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TORCH

TORCH infections refer to a group of infections transmitted from mother to fetus that can cause serious complications in newborns, including toxoplasmosis, rubella, cytomegalovirus, and herpes simplex virus. These infections may present with low birth weight, jaundice, rash, organomegaly, eye and neurological issues. Diagnosis involves testing body fluids and tissues through methods like culture, PCR, and serological tests to identify the specific infection.

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Jafar Nory
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333 views

TORCH

TORCH infections refer to a group of infections transmitted from mother to fetus that can cause serious complications in newborns, including toxoplasmosis, rubella, cytomegalovirus, and herpes simplex virus. These infections may present with low birth weight, jaundice, rash, organomegaly, eye and neurological issues. Diagnosis involves testing body fluids and tissues through methods like culture, PCR, and serological tests to identify the specific infection.

Uploaded by

Jafar Nory
Copyright
© © All Rights Reserved
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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‫بسم الله الرحمن الرحیم‬

‫وزارت تحصیالت عالی‬


‫پوهنتون طبی چراغ‬
‫دیپارتمنت داخله اطفال‬

‫موضوع لکلچر ‪TORCH Infection:‬‬


‫لکچر دهنده ‪:‬دوکتور احمد ضیاء (حیدری)‬
‫تاریخ ارایه لکچر ‪13/10/1391:‬‬
‫صنف ‪:‬پنجم ‪B‬‬
Contents
• Definition
• Clinical features
• Toxoplasmosis
• Rubella
• Cytomegalo virus
• Herpes simplex virus
• summary
TORCH Infections
• T=toxoplasmosis
• O=other (syphilis,varicell a,paravirus B19)
• R=rubella
• C=cytomegalovirus (CMV)
• H=herpes simplex (HSV)
Neonate may present with following features if infected with TORCH infection
 LBW
 Jaundice, rash
 Hepatosplenomegaly
 Thrombocytopenia
 Cataract
 Chorioretinitis
 Microcephaly
 CHD
TOXOPLASMOSIS
Toxoplasma Gondi
Incidence 1/1000 to1/10000 life birth
Pathophysiology
 Newly infected cats
 Unpasteurized milk
 raw meats
 Trimester III
 Infections earlier(abortion,stillbirth,sever disease)
 Visual impirament,learning disabilities(month,year)
Clinical Manifestations
• Most (70-90%) are asymptomatic at birth
• Classic triad of symptoms:
– Chorioretinitis
– Hydrocephalus
– Intracranial calcifications
• Other symptoms include fever, rash, HSM,
Microcephaly, seizures, jaundice, thrombocytopenia,
lymphadenopathy
Chorioretinitis of congenital toxoplasmosis
Diagnosis
 Direct isolation(body fluids or tissues,
placenta)
 Serologic test:
• IGM(1-2w)
• IgM IgG+(active infection)
• IgA>95%(acute infection)
Treatment
 Pyrimethamin+sulfadizene+folic acid
 Corticosteroid(ocular and acute CNS infection)
Prevention
 Women should avoid eating:
 Raw meat
 Eggs
 Avoid exposure to the cat faces
RUBELLA
 Viral infection
 Chronic intrauterine infection
 Damage to developing fetus
 0.1% to 2%
 Infected from respiratory secretion
 Maternal infection during first trimester(90%)
Clinical manifestation
• IUGR
• Microcephaly
• Microphthalamia
• Cataract ,Glaucoma, Chorioretinitis
• jaundice
• PDA
• Blueberry muffin rash
• Anemia,
• Asymptomatic at birth/present for 1 year
“Blueberry muffin” spots representing
extramedullary hematopoesis
Diagnosis
Cultures
CSF EX( protein)
Serologic studies( IgM)
Treatment
 There is no specific treatment
 Long term follow up(secondary to late onset
symptoms)
CYTOMEGALOVIRUS(CMV)
 DNA virus
 Herps virus group
 Transmitted to fetus:
 transplacental
 during birth
 and by breast milk
 Secrition,blood,urin and by sexual contact
Clinical features
 Sepsis
 IUGR
 Chorioretinitis
 Microcephaly
 Anemia,jaundice,hepatosplenomegaly
 Deafness, pneumonia
Diagnosis
 Culture(urin,saliva)
 Serologic tests(IgM+)
 Radiologic studies,CT scan
(intracranial calcification)
Ventriculomegaly and
calcifications of
congenital CMV
Treatment
• Ganciclovir x6wks in symptomatic
infants
• Treatment currently not recommended
in asymptomatic infants due to side
effects.
HERPES SIMPLEX VIRUS(HSV)
 DNA virus
 1in1000 to 1in 5000 deliveries per years
 3/4(HSH-2)
 Can be intrautren,postnatal and aquired(80)
 Entry from skin,eye, mouth and respiratory tract
 HSV are disease localized to:
• skin,eye and mouth
• CNS and Disseminated disease
Clinical manifestation
 Intrauterine infection
 Chorioretinitis
 Skin lesion
 Microcephaly
 Postnatal
 Encephalitis
 Skin vesicle
 keratoconjunctivitis
Diagnosis
• Culture of maternal lesions if present at
delivery
• Cultures in infant:
– Skin lesions, oro/nasopharynx, eyes, urine,
blood, /stool, CSF
• PCR
• Serologic Test(IgM)
Presentations of congenital HSV
TREATMENT
The first- line drug of choice is
Acyclovir
Second choice being
vidarabine
Which TORCH Infection Presents With…
• Chorioretinitis, hydrocephalus, and intracranial
calcifications?
– toxo
• Blueberry muffin lesions?
– rubella
• Periventricular calcifications?
– CMV
• No symptoms?
– All of them
Continue…
• CMV,HCV(culture/PCR)
• Toxoplasmosis(serologic test/PCR)
• Rubella ,syphilis(serologic method)
 Neonatal antibody titers are often difficult to
interpret because:
• IgG is required from the mother
• Determination of neonatal IgM titers to specific
pathogens is technically difficult to perform.
Continue…
 Neonatal infection with
CMV,HSV,toxoplasmosis,rubella and syphilis
present a diagnostic dilemma because:
• Clinical features
• Diseas may be in apparent
• Maternal infection is often asymptomatic
• Special laboroary studies needed
Continue…
 Systemic infection with CMV,HSV and
enteroviruses involve the liver(LFT)
 Neonatal HSV CNS disease maybe confirmed
by viral culture and PCR identification from
CSF
reference
• Nelson Textbook of pediatrics(19th
Edition)”640-641”
• OP Ghai(7th Edition)
• Basis of pediatrics(7th Edition)
• Current pediatrics(new Edition)

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