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]

  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]

  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]

• Fever

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

  Signs and symptoms include fever, feeding difficulties, petechial rash, jaundice, hepatosplenomegaly, chorioretinitis, and microcephaly. [curofy.com]

  Clinical aspects May include fever, difficulties feeding, small areas of bleeding under the skin (petechial rash), hearing impairment, abnormalities of the eyes, seizures, mental retardation. [accessanesthesiology.mhmedical.com]

• 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]

  […] facial development or mental ability is impaired because the mother drinks alcohol during pregnancy Gulf War syndrome, Persian Gulf illness - a medical condition of uncertain origin that affected many veterans of the 1991 Gulf War; characterized by fatigue [thefreedictionary.com]

  The treatment of cytomegalovirus is done according to the patient’s symptoms, such as fever or fatigue. In the case of Herpes Simplex virus, your doctor might suggest cesarean delivery if active lesions are found. [flo.health]

  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]

• Pediatric Disease

  Guide to pediatrics. Diseases of the fetus and newborn, congenital metabolic disorders. R.E. Berman, V.K. Vogan (eds). Trans. from English. Moscow: Meditsina, 1987; 504. (in Russ.) 21. Volpe J.J. Neurology of the newborn. Philadelphia: W.B. [ped-perinatology.ru]

• 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]

  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]

  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]

• Jaundice

  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]

  Signs and symptoms include fever, feeding difficulties, petechial rash, jaundice, hepatosplenomegaly, chorioretinitis, and microcephaly. [curofy.com]

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

  Diagnosis Association of intrauterine growth retardation, a hepatosplenomegaly, microcephaly, eye anomalies (chorioretinitis), jaundice, intracranial calcifications, and high intracranial pressure. Blood screening is possible. [accessanesthesiology.mhmedical.com]

  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]

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

  The acronym TORCH refers to a group of common infections, and is universally used to characterize a clinical status of fetuses or newborns which is compatible with a congenital infection, including rash, hepatosplenomegaly, hydrocephalus or microcephaly [medigraphic.com]

  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]

  Cytomegalic inclusion disease can include hepatomegaly, splenomegaly, paraventricular calcification, and intrauterine growth retardation. [pubmed.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]

• 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]

  Clinical aspects May include fever, difficulties feeding, small areas of bleeding under the skin (petechial rash), hearing impairment, abnormalities of the eyes, seizures, mental retardation. [accessanesthesiology.mhmedical.com]

  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]

  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]

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

• Vertigo

  […] and cataracts and some forms of cancer and other diseases; severe exposure can cause death within hours; "he was suffering from radiation" Ramsay Hunt syndrome - syndrome resulting from infection by the herpes varicella zoster virus; characterized by vertigo [thefreedictionary.com]

• Paresthesia

  […] experienced by a patient and is associated with a particular disease cervical disc syndrome, cervical root syndrome - an abnormal condition resulting from compression of spinal nerve roots in the neck region; involves neck pains and muscular weakness and paresthesia [thefreedictionary.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.

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]

Protocols for the diagnosis, treatment and prevention of intrauterine infections in newborns. Moscow, 2002; 100. (in Russ.) 7. Karpova A.L., Narogan M.V., Karpov N.Yu. Congenital cytomegalovirus infection: diagnosis, treatment and prevention. [ped-perinatology.ru]

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]

Your doctor will further elaborate if your test results are positive and recommend the best treatment. TORCH infections treatment The treatment or management of TORCH diseases differs and is based on the symptoms. [flo.health]

No specific therapy for congenital rubella or cytomegalovirus infections has been established, and so treatment is primarily supportive. [ncbi.nlm.nih.gov]

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]

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. [bionity.com]

Treatment and prognosis The treatment and prognosis depends upon the underlying cause. [dermnetnz.org]

Prognosis The prognosis is variable but can be severe with several of the reported patients dying within the first year of life. The documents contained in this web site are presented for information purposes only. [orpha.net]

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]

Introduction The etiology of extensive intracranial calcification in an infant mainly includes various congenital infections such as those caused by toxoplasmosis, rubella, cytomegalovirus (CMV), herpes (TORCH) group of organisms acquired during ante-natal [go.gale.com]

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

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]

This study intuitively describes the epidemiological characteristics and the disease burden of hospitalized children with congenital TORCH infections. [journals.plos.org]

Pathophysiology TORCH Syndrome refers to infection of a developing fetus or newborn by any of a group of infectious agents. Other agents include: Coxsackie, Treponema pallidum (syphilis), HIV, parvovirus B19, and herpes zoster. [accessanesthesiology.mhmedical.com]

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]

[…] 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 [mayocliniclabs.com]

Protocols for the diagnosis, treatment and prevention of intrauterine infections in newborns. Moscow, 2002; 100. (in Russ.) 7. Karpova A.L., Narogan M.V., Karpov N.Yu. Congenital cytomegalovirus infection: diagnosis, treatment and prevention. [ped-perinatology.ru]

[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]

However, some viral infections, notably rubella and varicella-zoster, can be prevented by vaccinating the mother prior to pregnancy. [bionity.com]

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

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

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