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Old 08-23-2012
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Heart Which congenital disease does this child have?

A 24-year-old Caucasian mother, who was G5P2TAb3, gave birth to a female neonate in the emergency department. The baby was born at 25 weeks of gestation. Her Apgar scores were 1/5. The infant had multiple fetal anomalies, including: hydrocephalus, with dilation of the lateral and the 3rd ventricles, lymphocytosis (78%), peri-ventricular leukomalacia with microcalcifications, and respiratory distress. The maternal history was significant for a “viral” infection at 12-13 weeks of gestation. The mother experienced 2-3 days of fever, tender lymphadenopathy of posterior and anterior cervical nodes for 2 weeks, myalgia, and a 2-3 day rash on the trunk, face, and extremities. The mother had received a measles, mumps and rubella (MMR) vaccination in childhood. A TORCH titer (performed on the baby’s serum) was positive for Cytomegalovirus (CMV) immunoglobulin (Ig)G. Five days after birth, given the severe brain injury, all support was withdrawn at the parents’ request, and the patient expired. What was the best diagnosis?

a) Congenital cytomegalovirus infection
b) Congenital herpes simplex
c) Congenital rubella
d) Congenital syphilis
e) Congenital toxoplasmosis
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Old 08-23-2012
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Ee...triad of hydrocephalus,intracranial calcification & retinitis
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Old 08-23-2012
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i'll go with e) congenital toxo
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Old 08-23-2012
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Default Thats why i hate microbiology

mother 12-13 infection: "experienced 2-3 days of fever, tender lymphadenopathy of posterior and anterior cervical nodes for 2 weeks, myalgia, and a 2-3 day rash on the trunk, face, and extremities"
These symptoms are consistent with rubella infection (but she had her MMR vaccine)

Child infection: hydrocephalus, retinitis, calcification= indicates congenital toxoplasmosis.

test reveals: CMV

Now someone in this world tell me what should i choose.
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One day i will infect these microbes and they will search for "Anti-MEbiotic"....
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Old 08-24-2012
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I'm jumping in, bitches:

a) Congenital cytomegalovirus
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Old 08-24-2012
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Default correct answer

The answer is e) Congenital toxoplasmosis

The clinical presentation is similar to CMV, with peri-ventricular necrosis and microcalcification. The mother’s symptoms in the first trimester of pregnancy are compatible with acute toxoplasmosis.

Option A (Congenital cytomegalovirus infection) is incorrect. TORCH titers are performed on the mother’s serum, to assess whether she has had any of the diseases in question. Positive IgG antibodies mean that the baby cannot have the disease, because the mother is immune. The positive titer on the baby’s serum is simply transplacental transfer of materal CMV IgG to the baby. It is meaningless.

Option B (Congenital herpes simplex) is incorrect. Herpes is acquired in the peri-natal period, after passage through the birth canal. A typical herpes infection, include vesicle formation on the skin, is more typical, though pneumonia may occur. Option C (Congenital rubella) is incorrect. The mother had received the MMR vaccine in childhood, thus ruling out congenital rubella.
Option D (Congenital syphilis) is incorrect. The presentation is not typical of syphilis, which often include deformities of the teeth and nose.
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