TORCH complex

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Congenital infections Main Page

Overview

Causes

Classification

Congenital Toxoplasmosis
Congenital syphilis
Congenital varicella syndrome
Congenital rubella syndrome
Congenital CMV
Neonatal herpes simplex

Differential Diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Aravind Kuchkuntla, M.B.B.S[2]

Synonyms and Keywords: TORCHES; TORCH infections

Overview

TORCH group of infections include: toxoplasmosis, Treponema pallidum , rubella, cytomegalovirus, herpesvirus, hepatitis viruses, Human immunodeficiency virus, and other infections such as varicella, parvovirus B19, and enteroviruses. All of these infections affect the fetus and can cause significant morbidity and mortality. Most of the infections reach the fetus via the transplacental route or by ascending infection. The timing of infection varies with individual infections to cause severe damage. Most of the infections can result in misscarriage or fetal demise or severe clinical manifestations in the newborn. The infections can compromise normal development during infancy and have poor development. Therefore, early diagnosis and treatment plays an important role in the management of these infections to improve outcomes in the newborn.[1]

Causes

The TORCH group of infections include bacteria, parasites and viruses:

Classification

The TORCH group of infections can be classified based on the causative pathogen into the following :

Differential Diagnosis

Diseases Causative Organism Transmission Timing of Infection Symptoms in the Mother Clinical features in the newborn Classification Diagnosis Treatment
Congenital syphilis Treponema Pallidum Vertical 16th to 28th week Based on the stage of Syphilis infection
  • Early congenital syphilis
  • Late congnenital syphilis
  • Stigmata
Congenital Toxoplasmosis Toxoplasma gondii Vertical Third Trimester
  • Majority : Asymptomatic
  • Few patients can have flu like symptoms
None
Congenital varicella syndrome Varicella zoster virus Vertical 13 to 20th week
  • Vesicular skin rash
  • Fever
None
Congenital CMV Cytomegalovirus Vertical First trimester
  • Symptomatic
  • Asymptomatic
Congenital rubella syndrome Rubella Virus Vertical 8 to 10th week None
  • Termination of pregnancy: If infection diagnosed before 18 weeks of pregnancy
  • No definitive Treatment
Neonatal herpes simplex HSV-1 and HSV-2
  • Direct Contact / Ascending infection from genital lesions
  • Contact with infected people
  • Vertical
At term
  • Skin, eye, mouth disease (SEM)
  • CNS Disease
  • Disseminated Disease

The list of clinical manifestations in TORCH group of infections include the following:[1][2]

Congenital Infection Cardiac Findings Skin Findings Ocular Findings Hepatosplenomegaly Hydrocephalus Microcephaly Intracranial Calcifications Hearing deficits
Congenital Varicella Syndrome - -
  • Cicatrical Skin Lesions
  • Skin Edema
-
  • Micropthalmus
  • Cataracts
- -
Toxoplasmosis - - - Diffuse intracranial calcifications -
Congenital Syphils - - - - - - -
Rubella - - -
Cytomegalovirus (CMV) - - Periventricular calcifications
Herpes simplex virus (HSV) - - - -
Parvovirus B19 - - - - - - -

References

  1. 1.0 1.1 Neu N, Duchon J, Zachariah P (2015). "TORCH infections". Clin Perinatol. 42 (1): 77–103, viii. doi:10.1016/j.clp.2014.11.001. PMID 25677998.
  2. Ajij M, Nangia S, Dubey BS (2014). "Congenital rubella syndrome with blueberry muffin lesions and extensive metaphysitis". J Clin Diagn Res. 8 (12): PD03–4. doi:10.7860/JCDR/2014/10271.5293. PMC 4316306. PMID 25654000.

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