TORCH complex

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TORCH Complex (aka TORCHES or the TORCH infections) is a medical acronym for a set of 5 congenital infections (i.e. that are passed from an infected mother to her fetus).

Conditions

The diseases present similarly, involving the heart, skin, eye, and CNS. They all cause chorioretinitis, microcephaly, and focal cerebral calcification.

It is possible for genetic conditions (Aicardi-Goutieres syndrome) to present in a similar manner.

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. The mother often has a mild infection with few or no symptoms. TORCH is an acronym.

Initial four

The infections are:

1. T – Toxoplasmosis / Toxoplasma gondii
2. O – Other infections (see below)
3. R – Rubella
4. C – Cytomegalovirus
5. H – HErpes simplex virus

Other

The "O" can stand for "other agents", namely Hepatitis B, Syphilis, Varicella-Zoster Virus, HIV, and Parvovirus B19.

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.

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

History

There were originally four conditions, with the "TO" referring to "Toxoplasma". The four-term form is still used in many modern references. The capitalization "ToRCH" is sometimes used in these contexts.

Some uses of the term redefine the "O" as "other", and include other conditions under the "O", such as syphillis.

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

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