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  • Other: Coxsackievirus, syphilis, varicella-zoster virus, HIV, and parvovirus B19; congenital Lyme disease

  • STORCH syndrome



  • TORCH complex


  • Toxoplasmosis, Otherother, rubella virus, cytomegalovirus (CMV), herpes simplex virus


  • 052.0 Postvaricella encephalitis

  • 055.0 Postmeasles encephalitis

  • 056.0 Rubella with neurological complications

  • 090.4 Juvenile neurosyphilis


  • A50.40 Late congenital neurosyphilis, unspecified

  • A50.45 Juvenile general paresis

  • B01.11 Varicella encephalitis and encephalomyelitis

  • B05.0 Measles complicated by encephalitis

  • B06.00 Rubella with neurological complication, unspecified


  • 5C Impaired Motor Function and Sensory Integrity Associated with Nonprogressive Disorders of the Central Nervous System—congenital origin or acquired in infancy or childhood


A 7-month-old male child is brought to a physical therapist to be evaluated for a delay in motor skills acquisition. According to parental report, he has been slower to achieve motor milestones than his siblings. He has recently begun rolling from supine to prone and prone to supine and reportedly is beginning to sit momentarily. He was diagnosed with chorioretinitis shortly after birth which was successfully treated with antibiotics and steroids, although he continues to demonstrate mild photosensitivity. Parents report that he had seizures in the first few weeks of life that are well controlled on his current medication. Prenatal maternal history is positive for mild flu-like symptoms in the second trimester that went unreported.

Upon physical examination, the infant plays in supine, while holding a small toy with both hands. He rolls to prone in both directions to secure a toy held out of reach. He is vocally responsive to his parents and the examiner. He smiles and turns toward a musical toy when it is introduced. Minimal redness of his eyes with some excess tearing is noted. When placed in sitting, propped forward on extended upper extremities, he is able to maintain the position briefly before falling forward. Laboratory studies revealed antibodies against toxoplasmosis. A recent brain scan revealed cerebral calcifications.

FIGURE 256-1

Mild maculopapular rash of rubella in a child. (From Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J, edseds. Harrison’s Principles of Internal Medicine. 18th ed. New York, NY: McGraw-Hill; 2012.)

FIGURE 256-2

Rubella. (Courtesy of the Centers for Disease Control and Prevention.)

FIGURE 256-3

Toxoplasmosis. Toxoplasma gondii life cycle shows oocysts from cat feces or cysts from inadequately cooked meat as infectious to humans and other animals. (Reproduced with permission from Nester EW, Anderson DG, Roberts CE Jr, Nester MT. Microbiology: A Human Perspective. 6th ed. New York, NY: McGraw-Hill; 2008.)




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