TORCH infections

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

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 can be transmitted to the unborn child in the womb or during childbirth. The mother often has a mild infection with few or no symptoms. TORCH is an acronym.

The infectious agents are:

• T – Toxoplasmosis / Treponema
• O – Other agents, such as Coxsackie virus, Listeria and human parvovirus
• R – Rubella
• C – Cytomegalovirus / Chlamydia
• HE – HErpes simplex virus / HEpatitis B / HHV4, i.e.Epstein-Barr virus / HHV3, i.e.varicella-zoster virus / HIV
• S – Syphilis

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

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. However, some viral infections, 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.