FeatureToxoplasma gondiiRubellaCytomegalovirus (CMV)HIVHSV-2SyphilisStreptococcus (GBS)
Pathogen TypeParasiteVirusVirus (Herpesvirus)Virus (Retrovirus)Virus (Herpesvirus)Bacterium (Treponema pallidum)Bacterium (Streptococcus agalactiae)
Classic Triad/PresentationChorioretinitis, hydrocephalus, intracranial calcificationsCataracts, heart defects, sensorineural hearing lossNo classic triad, but periventricular calcifications, microcephaly, and SNHL are characteristic.No classic triad; failure to thrive, recurrent infections, and developmental delay are commonNo classic triad; skin/mucous membrane lesions, encephalitis, or disseminated infection characterize.Early: “Snuffles,” rash, bone lesions, lymphadenopathy and hepatosplenomegaly; Late: Hutchinson teeth, interstitial keratitis, saddle nose, saber shinsEarly-onset: Respiratory distress, sepsis, pneumonia, meningitis (within first week, usually <24 hrs); Late-onset: Bacteremia, meningitis (after first week)
Other Key DifferentiatorsOften asymptomatic at birth, later chorioretinitis. Linked to cat feces/undercooked meat.”Blueberry muffin” rash, often mild maternal illness. Preventable by MMR vaccine.Most common congenital viral infection. Hearing loss can be late-onset.Opportunistic infections are a hallmark. ART is crucial for prevention.Vesicular lesions (but not always present). Often acquired during birth.Multisystem; early/late manifestations differ. Penicillin is treatment.Leading cause of neonatal sepsis/meningitis. Maternal colonization is key risk factor. Intrapartum antibiotics prevent early-onset disease.
TransmissionTransplacental, ingestionTransplacental, respiratoryTransplacental, body fluidsTransplacental, birth, breastfeedingPrimarily during birthTransplacental, birthVertical transmission during birth (primarily), ascending infection, rarely nosocomial/community-acquired (late-onset)

Congenital rubella infection


Clinical features

  • Intrauterine rubella infection: miscarriage, preterm birth, fetal growth restriction (especially likely if infection occurs during the first trimester)
  • Congenital rubella syndrome
    • Triad of congenital rubella syndrome
      • Cardiac defect: most common defect (e.g., patent ductus arteriosus, pulmonary artery stenosis)
      • Cataracts: Other eye manifestations may also occur later in life, including glaucoma and salt and pepper retinopathy (abnormal retinal pigmentation)
      • Cochlear defect: bilateral sensorineural hearing loss
    • Early features
      • Hepatosplenomegaly, jaundice
      • Hemolytic anemia, thrombocytopenia
      • Petechiae and purpura, i.e., blueberry muffin rash (due to extramedullary hematopoiesis in the skin)
    • Late features
      • CNS defects: microcephaly, intellectual disability, panencephalitis
      • Skeletal abnormalities

Mnemonic

CCC-Triad of congenital rubella syndrome: Cataracts, Cochlear defects, Cardiac abnormality

  • Prevention
    • Maternal preconception immunization with live attenuated rubella vaccine

Congenital syphilis


Pathogen

Treponema pallidum

Transmission

  • Fetus: transplacental transmission from infected mother
  • Neonate: perinatal transmission during birth

Clinical features of congenital syphilis

  • Perinatal
    • Intrauterine fetal demise
    • Prematurity, low birth weight
    • Focal necrosis of the umbilical cord
  • Mucocutaneous
    • Snuffles: copious rhinorrhea, often purulent or serosanguineous
    • Desquamating, maculopapular rash involving palms/soles
    • Fissures near orifices (eg, anal, oral)
    • Jaundice
  • Musculoskeletal
    • Long bone abnormalities (eg, periosteal thickening, metaphyseal erosion)Pasted image 20241106194729.png
      • Bilateral and symmetric metaphyseal erosions and periosteal inflammation of long bones
      • Pathologic fractures
      • Swelling, pain, and limited movement of affected extremities
  • Reticuloendothelial