A 3-Week-Old Boy Is Brought to the Emergency Department Due

A 3-week-old boy is brought to the emergency department due to a seizure.  The patient was born at term to a 23-year-old woman who had no prenatal care and delivered him at home.  The mother states that he was healthy until this morning, when he developed a low-grade fever.  The patient has been very fussy and refused to nurse at his last feed.  Subsequently, he experienced a 4-minute, generalized tonic-clonic seizure with mild perioral cyanosis.  Temperature is 38.3 C (100.9 F) .  The patient is lethargic but arouses to painful stimuli.  Pupils are equal and reactive; the anterior fontanel is full.  The remainder of the physical examination is normal.  Blood and urine samples are obtained and a lumbar puncture is performed, with results pending.  Brain imaging reveals patchy areas of increased attenuation in the cerebral cortex and edema and hemorrhage in the left temporal lobe and brainstem; no intracranial calcifications are seen.  Vertical transmission of which of the following is the most likely cause of this patient's presentation?

A) Cytomegalovirus
B) Group B Streptococcus
C) Herpes simplex virus
D) Listeria monocytogenes
E) Toxoplasma gondii

Correct Answer:

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