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| | __NOTOC__ |
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| | {{Roseola}} |
| | {{CMG}}:{{AE}}{{DAMI}} |
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| __NOTOC__
| | ==[[Roseola overview|Overview]]== |
| ==Overview== | | |
| TORCH group of infections include: [[toxoplasmosis]], [[Treponema pallidum]] , [[rubella]], [[cytomegalovirus]], [[herpesvirus]], [[hepatitis viruses]], [[human immunodeficiency virus]], and other infections, such as [[varicella]], [[parvovirus B19]], and [[enteroviruses]]. All of these infections affect the fetus and can cause significant [[morbidity]] and [[mortality]]. Most of the infections can reach the fetus via the [[transplacental route]] or by ascending infection. The timing of infection varies with individual infections to cause severe damage. Most of the infections can result in [[misscarriage]] or fetal demise or severe clinical manifestations in the [[newborn]]. The infections can compromise normal development during infancy and have poor development. Therefore, early diagnosis and treatment plays an important role in the management of these infections to improve outcomes in the [[newborn]].
| | ==[[Roseola historical perspective|Historical Perspective]]== |
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| | ==[[Roseola classification|Classification]]== |
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| | ==[[Roseola pathophysiology|Pathophysiology]]== |
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| | ==[[Roseola causes|Causes]]== |
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| | ==[[Roseola differential diagnosis|Differentiating Any Disease from other Diseases]]== |
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| | ==[[Roseola epidemiology and demographics|Epidemiology and Demographics]]== |
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| | ==[[Roseola risk factors|Risk Factors]]== |
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| | ==[[Roseola screening|Screening]]== |
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| | ==[[Roseola natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| ==Causes== | | ==Diagnosis== |
| The TORCH group of infections include bacteria, parasites and viruses:
| | [[Roseola history and symptoms|History and Symptoms]] | [[Roseola physical examination|Physical Examination]] | [[Roseola laboratory findings|Laboratory Findings]] | [[Roseola electrocardiogram|Electrocardiogram]] | [[Roseola chest x ray|Chest X Ray]] | [[Roseola CT|CT]] | [[Roseola MRI|MRI]] | [[Roseola echocardiography or ultrasound|Echocardiography or Ultrasound]] | [[Roseola other imaging findings|Other Imaging Findings]] | [[Roseola other diagnostic studies|Other Diagnostic Studies]] |
| *[[Congenital Toxoplasmosis]] is caused by coccidian parasite [[Toxoplasma gondii]]
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| *[[Congenital syphliis]] is caused by [[Treponema pallidum]]
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| *[[Congenital Varicella syndrome]] is caused by [[Varicella zoster virus]]
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| *[[Congenital rubella syndrome]] is caused by [[Rubella virus]]
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| *[[Congenital CMV]] is caused by [[Cytomegalovirus]]
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| *[[Neonatal herpes simplex]] is caused by [[HSV-1]] and [[HSV-2]]
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| ==Classification== | | ==Treatment== |
| The TORCH group of infections can be classified based on the causative pathogen into the following :
| | [[Roseola medical therapy|Medical Therapy]] | [[Roseola surgery|Surgery]] | [[Roseola primary prevention|Primary Prevention]] | [[Roseola secondary prevention|Secondary Prevention]] | [[Roseola cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Roseola future or investigational therapies|Future or Investigational Therapies]] |
| *'''Viral causes:''' [[cytomegalovirus]], [[hepatitis B]], [[hepatitis C]], [[human immunodeficiency virus]], [[parvovirus B19]], [[herpes virus]], [[varicella zoster virus]], [[rubella virus]]
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| *'''Bacterial causes :''' [[Treponema pallidum]]
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| *'''Parasite causes:''' [[Toxoplasma gondii]]
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| ==Differential Diagnosis== | | ==Case Studies== |
| {|
| | [[Roseola case study one|Case #1]] |
| |-style="background: #4479BA; color: #FFFFFF; text-align: center;"
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| ! rowspan="1" |Diseases
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| ! colspan="1" |Causative Organism
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| ! colspan="1" |Transmission
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| ! colspan="1" |Timing of Infection
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| ! rowspan="1" |Symptoms in the Mother
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| ! rowspan="1" |Clinical features in the newborn
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| ! rowspan="1" |Classification
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| ! rowspan="1" |Diagnosis
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| ! rowspan="1" |Treatment
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| |-style="background: #4479BA; color: #FFFFFF; text-align: center;"
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| |-
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| |style="background: #DCDCDC; padding: 5px; text-align: center;" | [[Congenital Syphilis]]
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| |style="background: #F5F5F5; padding: 5px;" |[[Treponema Pallidum]]
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| |style="background: #F5F5F5; padding: 5px;" |Vertical
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| |style="background: #F5F5F5; padding: 5px;" |16th to 28th week
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| |style="background: #F5F5F5; padding: 5px;" |Based on the stage of [[Syphilis]] infection
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| |style="background: #F5F5F5; padding: 5px;" |
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| *[[Low birth weight]]
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| *Non-immune [[Hydrops]]
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| *[[Maculopapular]] or [[Vesicobullous]] [[rash]] on the palms and soles
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| *Interstitial [[Keratitis]]
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| *[[Rhinitis]]
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| |style="background: #F5F5F5; padding: 5px;" |
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| *Early congenital syphilis
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| *Late congnenital syphilis
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| *Stigmata
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| |style="background: #F5F5F5; padding: 5px;" |
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| *Detection of [[IgM]] aganist [[T.pallidum]] in [[blood]] collected in [[chordocentesis]]
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| *[[Amniotic fluid]] [[PCR]] for [[T. pallidum]] [[DNA]]
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| *Antenatal [[Ultrasound]]
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| |style="background: #F5F5F5; padding: 5px;" |
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| *Aqueous crystalline [[penicillin G]]
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| |-
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| |style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Congenital Toxoplasmosis]]
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| |style="background: #F5F5F5; padding: 5px;" |[[ Toxoplasma gondii | Toxoplasma gondii]]
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| |style="background: #F5F5F5; padding: 5px;" |Vertical
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| |style="background: #F5F5F5; padding: 5px;" |[[Third Trimester]]
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| |style="background: #F5F5F5; padding: 5px;" |
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| *Majority : Asymptomatic
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| *Few patients can have [[flu]] like symptoms
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| |style="background: #F5F5F5; padding: 5px;" |
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| *[[Low birth weight]]
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| *[[Chorioretinitis]]
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| *[[Microcephaly]]
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| *[[Intracranial calcification]]
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| *Spasticities and Paresis
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| *[[Sensorineural hearing loss]]
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| |style="background: #F5F5F5; padding: 5px;" | None
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| |style="background: #F5F5F5; padding: 5px;" |
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| *[[Amniotic fluid]] [[PCR]] for [[T.gondii]] [[DNA]]
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| *Detection of [[parasite]] in [[amniotic fluid]]
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| *[[Serology]]
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| |style="background: #F5F5F5; padding: 5px;" |
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| *Infected mothers without [[fetal]] infection : [[Spiramycin]]
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| *Infected mothers with established [[fetal]] infection : [[Pyrimethamine]], [[sulfadiazine]], and [[folinic acid]]
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| |-
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| |style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Congenital Varicella Syndrome]]
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| |style="background: #F5F5F5; padding: 5px;" |[[Varicella zoster virus]]
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| |style="background: #F5F5F5; padding: 5px;" |Vertical
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| |style="background: #F5F5F5; padding: 5px;" |13 to 20th week
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| |style="background: #F5F5F5; padding: 5px;" |
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| *Vesicular skin rash
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| *[[Fever]]
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| |style="background: #F5F5F5; padding: 5px;" |
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| *Cicatrical skin lesions
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| *Limb hypoplasia
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| *[[Microcephaly]]
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| *[[Autonomic instability]]
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| *[[Chorioretinitis]]
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| *[[Microphalmia]] and [[anisocoria]]
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| |style="background: #F5F5F5; padding: 5px;" |None
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| |style="background: #F5F5F5; padding: 5px;" |
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| *[[Antenatal Ultrasound]]
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| *Fetal [[MRI]]
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| *[[Amniotic fluid]] [[PCR]] for [[VZV]] [[DNA]]
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| |style="background: #F5F5F5; padding: 5px;" |
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| *Termination of [[pregnancy]] with severe defects
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| *No definitive treatment
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| *Preconceptional [[vaccination]]
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| |-
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| |style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Congenital CMV]]
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| |style="background: #F5F5F5; padding: 5px;" |[[Cytomegalovirus]]
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| |style="background: #F5F5F5; padding: 5px;" |Vertical
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| |style="background: #F5F5F5; padding: 5px;" |[[First trimester]]
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| |style="background: #F5F5F5; padding: 5px;" |
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| *[[Fever]]
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| *[[Cervical lymphadenopathy]]
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| |style="background: #F5F5F5; padding: 5px;" |
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| *[[Small for gestational age|SGA]]
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| *[[Microcephaly]]
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| *[[Sensorineural hearing loss]]
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| *[[Cataracts]]
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| *[[Petechiae]] and [[purpura]]
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| *[[Jaundice]]
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| *Poor sucking when feeding
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| *[[Hypotonia]]
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| |style="background: #F5F5F5; padding: 5px;" |
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| *Symptomatic
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| *Asymptomatic
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| |style="background: #F5F5F5; padding: 5px;" |
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| *[[Antenatal Ultrasound]]
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| *[[Amniotic Fluid]] [[PCR]] for [[CMV]] [[DNA]]
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| *[[CT]] [[brain]]
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| |style="background: #F5F5F5; padding: 5px;" |
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| *IV [[Ganciclovir]]
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| *Oral [[Valganciclovir]]
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| |-
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| |style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Congenital Rubella Syndrome]]
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| |style="background: #F5F5F5; padding: 5px;" |[[Rubella]] Virus
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| |style="background: #F5F5F5; padding: 5px;" |Vertical
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| |style="background: #F5F5F5; padding: 5px;" |8 to 10th week
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| |style="background: #F5F5F5; padding: 5px;" |
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| *Asymptomatic
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| *[[Maculopapular rash]] starting on the [[face]] and spreads caudally
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| *[[Polyarthalgia]]
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| |style="background: #F5F5F5; padding: 5px;" |
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| *[[Low birth weight]]
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| *[[VSD]] and [[PDA]]
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| *[[Cataracts]], [[glacoma]], [[retinopathy]]
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| *[[Sensorineural hearing loss]]
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| *[[Microcephaly]]
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| *[[Encephalitis]]
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| |style="background: #F5F5F5; padding: 5px;" |None
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| |style="background: #F5F5F5; padding: 5px;" | | |
| * Direct isolation of the [[virus]]
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| * [[Viral]] [[nucleic acid]] quantification
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| * Detection of [[IgM]]/ [[IgA]] [[antibodies]] in [[fetal]] [[blood]]
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| *[[Serological Testing]]
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| |style="background: #F5F5F5; padding: 5px;" |
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| *Termination of pregnancy: If infection diagnosed before 18 weeks of [[pregnancy]]
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| *No definitive Treatment
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| |-
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| |style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Neonatal Herpes Simplex]]
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| |style="background: #F5F5F5; padding: 5px;" |[[HSV-1]] and [[HSV-2]]
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| |style="background: #F5F5F5; padding: 5px;" |
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| *Direct Contact / Ascending infection from genital lesions
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| *Contact with infected people
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| *Vertical
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| |style="background: #F5F5F5; padding: 5px;" |At [[term]]
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| |style="background: #F5F5F5; padding: 5px;" |
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| *[[Genital herpes]] or [[Orolabial herpes]]
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| |style="background: #F5F5F5; padding: 5px;" |
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| *Vesicular skin lesions
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| *[[Oral ulcers]]
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| *[[Chorioretinitis]] and [[conjunctival erythema]]
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| *[[Encephalitis]]
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| *[[DIC]]
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| *[[Pneumonitis]]
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| |style="background: #F5F5F5; padding: 5px;" |
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| *Skin, eye, mouth disease (SEM)
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| *[[CNS]] Disease
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| *Disseminated Disease
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| |style="background: #F5F5F5; padding: 5px;" |
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| *Surface Cultures
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| *[[CSF]] analysis
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| *Elevated [[Alanine Transaminase]]
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| |style="background: #F5F5F5; padding: 5px;" |
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| *SEM : IV [[Acyclovir]] for 10 days
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| *Disseminated and [[CNS]] disease: IV [[Acyclovir]] for 14 to 21 days
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| |}
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