A 1-Day-Old Boy Is Admitted to the Neonatal Intensive Care

A 1-day-old boy is admitted to the neonatal intensive care unit due to macrocephaly and jaundice.  The patient was born by spontaneous vaginal delivery at 41 weeks gestation to a 38-year-old woman, gravida 4 para 3 (2 live vaginal births and a first-trimester miscarriage) , who had consistent prenatal care.  The mother traveled to central Africa during the first trimester.  While there, she developed fever that lasted 2 weeks along with swollen lymph nodes and muscle aches that resolved spontaneously.  The patient's weight and length are at the 25th percentile; head circumference is above the 97th percentile.  Vital signs are normal.  Diffuse jaundice is noted on examination.  The liver is palpable 4 cm below the costal margin.  Heart and lung sounds are normal on auscultation.  CT scan of the head reveals hydrocephalus and diffuse intracranial calcifications.  Laboratory results include total bilirubin 7.2 mg/dL and direct bilirubin 5.5 mg/dL.  Which of the following maternal exposures most likely resulted in this patient's condition?

A) Infected genital secretions
B) Infected respiratory droplets
C) Mosquito bite
D) Saliva
E) Undercooked meat

Correct Answer:

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