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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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  • 052.0 Postvaricella encephalitis
  • 055.0 Postmeasles encephalitis
  • 056.0 Rubella with neurological complications
  • 090.4 Juvenile neurosyphilis

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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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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 in the United States every year, and the risk of transplacental transmission is greatest during the third trimester of pregnancy; international data varies widely.7
    • Herpes simplex: Overall, approximately 2% of women ...

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