TORCH infections

• 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

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

• 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

• 5C: Impaired Motor Function and Sensory Integrity Associated with Nonprogressive Disorders of the Central Nervous System – Congenital Origin or Acquired in Infancy or Childhood

Description

• 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

Essentials of Diagnosis

• 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

General Considerations

• 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

Demographics

• 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, ...