTs).
Other features of Congenital Rubella Syndrome
- Salt and Pepper Retinopathy: Black and white spots on the retina, the most common ocular finding.
- Blueberry Muffin Lesion: Purpuric, non-blanching, dome-shaped papules, found in severe CRS. Represents dermal erythropoiesis.
- Non-Specific: Also seen in other intrauterine infections.
Congenital Rubella Syndrome: Chronic Manifestations
- Progressive Rubella Panencephalitis (PRP): Onset during school going age, features similar to subacute sclerosing panencephalitis (SSPE), poor scholastic performance, seizures, and intellectual impairment.
- Adult-Onset Diabetes.
- Hypothyroidism.
Congenital Rubella Syndrome: Diagnosis
- Histology: Fetal IgM antibodies against rubella (Maternal IgM cannot cross the placenta).
- IgG: Not used because maternal IgG can cross the placenta.
Congenital Rubella Syndrome: Management
- No Treatment: Damage is permanent.
- Prevention: Immunization of parents during their childhood.
Congenital Cytomegalovirus (CMV) Infection
- Most common TORCH infection.
- Transmission Rate:
- Third Trimester (90%): Organogenesis is complete, often asymptomatic.
- First Trimester: Organogenesis is incomplete, leading to Congenital Cytomegalic Inclusion Disease.
Congenital CMV: Limb Manifestations
- Small head size (microcephaly).
- Vision and Hearing problems.
- Problems moving limbs and body.
- Brain damage.
- Seizures.
- Problems with feeding (difficulty swallowing).
Congenital CMV: Arthrogryposis Multiplex Congenita
- Coloboma (a gap or split in a normally rounded structure).
- Pigmentary retinal mottling (spots or flecks of pigment on the retina).
- Scarring in the macula of the eye.
Congenital Parvovirus B19 Infection
- Transmission: Across all trimesters of pregnancy.
- Most Sensitive Period: Second trimester.
- Tropism for erythroid lineage: Primarily affecting the pronormoblast stage.
Congenital Parvovirus B19 Infection: Clinical Features
- Severe anemia: Leads to high-output cardiac failure.
Congenital Parvovirus B19 Infection: Diagram of Transmission
- Flowchart depicts the transmission of parvovirus B19 from the bone marrow to the liver, and then to the heart, ultimately resulting in fetal hydrops.
Congenital Parvovirus B19 Infection: Direct Cytopathic effects on the Myocardium
- Myocarditis.
- Fetal cardiac arrest.
- Intrauterine death (IUD).
Post-Streptococcal Complications
- Acute rheumatic fever.
- Post-streptococcal glomerulonephritis (PSGN).
- Post-streptococcal reactive arthritis.
Post-Streptococcal Complications: Management
- Investigations: Throat swab.
- Treatment: Oral penicillin V for 10 days or Amoxicillin for 10 days.
Rubella (German Measles, 3-Day Measles)
- Etiology: Togaviridae (single-stranded RNA virus).
- Incubation Period: 14-21 days.
- Mode of Spread: Respiratory droplets.
- Infectivity period: 5 days before to 6 days after onset of rash.
Rubella: Clinical features
- Rash: The first and most prominent sign, appearing on day 1 without a prodromal stage. Maculopapular rash starts behind the ear/face, spreading downwards. Does not cause desquamation or discoloration after it fades.
- Exanthem:
- Forchheimer spots: Tiny, rose-colored lesions in the oropharynx. - Lymphadenopathy: Involving suboccipital, posterior auricular, and anterior cervical lymph nodes.
Rubella: Clinical Features: (continued)
- Pastia's lines: accentuation of the rash at skin creases.
TORCH Infections: Rubella Clinical Features
- Triad:
- Microcephaly.
- Chorioretinitis.
- Intracranial calcification.
- Other Features:
- Sensorineural Hearing Loss (SNHL): Most common long-term sequelae, the most common cause of non-syndromic hearing loss in children.
- Rash: Petechiae (due to low platelets), Blueberry muffin lesion, and can also be seen in other intrauterine infections.
TORCH Infections: Rubella Diagnosis
- PCR testing: Urine sample is preferred over blood or saliva. Performed as early as possible for screening.
- Serology: IgM antibodies against CMV (Low sensitivity).
TORCH Infections: Rubella Treatment
- Ganciclovir: IV for 6 weeks, followed by oral administration for 6 months. Prevents progression of neurological disorders and reduces the risk of SNHL.
TORCH Infections: Congenital Toxoplasmosis
- Transmission Risk: Highest in the third trimester.
- Clinical Features:
- Triad: Hydrocephalus (unique to toxoplasmosis), Chorioretinitis, and Intracranial calcification.
TORCH Infections: Congenital Toxoplasmosis Diagnosis
- Serology:
- IgM/IgA ELISA (more sensitive)
- Immunosorbent agglutination assay (ISAGA) test.
- PCR in CSF/tissue sample (if neurological involvement is present).
TORCH Infections: Congenital Toxoplasmosis Treatment
- Treatment: All cases, both symptomatic and asymptomatic, should be treated.
- Pyrimethamine + Sulfadiazine for 1 year, along with folinic acid to prevent bone marrow suppression caused by the medication.
TORCH Infections: Congenital Toxoplasmosis Other Manifestations
- Low IQ.
- Deafness (SNHL).
- Microcephaly in some cases.
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Description
Test your knowledge on congenital infections and their clinical features. This quiz covers key components of Hutchinson's triad, diagnosis methods, and various syndromes associated with congenital infections. Prepare to match descriptions and identify clinical signs related to conditions like Erythema Infectiosum and Congenital Zika Virus Infection.
