The acronym TORCH means toxoplasmosis, rubella virus, cytomegalovirus (CMV), and herpes simplex viruses. TORCH syndrome consists of a cluster of similar manifestations caused by these agents which account for most of the perinatal infections associated with serious fetal and neonatal morbidity and mortality [1] [2]. Effects of the infections include spontaneous abortions, intrauterine fetal death, fetal growth restriction, congenital fetal anomalies, premature deliveries, and stillbirths [2]. Risk factors for TORCH infection include pregnancy and immunocompromised state [3].

Toxoplasma gondii is a protozoan parasite which causes toxoplasmosis. Women become infected after consuming contaminated food or water. Following ingestion of the cysts, there is an incubation period ranging from one to three weeks. The infected woman usually does not develop any clinical manifestations but if pregnant, may suffer miscarriages, stillbirth, or may deliver a baby with congenital malformations [4] [5].

Rubella is a viral disease acquired through droplet infection. A pregnant woman, when infected, may have mild symptoms or may be asymptomatic but can transfer the infection vertically to her fetus via the placenta [6]. This can result in congenital anomalies if the infection occurs during the period of fetal organogenesis leading to fetal cardiac defects, cataracts, and hearing loss which together constitute the congenital rubella syndrome [7].

CMV infection is transmitted via direct contact with infected body fluids [8]. The incubation period ranges from one to three months and a pregnant woman can transmit the infection to the fetus transplacentally leading to fetal growth retardation, intracranial calcification with microcephaly, hepatosplenomegaly, chorioretinitis, thrombocytopenic purpura, and anemia [9].

Herpes simplex viral infection can be due to herpes simplex virus 1 (HSV1) or herpes simplex virus 2 (HSV2). HSV1 is transmitted by contacts of non-sexual nature while HSV2 is transmitted sexually. A majority of genital herpes infections in pregnancy are asymptomatic but can cause significant fetal morbidity and mortality with spontaneous abortions, premature delivery, and neonatal herpes infection [10] [11] [12] [13].

• Splenomegaly

  Cytomegalic inclusion disease can include hepatomegaly, splenomegaly, paraventricular calcification, and intrauterine growth retardation. [ncbi.nlm.nih.gov]

  Unexplained enlarged placenta Nephrotic syndrome (rare, usually at 2-3 months of age) The above are relatively specific for congenital syphilis, compared with other nonspecific signs of congenital infection: Hepatomegaly +/-splenomegaly (NB splenomegaly [adhb.govt.nz]

  Although the signs and symptoms may vary among those affected, the most common include: chorio-retinitis, splenomegaly, cerebral calcifications, epilepsy, anemia, febrile episodes, alterations of cerebrospinal fluid, etc. [lifepersona.com]

  Enlarged liver or spleen (Hepatomegaly and splenomegaly). Low platelet level. leads to hemorrhagic pneumonitis and petechiae. Jaundice due to hemolytic anemia. Cerebral calcification. Micrencephaly. [labpedia.net]

  The major findings in congenital rubella include hepatomegaly and hepatitis, splenomegaly with extramedullary hematopoeisis, congenital heart disease (patent ductus arteriosus, ventricular septal defect, atrial septal defect, pulmonic stenosis), myocardial [healio.com]

• Fever

  Rubella is a viral infection characterized by fever, upper respiratory infection, swelling of the lymph nodes, skin rash, and joint pain. [rarediseases.org]

  They include hepatosplenomegaly (enlargement of the liver and spleen), fever, lethargy, difficulty feeding, anemia, petechiae, purpurae, jaundice, and chorioretinitis. [en.wikipedia.org]

  Meningoencephalitis may develop with fever, seizures, neurological disorders. Cases of sepsis caused by herpes viruses in newborns have also been reported. [synevo.ge]

• Fatigue

  TORCH viral infections Cytomegalovirus Primary CMV infection is either asymptomatic or causes fever, fatigue, and enlarged lymph nodes. Primary, reactivated, or recurrent CMV infection can occur in pregnancy. [dermnetnz.org]

  In immunocompetent people it either occurs asymptomatically or with nonspecific symptoms - fatigue, fever, and enlarged lymph nodes (most often the neck lymph nodes). Acute toxoplasmosis is asymptomatic in most pregnant women. [synevo.ge]

  Cytomegalovirus: If you have this infection, you will be treated for individual symptoms like fatigue, fever and hepatomegaly. Treatment for neonates with CMV is not very effective. 4. [momjunction.com]

  "All of these viruses can cause an acute disease with symptoms lasting several weeks including yellowing of the skin and eyes (jaundice); dark urine; extreme fatigue; nausea; vomiting and abdominal pain. [embryology.med.unsw.edu.au]

• Failure to Thrive

  R  —  rubella C  —  cytomegalovirus H  —  herpes simplex Clinical signs intrauterine growth retardation or failure to thrive hydrops fetalis jaundice or hepatosplenomegaly skin rash (various) CNS damage: hydrocephalus (CMV, Toxoplamosis) or microcephaly [atlases.muni.cz]

  IUGR; failure to thrive. Investigations FBC, LFTs and syphilis serology on infant blood. Maternal syphilis serology. Infant CSF for VDRL, cells count and differential, protein and glucose concentrations. [adhb.govt.nz]

  Generally, symptoms may include: Anemia Irritability Failure to thrive Rashes Developmental and learning disabilities TORCH Infection Diagnosis: TORCH Screen Diagnosis of TORCH infection or another congenital infection is done through a TORCH screen. [nortonchildrens.com]

  In newborns: failure to thrive irritability watery nasal discharge (“sniffles”) rash and lesions early rash: small blisters on palms and soles of feet late rash: copper-colored on palms, soles, and face rash around mouth, genitalia, anus severe pneumonia [childrenshospital.org]

• Jaundice

  They include hepatosplenomegaly (enlargement of the liver and spleen), fever, lethargy, difficulty feeding, anemia, petechiae, purpurae, jaundice, and chorioretinitis. [en.wikipedia.org]

  However, this is less common in Hep B as jaundice occurs due to an immune response against the liver and the immune system in a newborn is not effective enough to damage the liver enough to cause jaundice. [dictionnaire.sensagent.leparisien.fr]

  […] addition, affected infants may develop areas of bleeding, resulting in reddish or purplish spots or areas of discoloration visible through the skin (petechia or purpura); yellowish discoloration of the skin, whites of the eyes, and mucous membranes (jaundice [rarediseases.org]

  But a number of problems can happen -- from jaundice (yellowish skin or eyes) and hearing problems to miscarriage and stillbirth. Toxoplasmosis Toxoplasmosis is rare and it’s caused by a parasite. [webmd.com]

  […] for T. gondii DNA Pyrimethamine, sulfadiazine, and folinic acid Avoidance of uncooked meat Avoidance of handling cat feces Immediate administration of spiramycin to prevent of fetal toxoplasmosis Syphilis Early congenital syphilis (onset < 2 years) Jaundice [amboss.com]

• Hepatosplenomegaly

  These may include fever; difficulties feeding; small areas of bleeding under the skin, causing the appearance of small reddish or purplish spots; enlargement of the liver and spleen (hepatosplenomegaly); yellowish discoloration of the skin, whites of [listeningears.in]

  They include hepatosplenomegaly (enlargement of the liver and spleen), fever, lethargy, difficulty feeding, anemia, petechiae, purpurae, jaundice, and chorioretinitis. [en.wikipedia.org]

  Ultrasound scan of the abdomen – to look for hepatosplenomegaly and neuroblastoma. [dermnetnz.org]

  However, there are some common signs and symptoms: generalized growth retardation, fever, hepatosplenomegaly, anemia, petechiae, Hydrocephalus, Calcifications, etc. (Díaz Villegas, 2016). [lifepersona.com]

• Hepatomegaly

  On the contrary, findings resembling congenital infectious diseases including neonatal icterus, hyperbilirubinemia, thrombocytopenia, and hepatomegaly, affect less than half of the patients. [ncbi.nlm.nih.gov]

  These may include listlessness (lethargy), fever, difficulties feeding, enlargement of the liver and spleen (hepatomegaly), and decreased levels of the oxygen-carrying pigment (hemoglobin) in the blood (anemia). [rarediseases.org]

  Jaundice and hepatomegaly reflect liver involvement, while thrombocytopenia and petechiae are hematologic manifestations. [healio.com]

• Hearing Impairment

  Causes of Hearing Impairment January 24, 2017 The Auditory System and Voice Production January 27, 2017 TORCH syndrome is a cluster of symptoms. [listeningears.in]

  Severely affected newborns and infants may have visual and/or hearing impairment, heart defects, calcium deposits in the brain, and/or other abnormalities. [rarediseases.org]

  Hearing impairment, eye problems, mental retardation, autism, and death can be the result of TORCH infections. Discuss TORCH Syndrome in our forums Discuss TORCH Syndrome with other members of Medigest in our forums. [medigest.uk]

  impairment, mental retardation, autism and pneumonitis. [invitro-test.com]

It is difficult to diagnose TORCH infections in pregnant women clinically as patients are often asymptomatic and do not manifest any signs. Serology testing forms the mainstay with the detection of corresponding antibodies. Polymerase chain reaction (PCR) is also used to identify the infection and for subsequent follow-up [3]. An adequate diagnosis may require a laboratory which offers specialized tests as serology is difficult to interpret, especially in CMV infection.

A primary CMV infection can be diagnosed in a pregnant woman by positive CMV IgM, IgG, and low IgG avidity, while more precise methods are composed of PCR testing of urine or serum samples and a rapid virus isolation. PCR is also used to detect HSV from genital lesions in pregnancy. Cultures from infected skin, oral and ocular lesions or cerebrospinal fluid (CSF) in infected neonates can help to diagnose HSV infection. Rubella can be detected in a pregnant woman with IgM and IgG antibody levels [14]. In ambiguous cases, amniotic fluid PCR and viral culture may be required to confirm the diagnosis.Ultrasonography is indicated to detect fetal complications resulting from these perinatal infections. Findings include fetal growth retardation, cardiac defects, microcephaly and intracranial calcifications in the case of CMV infection.

Ultrasonography is indicated to detect fetal complications resulting from TORCH infections. Findings may include fetal growth retardation, cardiac defects, microcephaly, and intracranial calcifications. A fetal echocardiogram can be performed if cardiac anomalies are detected on ultrasonography. Invasive tests like chorionic villus sampling and amniocentesis can also be performed to confirm TORCH syndrome but these tests are associated with a high incidence of fetal morbidity and loss.

Invasive tests like chorionic villus sampling and amniocentesis can also be performed to confirm TORCH syndrome but these tests are associated with a significant possibility of complications.

[citation needed] Prevention[edit] TORCH syndrome can be prevented by treating an infected pregnant woman, thereby preventing the infection from affecting the fetus.[4] Treatment[edit] The treatment of TORCH syndrome is mainly supportive and depends on [en.wikipedia.org]

The treatment of this medical condition usually focuses on the treatment of symptoms and medical complications. In the case of severe alterations during pregnancy, intrauterine transfusion may be used. [lifepersona.com]

Management and Treatment How are TORCH infections treated? Treatment for TORCH infections depends on the disease, when the infection occurred and the severity of symptoms. It may include antibiotics, antiparasitics or antiviral medications. [my.clevelandclinic.org]

In this review we discuss etiology, epidemiology, clinical, laboratory, radiologic, and pathologic findings, differential diagnosis, therapy, course, and prognosis of each of these congenital infections. [ncbi.nlm.nih.gov]

Treatment and prognosis The treatment and prognosis depends upon the underlying cause. See smartphone apps to check your skin. [Sponsored content] Related information [dermnetnz.org]

Prognosis Each type of TORCH infection has a different prognosis. The stage of the pregnancy at the time of infection also can change the effect on the newborn. Additional images CMV placentitis1.jpg CMV placentitis. [dictionnaire.sensagent.leparisien.fr]

Prognosis - TORCH syndrome Not supplied. Treatment - TORCH syndrome Treatment aims to relieve symptoms and prevent complications. [checkorphan.org]

In this review we discuss etiology, epidemiology, clinical, laboratory, radiologic, and pathologic findings, differential diagnosis, therapy, course, and prognosis of each of these congenital infections. [ncbi.nlm.nih.gov]

The etiology of BA is poorly understood. There is controversy about the etiological role of viruses. The studies have implicated reoviruses, rotaviruses and CMV [7]. [peertechz.com]

They are organised into groups, and further divided into clinical, etiological or histopathological sub-types. [orpha.net]

Neonatal pathology nonrelated to prematurity, birth asphyxia or infection + Congenital anomalies in liveborn infants + Kernicterus + Hemorrhagic disease of the newborn + Spontenous gastric perforation in a neonate Intrauterine infections (TORCH group) Etiology [atlases.muni.cz]

Congenital syphilis ∼ 23:100,000 live births per year in the US [7] Pathogen Treponema pallidum Transmission [7] Mother Sexual contact (contact with infectious lesion) See “Etiology” in “Syphilis.” [amboss.com]

Gabriele Halwachs-Baumann, Epidemiology - the influence of socioeconomic differences, Congenital Cytomegalovirus Infection, 10.1007/978-3-7091-0208-4_3, (53-73), (2011). [dx.doi.org]

In this review we discuss etiology, epidemiology, clinical, laboratory, radiologic, and pathologic findings, differential diagnosis, therapy, course, and prognosis of each of these congenital infections. [ncbi.nlm.nih.gov]

[…] pregnant woman, thereby preventing the infection from affecting the fetus.[4] Treatment[edit] The treatment of TORCH syndrome is mainly supportive and depends on the symptoms present; medication is an option for herpes and cytomegalovirus infections.[1] Epidemiology [en.wikipedia.org]

The specific infection may cause additional symptoms.[1] TORCH syndrome may develop before birth, causing stillbirth, in the neonatal period, or later in life.[4] Pathophysiology[edit] TORCH syndrome is caused by in-utero infection with one of the TORCH [en.wikipedia.org]

Pathophysiology TORCH profile includes the following tests: Toxoplasmosis antibody. Rubella antibody. Herpes Simplex. Cytomegalovirus some people include syphilis as well. [labpedia.net]

RUBELLA In 1941, Gregg discovered that maternal rubella during the first trimester of pregnancy was associated with an increased incidence of cataracts, deafness, and congenital heart disease.1 Most of our knowledge of the pathophysiology of congenital [healio.com]

The results observed in our study could possibly be caused by a similar pathophysiological effect of CMV IgG antibodies. [frontiersin.org]

[…] infection with Toxoplasma gondii, cytomegalovirus, or herpes simplex virus (HSV) Distinguishing between infection caused by HSV types 1 and 2, especially in patients with subclinical or unrecognized HSV infection Clinical Information Discusses physiology, pathophysiology [mayomedicallaboratories.com]

[citation needed] Prevention[edit] TORCH syndrome can be prevented by treating an infected pregnant woman, thereby preventing the infection from affecting the fetus.[4] Treatment[edit] The treatment of TORCH syndrome is mainly supportive and depends on [en.wikipedia.org]

Treatment of Syphilis in Pregnancy and Prevention of Congenital Syphilis. [amboss.com]

Since your baby lacks immunity to fight off diseases, TORCH infections can cause complications to the pregnancy or prevent your baby’s organs from developing properly. [my.clevelandclinic.org]

1. Stegmann BJ, Carey JC. TORCH Infections. Toxoplasmosis, Other (syphilis, varicella-zoster, parvovirus B19), Rubella, Cytomegalovirus (CMV), and Herpes infections. Curr Women's Health Rep. 2002;2:253–258.
2. Maruyama Y, Sameshima H, Kamitomo M, et al. Fetal manifestations and poor outcomes of congenital cytomegalovirus infections: possible candidates for intrauterine antiviral treatments. J Obstet Gynaecol. 2007;33(5):619–623.
3. Singh L, Mishra S, Prasanna S, Cariappa MP. Seroprevalence of TORCH infections in antenatal and HIV positive patient populations. Med J Armed Forces India. 2015;71(2):135–138
4. Montoya JG, Remington JS. Toxoplasma gondii. In: Mandel GL, Bennett JE, Dolin R, editors. Mandell, Douglas, and Bennetts’ Principles and Practice of Infectious Diseases. 5. Philadelphia: Churchill Livingstone. 2000; 2858–2888.
5. Jones J, Lopez A, Wilson M. Congenital toxoplasmosis. Am Fam Physician. 2003;67:2131–2138.
6. Prasoona KR, Srinadh B, Sunitha T, et al. Seroprevalence and Influence of Torch Infections in High Risk Pregnant Women: A Large Study from South India.J Obstet Gynaecol India. 2015;65(5): 301–309.
7. Lee JY, Bowden DS. Rubella virus replication and links to teratogenicity. Clin Microbiol Rev. 2000;13:571–587.
8. Fowler KB, Pass RF. Risk factors for congenital cytomegalovirus infection in the offspring of young women: exposure to young children and recent onset of sexual activity. Pediatrics. 2006;118:e286–e292.
9. Al-Hareth Z, Monem F, Abdel Megiud N. Is low birth weight a risk indicator for congenital cytomegalovirus infection? J. Infect Dev Ctries. 2010;4:044–047.
10. O’Riordan DP, Golden WC, Aucott SW. Herpes simplex virus infections in preterm infants. Pediatrics. 2006;118(6):e1612–e1620.
11. Brown ZA, Benedetti J, Ashley R, et al. Neonatal herpes simplex virus infection in relation to asymptomatic maternal infection at the time of labor. New Engl J Med. 1991;324(18):1247–1252.
12. Brown ZA, Selke S, Zeh J, et al. The acquisition of herpes simplex virus during pregnancy. New Engl J Med. 1997;337(8):509–515.
13. Biswas D, Borkakoty B, Mahanta J, et al. Seroprevalence and risk factors of herpes simplex virus type-2 infection among pregnant women in Northeast India. BMC Infect Dis. 2011;11:325.
14. Miller E, Cradock-Watson JE, Pollock TM. Consequences of confirmed maternal rubella at successive stages of pregnancy. Lancet.1982; 2(8302):781-784.