Torch Infection What is Torch Causes Symptoms Diagnosis and Treatment

Torch Infection An Overview:

TORCH complex (also known as STORCH, TORCHES or the TORCH infections) is a medical acronym for a set of perinatal infections(i.e. infections that are passed from a pregnant woman to her fetus). TORCH infections can lead to severe fetal anomalies or even fetal loss. They are a group of viral, bacterial, and protozoan infections that gain access to the fetal bloodstream transplacentally via the chorionic villi. Hematogenous transmission may occur at any time during gestation or occasionally at the time of delivery via maternal-to-fetal transfusion.

the acronym is spelt out as follows:

1. T – Toxoplasmosis / Toxoplasma gondii

2. O – Other infections (see below)

3. R – Rubella

4. C – Cytomegalovirus

5. H – Herpes simplex virus-2

The "other agents" included under O are Coxsackievirus, Syphilis,(Syphilis in Pregnancy and Neonate Read here ) Varicella-Zoster Virus, HIV(HIV and Its diagnosis an Overview), and Parvovirus B19.

Click on the specific infection for individual details:

Hepatitis B may also be included among "other agents", but the hepatitis B virus is a large virus and does not cross the placenta, hence it cannot infect the fetus unless there have been breaks in the maternal-fetal barrier, such as can occur in bleeding during childbirth or amniocentesis

The acronym has also been listed as TORCHES, for TOxoplasmosis, Rubella, Cytomegalovirus, HErpes simplex, Syphilis

Index of Suspicion:

•          When do you think of TORCH infections?

•          IUGR infants

•          HSM

•          Thrombocytopenia

•          Unusual rash

•          Concerning maternal history

•          “Classic” findings of any specific infection

Diagnosing TORCH Infection

!!!!!!DO NOT USE TORCH TITERS!!!!!!

•          Good maternal/prenatal history

•          Remember most infections of concern are mild illnesses often unrecognized

•          A thorough exam of the infant

•          Directed labs/studies based on most likely diagnosis…

•          Again, DO NOT USE TORCH TITERS!

Screening TORCH Infection

•          A retrospective study of 75/182 infants with IUGR who were screened for TORCH infections

•          1/75 with clinical findings, 11/75 with abnormal lab findings

•          All patients screened:

•          TORCH titers, urine CMV culture, head ultrasound,

•          Only 3 diagnosed with an infection

•          NONE by TORCH titer!!

•          Overall cost of all tests = $51,715

•          “Shotgun” screening approach NOT cost effective nor particularly useful

•          Diagnostic workup should be logical and directed by history/exam findings

Review: Which TORCH Infection Presents With…

Snuffles?

•          syphilis

Chorioretinitis, hydrocephalus, and intracranial calcifications?

•          toxo

Blueberry muffin lesions?

•          rubella

Periventricular calcifications? 

•          CMV

No symptoms?

•          All of them

Which TORCH Infections Can Absolutely Be Prevented?

•          Rubella

•          Syphilis

When Are TORCH Titers Helpful in Diagnosing Congenital Infection?

•          Never