# A newborn is admitted to the NICU with suspected congenital toxoplasmosis. Which assessment finding would be most characteristic of this TORCH infection? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=543294 > language: ko > subject: Infectious Diseases ## 문제 A newborn is admitted to the NICU with suspected congenital toxoplasmosis. Which assessment finding would be most characteristic of this TORCH infection? ## 보기 1. Chorioretinitis with bilateral retinal scarring **✔ 정답** 2. Blueberry muffin rash on trunk and extremities 3. Sensorineural hearing loss with cochlear damage 4. Cataracts with cloudy lens opacity **정답: 1** ## 해설 Chorioretinitis with bilateral retinal scarring is the most characteristic ocular finding of congenital toxoplasmosis, distinguishing it from other TORCH infections. Other options are typical of rubella (blueberry muffin rash), CMV (sensorineural hearing loss), or congenital rubella syndrome (cataracts). ## 심화 해설 Correct Answer: 1. Chorioretinitis with bilateral retinal scarring Clinical Reasoning and Core Pathophysiology The question asks for the most characteristic assessment finding in a newborn with suspected congenital toxoplasmosis, a key infection within the TORCH complex. While congenital toxoplasmosis can present with a wide clinical spectrum ranging from asymptomatic to severe multi-organ failure, the classic triad often cited includes hydrocephalus, intracranial calcifications, and chorioretinitis. However, the specific presentation can vary, and the absence of one classic sign does not rule out the disease. The protozoan Toxoplasma gondii has a strong predilection for the developing central nervous system and the retina. After transplacental transmission, the parasite invades retinal tissue, leading to inflammation and necrosis. This focal necrotizing retinitis is the hallmark ocular lesion. As the acute inflammation resolves, it leaves behind characteristic scars. The bilateral nature of the scarring is a critical clinical clue, as it reflects the hematogenous dissemination of the parasite to both eyes during fetal development. The provided evidence supports this as a primary finding. One case report explicitly describes an infant presenting with progressive macrocephaly where an ophthalmologic examination demonstrated bilateral chorioretinitis as a key diagnostic feature [1]. A review on the implications of TORCH diseases in retinal development specifically focuses on congenital toxoplasmosis as a teratogenic infection that causes irreversible disturbances to the developing retina, underscoring that retinal pathology is a central and defining consequence of this infection [4]. Analysis of Incorrect Options Option 2: Blueberry muffin rash on trunk and extremities A "blueberry muffin" rash represents dermal erythropoiesis. This finding is classically associated with congenital infections that cause severe anemia or thrombocytopenia, most notably congenital rubella syndrome and congenital cytomegalovirus (CMV). It can also be seen in congenital parvovirus B19 infection or hematologic disorders like congenital leukemia. While congenital toxoplasmosis can involve hematologic abnormalities such as thrombocytopenia, which was noted in a fatal case progressing to liver failure , the blueberry muffin rash is not its most characteristic dermatologic or systemic manifestation. Option 3: Sensorineural hearing loss with cochlear damage Sensorineural hearing loss is the single most common sequela of congenital CMV infection. CMV has a specific tropism for the cochlear structures, leading to progressive hearing deficits that may not be present at birth. While congenital toxoplasmosis can cause widespread neurological damage, including to the brain, it is not primarily characterized by isolated cochlear damage and sensorineural hearing loss in the way that CMV is. The neuroimaging findings in toxoplasmosis more typically reveal hydrocephalus, ring-enhancing lesions, or intracranial calcifications [1, 2]. Option 4: Cataracts with cloudy lens opacity Congenital cataracts are a hallmark finding of congenital rubella syndrome. The rubella virus can infect the developing lens, causing it to become opaque. While a case report does document a unilateral fetal cataract in the context of congenital toxoplasmosis, the authors note it as a rare and coincidental finding alongside polydactyly, not a typical or most characteristic presentation . The classic ocular finding in toxoplasmosis is the retinal scar from chorioretinitis, not a primary lens opacity. The damage is to the retina and choroid, not the lens. NCLEX-RN Practice Connection For the NCLEX-RN, distinguishing between TORCH infections based on their classic presentations is a high-yield skill. When you see a combination of neurological findings (like hydrocephalus or intracranial calcifications) and specific eye findings, let the type of eye pathology guide you. A retinal scar points directly to toxoplasmosis, a cataract points to rubella, and hearing loss points to CMV. The clinical evidence confirms that bilateral chorioretinitis remains a defining and most characteristic assessment finding for congenital toxoplasmosis, even when other classic signs like intracranial calcifications are absent [1].References (research sources) - [1]Congenital Toxoplasmosis With Atypical Neuroimaging: Hydrocephalus and Bilateral Chorioretinitis Without Intracranial Calcifications.Research articleDhakal S, Regmi PR, Dhakal P, Adhikari B, Shingh SS, Paudel BS. (2026) · DOI: 10.1155/crra/3021918 - [4]Implications of TORCH Diseases in Retinal Development—Special Focus on Congenital ToxoplasmosisResearch articleViviane Souza de Campos, Karin da Costa Calaza, Daniel Adesse (2020) · DOI: 10.3389/fcimb.2020.585727 ## 임상 시나리오 Congenital Toxoplasmosis ScreeningOcular Assessment in the NICU The classic triad includes hydrocephalus, intracranial calcifications, and chorioretinitis. However, bilateral retinal scarring is the most characteristic ocular finding, resulting from focal necrotizing retinitis. A dilated fundoscopic exam is essential. Lesions are often located in the macula, which can severely impair central vision. The bilateral nature reflects hematogenous dissemination of Toxoplasma gondii. CautionDo not rule out toxoplasmosis if the classic triad is incomplete. Up to 70-90% of infected newborns are asymptomatic at birth but remain at high risk for late-onset retinal lesions and visual impairment. ## 핵심 개념 - **Chorioretinitis** — Inflammation of the choroid and retina; in congenital toxoplasmosis, it leads to focal necrotizing retinitis and subsequent scarring. - **TORCH** — Acronym for maternal infections that can cause congenital defects: Toxoplasmosis, Other (syphilis), Rubella, Cytomegalovirus, Herpes simplex virus. - **Toxoplasma gondii** — An obligate intracellular protozoan parasite transmitted transplacentally, with a predilection for the fetal central nervous system and retina. ## 같은 주제 문제 - [A nurse is assessing a newborn whose mother had a positive TORCH screening during pregnanc…](https://mymerci.kr/pages/nclex_q.php?qn_id=541921) - [A nurse is assessing a newborn whose mother had a positive TORCH screening during pregnanc…](https://mymerci.kr/pages/nclex_q.php?qn_id=541922) - [A nurse is assessing a newborn whose mother had a positive cytomegalovirus (CMV) titer dur…](https://mymerci.kr/pages/nclex_q.php?qn_id=541923) - [A nurse is assessing a 1-week-old infant whose mother had a positive cytomegalovirus (CMV)…](https://mymerci.kr/pages/nclex_q.php?qn_id=543295) - [A nurse is assessing a newborn whose mother had a positive cytomegalovirus (CMV) titer dur…](https://mymerci.kr/pages/nclex_q.php?qn_id=543296) --- More free questions: [기출문제](https://mymerci.kr/) _학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._