TORCH is an acronym that is used to describe the more common fetal infections : T oxoplasmosis O ther, which refers to syphilis an...
TORCH is an acronym that is used to describe the more common fetal infections :
- T oxoplasmosis
- O ther, which refers to syphilis and HIV infection principally, but may also refer to gonorrhoea and varicella
- R ubella
- C ytomegalovirus
- H erpes, and also hepatitis
- protozoal infection (Toxoplasma gondii)
- incidence: 1/1000 pregnancies
- source: raw meat, unpasteurized goatÃs milk, cat urine/feces
- greatest risk of transmission in T3
- severity of fetal infection greatest in T1
- 75% asymptomatic at birth, but may later develop sequelae
- risk of congenital toxoplasmosis (chorioretinitis, hydrocephaly,intracranial calcifications, MR, microcephaly) if primary maternal infection during pregnancy
- diagnosis based on serologic testing for both IgM and IgG
- confirmation of diagnosis based on presence of IgM antibodies in cord blood
- self-limiting infection, spiramycin (macrolide) decreases fetal morbidity
Rubella
- RNA togavirus with transmission by respiratory droplets (highly contagious)
- maternal infection during pregnancy (greatest in T1) may cause spontaneous abortion or Congenital Rubella Syndrome: hearing loss, cataracts, cardiovascular lesions, MR, symmetric IUGR, hepatitis, CNS defects and osseous changes
- diagnosis best made by serologic testing
- all pregnant women screened for rubella immunity (rubella titer > 1:16 = immune)
- non-immune
- should be offered vaccination following pregnancy (not a contraindication for breast feeding)
- rubella vaccine should be avoided before (3 months) or during pregnancy since it is an attenuated live vaccine
- DNA virus (herpes family)
- transmission:
- blood transfusion
- organ transplant
- sexual contact
- breast milk
- transplacental
- direct contact during delivery
- congenital infection can occur from primary or re-infection of the mother
- increased fetal morbidity with primary infection
- risk of transmission constant across trimesters
- 5-10% of fetuses infected in utero will develop neurologic involvement (MR, cerebral calcification, hydrocephalus or microcephaly, deafness, chorioretinitis)
- diagnosis:
- isolation of virus in urine culture (or culture of other secretions)
- serologic screening for antibodies
