TORCH infections

TORCH or TORCHES infections are a group of infections that in a pregnant woman can lead to severe fetal anomalies or even fetal loss. They are a group of viral, and rarely bacterial infections, which gain access to the fetal bloodstream transplacentally via the chorionic villi. Hematogenous transmission may occur any time during gestation or occasionally -as with HIV and Hep B- at the time of delivery via maternal-to-fetal transfusion. [Robbins and Cotran Pathological Basis of Disease, pg 480] The mother often has a mild infection with few or no symptoms. "TORCH" is an acronym.

The infectious agents are:
* T – Toxoplasmosis
* O – Other agents, such as Varicella zoster virus and human parvovirus
* R – Rubella
* C – Cytomegalovirus
* HE – HErpes simplex virus / HIV
* S – Syphilis

The acronym has also been listed as TORCHES, for Toxoplasmosis, Rubella, CMV, Herpes simplex, Syphilis.

Listeria, E. coli and group B streptococci can also be acquired after membrane rupture and are the 3 most common causes of meningitis of the newborn.

Features

Symptoms of a TORCH infection may include fever and poor feeding. The newborn is often small for gestational age. A petechial rash on the skin may be present, with small reddish or purplish spots due to bleeding from capillaries under the skin. An enlarged liver and spleen (hepatosplenomegaly) is common, as is the yellowish discoloration of the skin and eyes called jaundice. Hearing impairment, eye problems, mental retardation, autism, and death can be caused by TORCH infections.

Diagnosis

When physical examination of the newborn shows signs of the TORCH syndrome, the examiner may test blood, urine, and spinal fluid for evidence of the infections listed above. Diagnosis can be confirmed by culture of one of the specific pathogens or by increased levels of IgM against the pathogen.

Treatment and prevention

Some of the TORCH infections, such as toxoplasmosis and syphilis, can be effectively treated with antibiotics if the mother is diagnosed early in her pregnancy. Many of the viral TORCH infections have no effective treatment, but some, notably rubella and varicella-zoster, can be prevented by vaccinating the mother prior to pregnancy. If the mother has active herpes simplex, delivery by Caesarean section can prevent the newborn from contact, and consequent infection, with this virus.

Prognosis

Each type of TORCH infection has a different prognosis. The stage of the pregnancy at the time of infection also can change the effect on the newborn.

References