Congenital Infections of the Newborn| | | | | | | Table 2-1 Congenital Infections of the Newborn | | | Infection | | Clinical Findings | | Extracutaneous Findings | | Important Points | | | Cytomegalovirus
(CMV) | | Petechiae, purpura, vesicles, and “blueberry muffin” lesions
(Blueberry muffin lesions: red-blue papules/nodules due to dermal erythropoiesis) | | Intrauterine growth retardation, chorioretinitis, intracranial calcification | | ⇒ Leading infectious cause of deafness and mental retardation
⇒ Typical findings on histology: enlarged endothelial cells with intranuclear inclusions | | | Herpes Simplex
Virus
(HSV) | | Localized or disseminated skin lesions (vesicles, erosions, scarring) | | Encephalitis (predilection for temporal lobes), multi-organ failure, ocular infection | | ⇒ Majority HSV2, 85% acquired perinatally
⇒50–75% mortality if left untreated | | | Rubella | | “Blueberry muffin” lesions | | Cataracts, deafness, congenital heart disease, CNS findings (microcephaly, hydrocephaly), hepatosplenomegaly (HSM) | | ⇒ 50% chance of deafness
⇒ Severe birth defects if within first 16 weeks of pregnancy
⇒ Non-immune pregnant woman transfer the virus to the fetus | | | Toxoplasmosis | | “Blueberry muffin” lesions favoring the trunk | | Ocular abnormalities (chorioretinitis, blindness), CNS abnormalities (deafness, mental retardation, seizures), thrombocytopenia, intracranial calcification | | | | | Varicella | | Cicatricial skin lesions | | Ocular abnormalities (chorioretinitis, cataracts), cortical atrophy, psychomotor retardation, hypoplastic limbs | | ⇒ Greatest risk in first 20 weeks
⇒ 2% risk of embryopathy in women with infection within first two trimesters | | | Syphilis, Early
Congenital | | Syphilitic pemphigus, rhagades (radial furrows/fissures in perioral area, turn into parrot lines), papulosquamous macules/papules (like secondary syphilis) | | Snuffles (rhinitis, secondary to ulcerated mucosa), enlarged lymph nodes and spleen, neurosyphilis
(Be able to differentiate early and late congenital syphilis findings) | | ⇒ Early congenital syphilis occurs from birth to 2 years of age
⇒ Only congenital syphilis may show bullous lesions
⇒ Papulosquamous lesions common in the diaper area | | | Syphilis, Late
Congenital | | Hutchinson’s teeth, Higoumenakis sign, mulberry molars, saddle nose, saber shins, parrot lines and furrows | | Interstitial keratitis, gummas along long bones/skull, tabes dorsalis, generalized paresis | | ⇒ Includes permanent sequelae of early congenital signs
⇒ Higoumenakis sign: congenital thickening of the medial aspect of the clavicle | | | | | | | | | |
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| | | | | | | Table 2-1 Congenital Infections of the Newborn | | | Infection | | Clinical Findings | | Extracutaneous Findings | | Important Points | | | Cytomegalovirus
(CMV) | | Petechiae, purpura, vesicles, and “blueberry muffin” lesions
(Blueberry muffin lesions: red-blue papules/nodules due to dermal erythropoiesis) | | Intrauterine growth retardation, chorioretinitis, intracranial calcification | | ⇒ Leading infectious cause of deafness and mental retardation
⇒ Typical findings on histology: enlarged endothelial cells with intranuclear inclusions | | | Herpes Simplex
Virus
(HSV) | | Localized or disseminated skin lesions (vesicles, erosions, scarring) | | Encephalitis (predilection for temporal lobes), multi-organ failure, ocular infection | | ⇒ Majority HSV2, 85% acquired perinatally
⇒50–75% mortality if left untreated | | | Rubella | | “Blueberry muffin” lesions | | Cataracts, deafness, congenital heart disease, CNS findings (microcephaly, hydrocephaly), hepatosplenomegaly (HSM) | | ⇒ 50% chance of deafness
⇒ Severe birth defects if within first 16 weeks of pregnancy
⇒ Non-immune pregnant woman transfer the virus to the fetus | | | Toxoplasmosis | | “Blueberry muffin” lesions favoring the trunk | | Ocular abnormalities (chorioretinitis, blindness), CNS abnormalities (deafness, mental retardation, seizures), thrombocytopenia, intracranial calcification | | | | | Varicella | | Cicatricial skin lesions | | Ocular abnormalities (chorioretinitis, cataracts), cortical atrophy, psychomotor retardation, hypoplastic limbs | | ⇒ Greatest risk in first 20 weeks
⇒ 2% risk of embryopathy in women with infection within first two trimesters | | | Syphilis, Early
Congenital | | Syphilitic pemphigus, rhagades (radial furrows/fissures in perioral area, turn into parrot lines), papulosquamous macules/papules (like secondary syphilis) | | Snuffles (rhinitis, secondary to ulcerated mucosa), enlarged lymph nodes and spleen, neurosyphilis
(Be able to differentiate early and late congenital syphilis findings) | | ⇒ Early congenital syphilis occurs from birth to 2 years of age
⇒ Only congenital syphilis may show bullous lesions
⇒ Papulosquamous lesions common in the diaper area | | | Syphilis, Late
Congenital | | Hutchinson’s teeth, Higoumenakis sign, mulberry molars, saddle nose, saber shins, parrot lines and furrows | | Interstitial keratitis, gummas along long bones/skull, tabes dorsalis, generalized paresis | | ⇒ Includes permanent sequelae of early congenital signs
⇒ Higoumenakis sign: congenital thickening of the medial aspect of the clavicle | | | | | | | | | |
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