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Signs herpes outbreak is coming

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Caused by the protozoan called toxoplasma gondii, Toxoplasma is very common parasite found in humans.
When a pregnant woman gets infected with toxoplasma, there is a chance that the infection can be passed to the fetus via the chorionic villi in the placenta. Even with the infection, a good majority (67% of infected fetuses) are born with no symptoms. If the mother is confirmed to be infected with toxoplasma, then treat the mom with spiramycin. Avoid handling cat litter, particularly cats who have access to the outdoors where they may eat infected rodents and small birds.
Wear gloves if you are going to be working in the garden or will be handling soil which may potentially have toxoplasma.
Rubella is spread through respiratory droplets, and the mother who gets it will show upper respiratory tract symptoms, rash that starts on the trunk, lymphadenopathy, and arthritis.
The baby is often born with intrauterine growth restriction (IUGR), meaning they are restricted from growth in the placenta.
Unfortunately there is currently no antiviral treatment available for congenital rubella, and the only thing you can do is give the baby supportive therapy. Rubella, however, is an easy disease to prevent, and anyone who has not been vaccinated with MMR should consider it before getting pregnant.
CMV is transmitted via bodily fluids, which includes sexual contact, organ transplants, blood transfusions, breast milk, saliva, urine, and transplacentally from mother to fetus. Congenital CMV infects up to 40,000 newborns annually in the US but the majority are asymptomatic.
For those who are born with symptoms, you may see intrauterine growth restriction (leading to mental retardation and microcephaly), jaundice, seizures, periventricular calcifications (in brain on CT), hearing loss, petechial rash, pneummonia, hepatosplenomegaly, or psychomotor retardation.
You can diagnose the doing CMV titers (part of TORCH screen) on the newborn baby and confirm with viral cultures from urine or saliva samble from the baby.
To prevent congenital CMV, the pregnant mother should wash hands thoroughly after touching diapers or saliva, and avoid any contact with bodily fluids, particularly from young children who are at more risk of getting CMV. Herpes simplex virus (HSV) comes in two strains, HSV 1 (oral herpes), and HSV 2 (genital herpes). HSV is transmitted via skin or mucous membrane contacts, such as during birth through an infected genital tract.


To diagnose on a neonate, you can take a swab sample from the conjunctivae or oropharynx of the neonate and do a viral culture to detect the virus.
Neonates who have a confirmed diagnosis of HSV should be treated with a full course of intravenous acyclovir.
If you suspect HSV in the mother, or if the mother has a history of HSV, then you should recommend doing a c-section to prevent the fetus from passing through a potentially infected vaginal canal. Unlike other TORCH infections where the infected patient is often asymptomatic, in congenital syphilis, 40% of fetuses get hydrops fetalis and do not make it past birth. Early symptoms (before 2 yrs): Early on, you will find failure to thrive, anemia, maculopapular rash, hepatosplenomegaly, periostitis, and rhinitis. Late symptoms (after 2 yrs): Later on, the patients may develop Hutchinson teeth (notched teeth), saddle nose (from bridge of nose breaking), saber shin (anteriorly-curved tibia), and short maxilla. If the neonate tested positive for syphilis, treat with parenteral penicillin G for 10 days.
To prevent congenital syphilis, screen the expectant mother for syphilis and treat her with penicillin G to minimize transmission to the fetus.
They can infect anytime during gestation, and sometimes during the time of delivery as well. If both the baby and the mom are infected, then treat the mother with pyrimethamine and sulfonamide, which will cross the placenta and treat the fetus as well. Rubella cases in the  US mainly happen in mothers from countries who did not have an MMR vaccination program.
Like all other TORCH infections, the mother may also be asymptomatic yet still have the risk of transmitting the infection to fetuses.
It is often symmetric, meaning both the head and the body are restricted from growing, and this causes the baby to be born with a small head (microcephaly), and therefore mental retardation. For those women who do get the vaccine, they should wait at least 28 days before attempting to get pregnant, since MMR is a live vaccine and your body needs time to build up those antibodies against it. In fact, up to 60% of adults in the US have tested seropositive for it, and like toxoplasma, most people’s immune systems are strong enough to make them asymptomatic. Usually it can transmit from the mother to fetus when the mother has either a primary infection or reactivation of the CMV during pregnancy. Physical and supportive therapy is the only thing you can do at this point, like giving hearing aids, special education, etc.
Women who are confirmed to be infected should get ganciclovir treatment to decrease the risk of spread to the fetus.


HSV 1 can also be found in genital herpes and vice versa, but in terms of congenital HSV, HSV 2 is the more common one you’ll see. Like many TORCH infections, mother who have genital herpes often may not show signs of an outbreak, but still have the risk of transmitting it to the fetus during vaginal birth. Neonates with this presentation have the best survival and usually have no mental retardation or developmental delays. You see meningoencephalitis, seizures, bulging anterior fontanel, poor feeding, and irritability.
You could also do dark field microscopy to detect the bacterium, which is a more accurate test, especially in primary syphilis.
If the neonate tested negative but the mother is postive for untreated syphilis, then treat the baby with a dose of IM benzathine penicillin. Since they can cause mental retardation, morbidity, and even death, they are important to recognize and prevent. But because pyrimethamine and sulfonamide have the adverse effect of bone marrow suppression, you would also want to treat with leukovorin. The mother may have heterophile negative mononucleosis, presenting with fever, sore throat, and fatigue.
So far in my pediatric rotation, I have seen a case of it, and so it is something we will see more as doctors. When other animals outside get contaminated with these feces, then they too catch the infection. Also because there is risk for retinitis, you’d also want to give to refer the baby for an ophthalmic examination for risk for retinitis. Like other TORCH infections, mothers who do not show signs of the infection can still be at risk of passing the infection to their fetuses.
You usually only find symptoms of the infection when people become immunocompromised, like in HIV patients.
Toxoplasma spreads through the blood and eventually encysts in tissue cells permanently (but contained by our immune systems). While humans can get it through handling cat litter, the major cause of transmission in the US and Europe is actually through eating meat containing the cysts, particularly pork, venison, and lamb.



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