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]

  Symptoms and Signs Symptoms of a TORCH infection may include fever and poor feeding. An enlarged liver and spleen (hepatosplenomegaly) is typical, as is the yellowish discoloration of the skin and eyes called jaundice. [medigest.uk]

• 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]

  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]

• Abdominal Mass

  Jon Hyett, Intra‐abdominal masses: prenatal differential diagnosis and management, Prenatal Diagnosis, 28, 7, (645-655), (2008). [dx.doi.org]

• Oral Ulcers

  In herpes simplex virus infections, 80% of symptomatic infants show single or grouped cutaneous vesicles, oral ulcers, or conjunctivitis. Extracutaneous signs and symptoms are variable and can be severe. [ncbi.nlm.nih.gov]

• 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]

  Cutaneous manifestations, including petechiae, purpura, jaundice, and dermal erythropoiesis, are commonly seen in toxoplasmosis, rubella, and cytomegalovirus infections. [ncbi.nlm.nih.gov]

  […] 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]

  An enlarged liver and spleen (hepatosplenomegaly) is typical, as is the yellowish discoloration of the skin and eyes called jaundice. Hearing impairment, eye problems, mental retardation, autism, and death can be the result of TORCH infections. [medigest.uk]

• 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]

  It is important to consider TORCH infections whenever a neonate presents with intrauterine growth restriction (IUGR), microcephaly, intracranial calcifications, conjunctivitis, hearing loss, rash, hepatosplenomegaly, or thrombocytopenia. [pedclerk.bsd.uchicago.edu]

• 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]

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

  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]

  Fetus: repeated ultrasound examinations (placentomegaly, hepatomegaly, ascites, and/or hydrops fetalis) Treatment 14 days of IV penicillin G for both pregnant women and newborns Prevention Hutchinson triad: interstitial keratitis, sensorineural hearing [amboss.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.

[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[edit] Developing countries are more severely affected by TORCH syndrome [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]

Treatment - TORCH syndrome Treatment aims to relieve symptoms and prevent complications. In the immunosuppressed patient, CMV may be treated with acyclovir, ganciclovir, valganciclovir, cidofovir and, possibly, foscarnet. [checkorphan.org]

The congenital effects are not amenable to change or to amelioration by any known treatment. [medical-dictionary.thefreedictionary.com]

Diagnosis Treatment Prevention Congenital listeriosis Epidemiology Pathogen Transmission Clinical features Diagnosis Treatment Prevention Congenital varicella infection Epidemiology Pathogen Transmission Clinical features Diagnosis Treatment Prevention [amboss.com]

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]

Exhaustive TORCH Pathogen Diagnostics Corroborate Zika Virus Etiology of Congenital Malformations in Northeastern Brazil. mSphere, 3,. [embryology.med.unsw.edu.au]

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 person, thereby preventing the infection from affecting the fetus.[3] 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.[3] 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]

[…] 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]

[edit] TORCH syndrome can be prevented by treating an infected pregnant person, thereby preventing the infection from affecting the fetus.[3] Treatment[edit] The treatment of TORCH syndrome is mainly supportive and depends on the symptoms present; medication [en.wikipedia.org]

Diagnosis Treatment Prevention Congenital listeriosis Epidemiology Pathogen Transmission Clinical features Diagnosis Treatment Prevention Congenital varicella infection Epidemiology Pathogen Transmission Clinical features Diagnosis Treatment Prevention [amboss.com]

Prevention. With widespread use of effective live vaccines for the past decade, rubella is now largely a preventable disease. [healio.com]

Many of the viral TORCH infections have no effective treatment, but some, notably rubella and varicella-zoster, can be prevented by vaccinating the mother prior to pregnancy. [dictionnaire.sensagent.leparisien.fr]

Rubella and varicella-zoster can be prevented by vaccinating the mother prior to pregnancy. If the mother has active herpes simplex, delivery by Caesarean section can prevent the newborn from contact, and consequent infection, with this virus. [siemens-healthineers.com]

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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.
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