Sandbox:Hanan Elkalawy

# Historical perspective
historical
Common complications of perinatal infection may not appear for months or years after the infants birth. Children with congenital rubella syndrome are at increased risk for diabetes mellitus and hypothyroidism later in life. When patients with congenital rubella syndrome originally identified by Sir Normal McAlister Gregg in 1941 were reevaluated in 20002001, 60 years after congenital infection, the prevalence of diabetes, thyroid disorders, osteoporosis, and early menopause among women was increased compared with the general Australian population (Forrest et al., 2002). These phenomena appear unique to rubella, although comparable longterm follow-up studies have not been conducted in children who have survived congenital infections due to other agents. Infants with congenital syphilis can have a constellation of late findings that can include saber shins, saddlenose deformity, frontal bossing, mulberry molars, rhagades, and the combination of sensorineural deafness, interstitial keratitis, and peg-shaped upper incisors, features known as the Hutchisons triad (Tsimis and Sheffield, 2017). Late onset or progressive sensorineural hearing loss affects up to 12% of infants with otherwise asymptomatic congenital CMV infection; the pathogenesis of this phenomenon is not well understood (Fowler et al., 1997; Goderis et al., 2014). Children with CMV are also at risk for subsequent vestibular dysfunction. In a retrospective cohort study of children with sensorineural hearing loss secondary to CMV, more than 90% had an abnormal global vestibular assessment with complete vestibular loss (i.e., no response to any vestibular test) in nearly one-third (Bernard et al., 2015). Bernard et al. (2015) observed a correlation between the laterality of vestibular dysfunction and hearing impairment; by contrast, they observed no correlation between the initial severity of congenital CMV infection and vestibular dysfunction. Infants with congenital Zika syndrome or congenital lymphocytic choriomeningitis syndrome are at risk for postnatal, obstructive hydrocephalus (Wright et al., 1997; Da Silva et al., 2016). In the case of lymphocytic choriomeningitis virus, hydrocephalus appears to be secondary to aqueductal stenosis as a result of inflammation of ependymal cells lining the aqueduct of Sylvius (Bonthius, 2012) .

# Causes

## Stroke
- A
- b
- c
- d

## MI
The prognosis of a neonate who has contracted an infection perinatally depends on the specific infection.Examples include the following:
- Chlamydia: Without treatment, the most serious consequences of chlamydial infection are related to complications of premature delivery. Treatment of the mother with antibiotics during the third trimester can prevent premature delivery and the transfer of the infection to the baby. Infants treated with antibiotics for eye infection or pneumonia generally recover.
- Cytomegalovirus: The chance for recovery after exposure to CMV is very good for both the mother and the infant. Exposure to CMV can be serious and even life threatening for mothers and infants whose immune systems are compromised, for example, those receiving chemotherapy or who have HIV/AIDS. Those infants who develop birth defects after CMV exposure may have serious, lifelong complications.
- Genital herpes: Once a woman or infant is infected, outbreaks of genital herpes sores can recur at any point during their lifetimes.
- Hepatitis B: Infants treated at birth with immune globulin and the series of vaccinations are protected from development of hepatitis B infection. Infants infected with hepatitis B develop a chronic, mild form of hepatitis and are at increased risk for developing liver disease.
- Human immunodeficiency virus (HIV): A combination of treatment with highly active antiretroviral therapy during pregnancy, zidovudine (AZT) during delivery, and AZT to the baby for six weeks after birth significantly reduces the chance that the infant will be infected with HIV from the mother.
- Human papillomavirus: Once infected with HPV, there is a lifelong risk of developing warts and an increased risk of some cancers.
- Rubella (German measles): Infants exposed to rubella virus in the uterus are at high risk for severe birth defects, including heart defects, blindness, and deafness.
- Streptococcus: Infection of the urinary tract or genital tract of pregnant women can cause premature birth. Infants infected with GBS can develop serious, life-threatening infections.
- Syphilis: Premature birth, birth defects, or the development of serious syphilis symptoms is likely to occur in untreated pregnant women
Parvovirus B19 Infection during pregnancy occurs in 15% of pregnancies. The virus can cause miscarriage, fetal anaemia, hydrops fetalis (abnormal accumulation of fluid in the fetal tissues), myocarditis, and/or intrauterine fetal death.
TEXTBOOKS
Nelson Textbook of Pediatrics, 15th Ed.: Richard E. Behrman, Editor; W.B. Saunders Company, 1996. Pp. 518, 521.
JOURNAL ARTICLES
The Torch Syndrome, A Clinical Review. J. D. Fine et al.; J Amer Acad Dermatol (April 1985; 12(4)). Pp. 2477-78.
Torch, A Literature Review and Implications for Practice. L. Haggerty; J Obstet Gynecol Nurs (March-April 1985; 14(2)). Pp. 124-29.
Timely Diagnosis of Congenital Infections. J.K. Stamos et al.; Pediatr Clin North Am (Oct 1994; 41(5)). Pp. 1017-33.
Torch Syndrome. R.E. Epps et al.; Semin Dermatol (Jun 1995; 14(2)). Pp. 179-86.
Torch Congenital Infections. E. Domenech et al.; An Esp Pediatr (Jun 1997; Spec No 1). Pp. 58-62.
Serologic and DNA-Based Testing for Congenital and Perinatal Infections. C.M. Litwin et al.; Pediatr Infect Dis J (Dec 1997; 16(12)). Pp. 1166-75.
Current Use of the Torch Screen in the Diagnosis of Congenital Infection. A. Cullen et al.; J Infect (Mar 1998; 36(2)). Pp. 185-88.
Torch Syndrome. Y. Hidaka et al.; Ryoikibetsu Shokogun Shirizu (1999; 25(Pt 3)). Pp. 85-88.

## Pathophysiology

### Cause
- CVS
- CNS
Parkinson
Tremor
- Parkinson
Tremor
- Tremor
- Respiratory

# Table2

# Table2