Review Question - QID 214949

A 4-day-old boy is brought to the emergency room due to 1 hour of rhythmic jerking of his upper and lower extremities. This episode was accompanied by several episodes of vomiting. He was born at home to a 34-year-old gravida 3 para 3 woman at 38 weeks of gestation via an uncomplicated spontaneous vaginal delivery. Although the patient's mother received no prenatal care, the patient has had an uncomplicated postnatal course. The patient's mother notes that her previous pregnancy 2 years ago was complicated by lactational mastitis that began 8 weeks after the initiation of breastfeeding. The patient's mother expresses concern that she may have transmitted an infection to her newborn since she just started breastfeeding him. The patient's mother has a remote history of phencyclidine use and is currently undergoing treatment for hepatitis C infection. She was also treated for tuberculosis infection in her 20s. Maternal urine drug screen is negative. The newborn’s temperature is 99.5°F (37.7°C), blood pressure is 70/45 mmHg, pulse is 130/min, and respirations are 45/min. Physical exam reveals a lethargic infant but is otherwise unremarkable. His labs are notable for a total bilirubin of 7.1 mg/dL. Which of the following is a contraindication to breastfeeding in this patient?