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Condition/Disorder Synonyms

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  • STORCH syndrome

  • TORCH

  • TORCH complex

  • TORCHES

  • Toxoplasmosis, other, rubella virus, cytomegalovirus (CMV), herpes simplex Virus

  • Other: coxsackievirus, syphilis, varicella-zoster virus, HIV, and parvovirus B19; Congenital Lyme disease

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ICD-9 Codes

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  • 052.0 Postvaricella encephalitis

  • 055.0 Postmeasles encephalitis

  • 056.0 Rubella with neurological complications

  • 090.4 Juvenile neurosyphilis

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ICD-10 Codes

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  • A50.40 Late congenital neurosyphilis, unspecified

  • A50.45 Juvenile general paresis

  • B01.11 Varicella encephalitis and encephalomyelitis

  • B05.0 Measles complicated by encephalitis

  • B06.00 Rubella with neurological complication, unspecified

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Preferred Practice Pattern1

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Key Features

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Description

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  • Acronym for perinatal infections

    • T: toxoplasmosis

    • O: other infections

    • R: rubella

    • C: cytomegalovirus

    • H(HE): herpes simplex virus 2

    • S: Syphilis

  • Can lead to fetal loss or severe fetal anomalies

  • Congenital syndrome characterized by a variety of central nervous system, growth, cognitive, visual, and auditory deficits

  • Hepatitis B: maternal to fetal during birth, option for Caesarean section to avoid contact

  • Varicella encephalitis and encephalomyelitis

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Essentials of Diagnosis

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  • Prenatal viral, bacterial, parasitic infectious exposure resulting in congenital birth defects

  • Passed from mother to fetus in the womb across the placenta or during delivery

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General Considerations

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  • Infections that are mild may go unnoticed in a pregnant woman but can have devastating consequences for the unborn child

  • The timing of the prenatal exposure greatly impacts the long-term infant outcome; first trimester exposure is tied to more-severe deficits.

  • There is significant variability in newborn outcomes across different infectious organisms

    • Associated disorders

      • Intrauterine growth retardation resulting in infant being small for gestational age

      • Cognitive impairment ranging from mild deficits to severe mental retardation

      • Visual deficits including chorioretinitis due to central nervous system (CNS) involvement of the second cranial nerve

      • Auditory deficits secondary to eighth cranial nerve involvement

      • Skin lesions, eye lesions, and rash

      • Hepatosplenomegaly

      • Impaired motor development due to damage to the brain while developing

      • Seizures

      • Cardiac defects

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Demographics

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  • Overall rate of 17.3 infants per 1000 births receiving antibiotics for suspected neonatal sepsis2

  • Cytomegalovirus: 1 in 150 children is born with congenital CMV disease

    • Approximately 1 of every 5 children born with congenital CMV infection will develop permanent problems (such as hearing loss or developmental disabilities) due to the infection.2

    • 0.3% to 2% of live-born infants contract CMV, making it the most common intrauterine infection.3

    • Syphilis: With untreated early syphilis in pregnant women, 25% of pregnancies result in stillbirth and 14% in neonatal death, an overall perinatal mortality of about 40%.4,5

    • Rubella congenital syndrome is rare, as indicated by an incidence of fewer than 1 person in 2000.6

    • Toxoplasmosis: Approximately 3500 infected children are born ...

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