Pregnant mother with worsening flu-like symptoms

Figure 8. Demineralization of proximal tibia (Wimberger Sign) in congenital syphilis. Image: James H. Brien, DO

Columnist comments

The issue of congenital CMV was reviewed at the 39th Annual Infectious Diseases in Children Symposium in New York last November. An introduction to the key areas of detection and treatment was given by David Kimberlin (my “go-to” expert on all herpes family viruses), and can be found at the following link: Physicians can help raise awareness of congenital CMV.

For a little historical perspective, the 1982 (19th) edition of the Red Book (my oldest) contains two and a half pages on CMV, including three sentences on congenital CMV. The current Red Book (33rd Ed, 2024-2027) has eight pages (which are larger than the older edition), with a large portion on congenital infections, including a full page (349) on treatment. The syphilis chapter in 1982 is six pages, with a substantial portion on congenital infection. The current Red Book has 16 pages with a large portion on congenital syphilis. Toxoplasmosis has two pages in the 1982 issue, with seven sentences on congenital infections, and minimal mention of treatment of the infected newborn. The current Red Book has seven pages and a substantial portion on congenital infection. Interestingly, the treatment of infected children in 1982 included the same drugs as we use today: pyrimethamine, sulfadiazine and folinic acid. Rubella in 1982 included five pages and began with congenital infections and a large portion on immunization. The current Red Book includes seven pages with more detail in all areas. These comparisons point to the increased importance of avoidance, prevention, detection and treatment of these old foes.

With vaccine hesitancy leading to avoidance, combined with the ongoing problem of decreased public health funding, the perfect storm that leads to an increase in vaccine-preventable diseases in children (and their parents) is inevitable. Diseases with potentially serious consequences, like rubella, measles, mumps, varicella, pertussis, diphtheria, polio and others will predictably occur in schools and daycare environments, taking the disease home to their unvaccinated family members and others, including us grandparents. Thankfully, the original vaccine-preventable disease, smallpox, does not depend on parental compliance or public health funding, and therefore will not be coming back (hopefully).

Number 500

This is my 500th “What’s Your Diagnosis?” column. On this auspicious occasion, I am reminded how time flies. Despite my progressive age-related memory failures, I can clearly recall when I began writing for both Infectious Disease News (December 1988), then Infectious Diseases in Children shortly thereafter. It was possible because of my infectious disease fellowship program director, Colonel James W. Bass, MD, who taught me medical photography and always supported me with advice on style and content. There are times I feel he still speaks to me when I get stuck on finishing a column. I am not sure how much longer I can write, but as long as readers want to see it, I will keep writing it.

As we start a new year, I would like to make a special request for readership feedback. Let me know if you want to see changes in this column. Also, as usual, if you have an interesting case that you would like to see featured here, or you want to see a particular topic reviewed, please let me know at jhbrien@aol.com, and I’ll do my best to make it happen. In the meantime, I wish you good health and a great year ahead.