TORCHES, rashes of childhood, and unimmunized children

Question 1

Non-specific signs common to many TORCHES infections (4)

Answer 1

Hepatosplenomegaly
Jaundice
Thrombocytopenia
Growth retardation

Question 2

Transmission of toxoplasmosis

Answer 2

Cat feces

ingestion of undercooked meat

Question 3

Maternal manifestations of toxoplasmosis

Answer 3

Usually asymptomatic

Sometimes lymphadenopathy

Question 4

Neonate manifestations of toxo

Answer 4

Triad: chorioretinitis, hydrocephalus, “multiple ring-enhancing lesions on CT”

Question 5

Names the TORCHES infections

Answer 5

Toxoplasma
Rubella
CMV
HIV
HSV 2
Syphilis

Question 6

Which TORCHES infections are screened for? Which aren’t?

Answer 6

Screen for rubella, HIV, HSV, and syhpilis

Do NOT screen for Toxo or CMV

Question 7

Transmission of rubella

Answer 7

Respiratory droplets

Vertically from mother from 1 month prior to conception through 2nd term

Question 8

Maternal manifestations of rubella

Answer 8

Rash, lymphadenopathy, and arthritis

Question 9

Neonate manifestation of rubella

Answer 9

Triad: PDA (or pulmonary artery hypoplasia, or any form of congenital heart disease), cataracts, and deafness
+/- blueberry muffin rash

Question 10

CMV transmission

Answer 10

Sexual contact, organ transplants, or infected secretions

Question 11

Maternal CMV

Answer 11

90% are asymptomatic

Mono-like symptoms

Question 12

Neonatal CMV

Answer 12

Periventricular calcifications
Chorioretinitis
Hearing loss
Petechiae

Question 13

Transmission of HIV

Answer 13

Sexual contact, infected secretions, needlestick

Question 14

Neonate HIV

Answer 14

Recurrent infections

Chronic diarrhea

Question 15

HSV 2 transmission

Answer 15

Skin or mucous membrane contact

Question 16

Neonatal HSV 2
Week 1
Week 2
Week 3

Answer 16

Week 1: Shock and DIC
Week 2: Vesicular skin lesions
Week 3: Encephalitis (33%)

Question 17

Syphilis transmission

Answer 17

Sexual contact

Question 18

Maternal syphilis

Answer 18

1º and 2º are mostly likely stages to result in fetal infection

Question 19

Neonate syphilis

Answer 19

Rash on pals and soles
Snuffles
Often causes stillbirth or hydrops fetalis
Facial abnormalities (notched teeth, saddle nose, short maxilla)
Saber shins
CN VIII deafness

Question 20

Vesicular rash on palms and soles
Vesicles and ulcers on oral mucosa

Cause and associated disease

Answer 20

Coxsackievirus A

Hand foot and mouth disease

Question 21

Macular rash over body appears after several days of high fever.
Can present with febrile seizures.
Usually affects infants

Cause and associated disease

Answer 21

HHV-6

Roseola

Question 22

Rash that begins at head and moves downward

Rash is preceded by cough, coryza, conjunctivitis, and blue-white spots on buccal mucosa

Answer 22

Measles virus

Rubeola

Question 23

“slapped cheek” rash on face.

Can cause hydrops fetals in pregnant women

Answer 23

Parvovirus B19
Erythema infectiosum (5th disease)

Question 24

Rash begins at head and moves downward.
Fine truncal rash
Post-auricular lymphadenopathy

Answer 24

Rubella virus

rubella

Question 25

Erythematous, sandpaper-like rash with fever and sore throat

Answer 25

Streptococcus pyogenes | Scarlet fever

Question 26

Vesicular rash that begins on trunk; spreads to face and extremities with lesions of different ages

Answer 26

VZV | Chickenpox

Question 27

Causes meningitis. The microbe colonizes the oropharynx

Answer 27

HiB

Question 28

Causes meningitis. Microbe may also lead to myalgia and paralysis

Answer 28

Poliovirus

Question 29

Fever with dysphagia, drooling, and difficulty breathing

Answer 29

HiB-> epiglottitis | look for "cherry red" epiglottis

Question 30

The diphtheria toxin does what that is considered truly deadly?

Answer 30

Elaborates the toxin that causes necrosis in the pharynx, cardiac, and CNS tissue

Question 31

Best initial test for Toxo? | Most accurate test for Toxo?

Answer 31

1. Elevated IgM to toxoplasma | 2. Most accurate is PCR to toxo

Question 32

Best initial test for syphilis? | Most accurate test for syphilis?

Answer 32

1. initial: VDRL or RPR | 2. accurate: FTA ABS or dark field microscopy

Question 33

Rubella testing (1)

Answer 33

Maternal IgM status

Question 34

CMV initial test | Most accurate CMV test

Answer 34

1. initial: urine or saliva viral titers | 2. accurate: urine of saliva for PCR for viral DNA

Question 35

Herpes: initial and most accurate

Answer 35

1. initial: Tzanck smear | 2. accurate: PCR