Congenital and neonatal infection

1-This means that something occurs during pregnancy or delivery.

2-Causes are the following using mnemonic       TORCH

-TO---Toxoplasmosis.

-R ---Rubella.

-C---Cytomegallovirus (CMV).

-H---Herpes simplex virus (HSV) type 2.

All these lesions cause fixed manifestation which is intra cranial calcification ( spots or dots in the basal ganglia or peri ventricular mainly but it could affect also the rest of the brain).

So presence of these dots of calcification any where in the brain tissue of a neonate is equal to intra cranial infection.

Other causes of intracranial calcification which could be mistaken with intra cranial infection are cysticercosis and tuberous sclerosis.

Most common intra cranial infection seen in the practice are toxoplasmosis and cytomegallovirus and are usually causing calcification plus hydrocephalus due to obstruction of aqueduct of sylvius.

3-Route of transmission:

-Hematogenous:  Most viruses except HSV type 2.

-In the birth canal: HSV type 2.

-Ascending: Bacteria.

4-Important rule:

-Look to the distribution of the calcium dots, it will help you making diagnosis especially in toxoplasma and cytomegallovirus.

-They are concluded that  toxoplasma has a relation with basal ganglia and the calcium dots are away from the ventricular wall while in case of cytomegallovirus, the calcium dots are adherent to the ventricular wall.

-Almost in all circumstances, you write in the report that this lesion is intra cranial infection then let serology do its role.

-Cytomegallovirus are common in immune-suppressive patient.