<prompt> Which of the following infection, if occurs in the first trimester, leads to maximum incidence of congenital malformations: March 2010RubellaToxoplasmosisCMVAll of the above  <response>: Ans. A: Rubella T toxoplasmosis: Caused by protozoan - Toxoplasma gondii - Domestic cat is the definitive host with infections : Ingestion of cysts meats, garden products, Contact with oocysts in feces - Much higher prevalence of infection in European countries - Acute infection usually asymptomatic 13 risk of fetal infection with primary maternal infection in pregnancy - Infection rate higher with infection in 3rd trimester - Fetal death higher with infection in 1st trimester - Mostly 70-90 asymptomatic at bih Classic triad of symptoms: Chorioretinitis Hydrocephalus Intracranial calcifications 0other syphilis - Early congenital typically 1st 5 weeks: Cutaneous lesions palmssoles Jaundice Anemia Snuffles Periostitis and metaphysial dystrophy Funisitis umbilical cord vasculitis - Late congenital: Frontal bossing Sho maxilla High palatal arch Hutchinson teeth 8th nerve deafness Saddle nose Perioral fissures R rubella Sensorineural hearing loss 50-75 Cataracts and glaucoma 20-50 malformations 20-50 Neurologic 10-20 Others to include growth retardation, bone disease, thrombocytopenia, blueberry muffin lesions C cytomegalovirus CMV 90 are asymptomatic at bih Up to 15 develop symptoms later, notably sensorineural hearing loss Symptomatic infection Petechiae, jaundice, chorioretinitis, periventricular calcifications, neurological deficits 80 develop long term complications Hearing loss, vision impairment, developmental delay Hherpes simplex HSV Most are asymptomatic at bih - 3 patterns of equal frequency with symptoms between bih and 4 weeks: Skin, eyes, mouth SEM CNS disease Disseminated disease present earliest Initial manifestations very nonspecific with skin lesions NOT necessarily present 