A neonate born to a 26-year-old woman is evaluated in the newborn nursery. The patient was delivered vaginally at 38 weeks gestation, and Apgar scores were 8 and 9 at 1 and 5 minutes, respectively. Initial evaluation shows hydrocephalus, jaundice, and hepatosplenomegaly. Funduscopic examination reveals retinal exudates and scarring. Histopathologic evaluation of the placenta shows infiltration of lymphocytes, plasma cells, and macrophages, as well as many areas of calcification. Within the placental tissue, there are numerous intracellular, crescent-shaped organisms with a central nucleus. Which of the following maternal interventions would have been most effective in preventing this patient's condition?

Question

A neonate born to a 26-year-old woman is evaluated in the newborn nursery.  The patient was delivered vaginally at 38 weeks gestation, and Apgar scores were 8 and 9 at 1 and 5 minutes, respectively.  Initial evaluation shows hydrocephalus, jaundice, and hepatosplenomegaly.  Funduscopic examination reveals retinal exudates and scarring.  Histopathologic evaluation of the placenta shows infiltration of lymphocytes, plasma cells, and macrophages, as well as many areas of calcification.  Within the placental tissue, there are numerous intracellular, crescent-shaped organisms with a central nucleus.  Which of the following maternal interventions would have been most effective in preventing this patient's condition?

Quizplus · Accepted Answer

11ec160b_3861_afa4_9249_852e92daabe2_MD0001_00 This neonate with retinal lesions (chorioretinitis) and hydrocephalus has a placenta containing inflammatory cells, calcifications, and crescent-shaped organisms. These findings are consistent with congenital toxoplasmosis, an infection caused by the intracellular parasite Toxoplasma gondii. Nonspecific neonatal findings of jaundice and hepatosplenomegaly are often present; diffuse intracranial calcifications are the classic finding on imaging. Parasitic spread of Toxoplasma begins via infected cats (host), which excrete oocysts that contaminate soil and water. Humans typically acquire the infection due to either of the following: Ingestion of contaminated meat is the most common method of spread in pregnancy. Therefore, although maternal infection is often asymptomatic, pregnant women are advised to avoid raw, cured, and undercooked meat to reduce the risk of infection and transplacental transmission to the fetus. (Choice A) Preconception maternal immunization with the measles, mumps, and rubella vaccine can prevent congenital rubella infection. Characteristic features of congenital rubella include hearing loss, cataracts (cloudy cornea), and cardiac defects (eg, patent ductus arteriosus), none of which are seen in this patient. Moreover, retinal lesions and hydrocephalus are uncommon, and rubella is a virus, not a crescent-shaped, intracellular parasite. (Choice C) Pregnant women should avoid, not preferentially consume, unpasteurized milk products, primarily to prevent congenital Listeria monocytogenes infection, which can lead to multiorgan abscesses or fetal demise. Although rare, Toxoplasma and other pathogens can also spread through raw milk. (Choice D) Malaria, a parasitic infection transmitted by mosquitoes, can cause intrauterine infection, but infants with congenital malaria typically present with fever and anemia, not hydrocephalus and chorioretinitis. In addition, although Plasmodium falciparum is a crescent-shaped intracellular organism, placental biopsy would show intervillous accumulation of parasitized red blood cells without calcifications. (Choice E) Prophylactic penicillin is used during labor to prevent group B Streptococcus (GBS) transmission to the fetus during delivery. Infection typically leads to early neonatal sepsis (eg, lethargy, hypoxia, temperature instability), findings not seen in this patient. Moreover, in contrast to this patient's pathologic findings, GBS is a gram-positive coccus that forms chains. Educational objective: Pregnant women should avoid consumption of undercooked meat to prevent infection with Toxoplasma gondii, an intracellular, crescent-shaped parasite that can cross the placenta to the fetus. Typical features of congenital toxoplasmosis include chorioretinitis, hydrocephalus, and diffuse intracranial calcifications.

A Neonate Born to a 26-Year-Old Woman Is Evaluated in the Newborn