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Pediatrics
infectious disease
cytomegalovirus
A 3-day-old female infant, born at 39 weeks' gestation via spontaneous vaginal delivery, is undergoing evaluation in the neonatal intensive care unit. Her mother, a G2P1, experienced an unspecified febrile illness with flu-like symptoms during the first trimester, for which she received no specific treatment or detailed investigation due to limited access to care. The infant's vital signs are: temperature 37.2°C, heart rate 140 beats/min, respiratory rate 45 breaths/min, and blood pressure 65/45 mmHg. On physical examination, diffuse purpuric lesions resembling a "blueberry muffin" rash are noted across the trunk and extremities, along with significant hepatosplenomegaly extending 3 cm below the costal margins. Fundoscopic examination reveals focal retinal scarring and areas of active inflammation. Neurological assessment shows subtle hypotonia and a weak suck reflex. Given these findings, what is the most likely underlying congenital infection and the appropriate initial therapeutic intervention?
| Lab Parameter | Value | Reference Range |
|---|---|---|
| Platelet Count | 70 x 10^9/L | 150-450 x 10^9/L |
| White Blood Cell Count | 18.5 x 10^9/L | 5.0-20.0 x 10^9/L (neonates) |
| Hemoglobin | 135 g/L | 140-200 g/L (neonates) |
| Direct Bilirubin | 50 µmol/L | < 25 µmol/L |
| Alanine Aminotransferase (ALT) | 90 U/L | < 40 U/L |

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