From the Guidelines
A comprehensive TORCH workup is essential for pregnant women or newborns with suspected congenital infections, and it should include serological testing for IgG and IgM antibodies against Toxoplasmosis, Other infections, Rubella, Cytomegalovirus, and Herpes simplex virus, as well as direct detection methods like PCR and imaging studies. The workup for TORCH infections involves a combination of serological tests, direct detection methods, and imaging studies to diagnose and manage congenital infections. For pregnant women with suspected infection, testing should be done promptly, with paired acute and convalescent samples taken 2-3 weeks apart to detect seroconversion 1.
Key Components of TORCH Workup
- Serological testing for IgG and IgM antibodies against Toxoplasmosis, Other infections, Rubella, Cytomegalovirus, and Herpes simplex virus
- Direct detection methods like PCR of blood, urine, or CSF depending on the suspected pathogen
- Imaging studies like cranial ultrasound to detect any fetal abnormalities
- Complete blood count and liver function tests to monitor for any adverse effects of the infection
Diagnosis and Management
For newborns, testing should include both serological tests and direct detection methods, and additional tests may include complete blood count, liver function tests, and imaging studies like cranial ultrasound 1. Early detection is crucial as some infections can be treated during pregnancy (toxoplasmosis with spiramycin 1g orally three times daily) or in the newborn period, potentially reducing long-term complications 1. These infections can cause serious consequences including developmental delays, hearing loss, vision problems, and neurological damage if left untreated.
Recent Guidelines
According to the 2017 guidelines from the American Academy of Pediatrics, the interpretation of maternal infection status has typically been based on testing at a single time point performed usually because of fetal ultrasonographic abnormalities or maternal signs or symptoms suggestive of toxoplasmosis 1. The guidelines also emphasize the importance of serologic testing for Toxoplasma-specific IgM, IgA, or IgE in neonatal serum within the first 6 months of life or persistence of specific IgG antibody beyond age 12 months to diagnose congenital toxoplasmosis 1.
From the Research
TORCH Infections Workup
The workup for TORCH (Toxoplasmosis, Other, Rubella, Cytomegalovirus, Herpes) infections involves several steps:
- Serologic screening for toxoplasmosis, rubella, cytomegalovirus, and herpes simplex virus type 1 and 2 (HSV-1 and HSV-2) should be performed in pregnant women considered to be at risk for primary infection 2.
- Suspected recent infection in a pregnant woman should be confirmed before intervention by having samples tested at a toxoplasmosis reference laboratory, using tests that are as accurate as possible and correctly interpreted 2.
- Amniocentesis should be offered to identify Toxoplasma gondii in the amniotic fluid by polymerase chain reaction (PCR) if maternal primary infection is diagnosed, if serologic testing cannot confirm or exclude acute infection, or in the presence of abnormal ultrasound findings 2.
Screening Recommendations
- Routine universal screening should not be performed for pregnant women at low risk 2.
- Screening for TORCH infections should be offered to pregnant women with ultrasound findings consistent with possible TORCH infection, including intracranial calcification, microcephaly, hydrocephalus, ascites, hepatosplenomegaly, or severe intrauterine growth restriction 2.
- Women who are immunosuppressed or HIV-positive should be offered screening because of the risk of reactivation and toxoplasmosis encephalitis 2.
Diagnosis and Management
- The diagnosis of TORCH infections can be made by detecting immunoglobulin G (IgG) and immunoglobulin M (IgM) antibodies in mothers and IgM antibodies in newborns using enzyme-linked immunosorbent assay (ELISA) testing 3.
- Treatment for toxoplasmosis in pregnancy includes spiramycin for fetal prophylaxis and a combination of pyrimethamine, sulfadiazine, and folinic acid for women in whom fetal infection has been confirmed or is highly suspected 2.
- The management of TORCH infections in pregnant women and their newborns requires a multidisciplinary approach, including obstetricians, pediatricians, and infectious disease specialists 4, 5, 6.