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Difficulty: MediumPediatric Infectious Diseases

Correlate the following classic neonatal clinical presentations with their most likely causative congenital infectious agent.

  • A neonate exhibits microcephaly, hepatosplenomegaly, and purpura. Cranial ultrasonography demonstrates periventricular calcifications.Cytomegalovirus
  • A newborn is found to have diffuse scattered intracerebral calcifications, severe bilateral chorioretinitis, and hydrocephalus.Toxoplasma gondii
  • A 14-day-old infant develops profuse blood-tinged rhinorrhea and a maculopapular desquamating rash on the palms and soles.Treponema pallidum
  • An infant is diagnosed with a patent ductus arteriosus, bilateral cataracts, and sensorineural hearing loss.Rubella virus

Answer

The clinical presentations map sequentially to Cytomegalovirus, Toxoplasma gondii, Treponema pallidum, and Rubella virus.
Each major congenital infection has a distinct classic clinical presentation. Cytomegalovirus is identified by periventricular calcifications; Toxoplasmosis is identified by diffuse parenchymal calcifications and hydrocephalus; Syphilis presents with 'snuffles' and a palmar/plantar rash; and Rubella is defined by cataracts, congenital heart defects, and sensorineural deafness.

Step-by-Step Solution

1
Analyze the first clinical presentation.
Identified periventricular calcifications combined with microcephaly.
These neuroimaging and physical findings are the hallmark signs of congenital Cytomegalovirus infection, helping to distinguish it from other congenital pathogens.
2
Evaluate the second clinical presentation.
Identified diffuse intracerebral calcifications and hydrocephalus.
This triad (including chorioretinitis) points directly to congenital Toxoplasma gondii infection, distinguishing its diffuse calcification pattern from the periventricular pattern of CMV.
3
Assess the third clinical presentation.
Identified blood-tinged rhinorrhea and a palmar/plantar rash.
Syphilitic rhinitis ('snuffles') and a rash involving the palms and soles are classic early manifestations of congenital Treponema pallidum infection.
4
Analyze the fourth clinical presentation.
Identified a patent ductus arteriosus, cataracts, and hearing loss.
This classic physical exam triad is pathognomonic for congenital Rubella virus infection.

Key Concept

Differentiating classic presentations of congenital (TORCH) infections
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Topics

Pediatric Infectious Diseases

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