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].

• Fever

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

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

• Splenomegaly

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

  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]

  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]

  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]

  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]

• 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]

• 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]

  […] 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]

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

  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]

  Symptoms - TORCH syndrome * Enlarged liver * Enlarged spleen * Chorioretinitis * Fetal malformations * Jaundice * Low blood platelet level * Central nervous system abnormalities * Asymptomatic manifestations may occur later in life * Brain infection * [checkorphan.org]

• Hepatosplenomegaly

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

  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]

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

  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, [symptoma.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]

• Cutaneous Manifestation

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

• 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]

  The child had delayed developmental milestones, hypertonic reflexes, and a bilateral sensorineural hearing impairment. [nature.com]

• Short Attention Span

  Later, ataxic ( unsteady) gait hand -flapping, happy demeanor with frequent laughter, intellectual disability, hyperactivity, short attention span, severe language impairment, feeding problems, chewing/mouthing objects, gene involved is on chromosome [healthtap.com]

• Akinesia

  The differential diagnosis of intracranial calcification in an infant includes congenital infections like TORCH group, various genetic conditions such as AGS, CS, fetal akinesia deformation sequence (FADS), and Fowler type. [asianjns.org]

  The spinal motor cell loss was thought to explain the intrauterine akinesia, arthrogryposis, and neurogenic muscle atrophy (8). [pubs.rsna.org]

• Generalized Seizure

  Case Report An 8-month-old male child presented with repeated episodes of generalized seizure and microcephaly since birth. Ante-and perinatal history were insignificant. Head circumference (42 cm) was grossly below the average value for that age. [asianjns.org]

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.

• Posterior Fossa Cysts

  Dandy–Walker syndrome is a group of congenital hind brain anomaly with large posterior fossa cyst. [asianjns.org]

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