From the Guidelines
TORCH syndrome refers to a group of infections that can be transmitted from a mother to her baby during pregnancy or childbirth, potentially causing serious birth defects or developmental problems. The acronym TORCH stands for Toxoplasmosis, Other (including syphilis, varicella-zoster, parvovirus B19), Rubella, Cytomegalovirus (CMV), and Herpes simplex virus. These infections can cross the placenta and affect the developing fetus, leading to various complications such as growth restriction, microcephaly, hearing loss, vision problems, intellectual disability, or even fetal death. Some key points to consider in the management and prevention of TORCH syndrome include:
- Prenatal screening for these infections, as recommended by the Society for Maternal-Fetal Medicine 1
- Good hygiene practices, especially handwashing, to prevent the spread of infections
- Avoiding undercooked meat and avoiding cat litter during pregnancy to prevent toxoplasmosis
- Ensuring rubella vaccination before pregnancy to prevent congenital rubella syndrome
- Early detection and intervention are essential to manage complications and improve outcomes for affected infants, with treatment depending on the specific infection and may include antibiotics for bacterial infections or antivirals for viral infections, though many congenital infections have limited treatment options once established 1. It is also important to note that some studies have investigated the association between prenatal exposure to viral infections and the risk of neuropsychiatric disorders in offspring, highlighting the need for further research in this area 1. Overall, a comprehensive approach to prevention, diagnosis, and management of TORCH syndrome is crucial to minimize its impact on maternal and fetal health.
From the Research
Definition of TORCH Syndrome
TORCH syndrome refers to a group of congenital infections caused by certain pathogens, including:
- Toxoplasmosis
- Rubella
- Cytomegalovirus (CMV)
- Herpes simplex virus (HSV) These infections can cause significant morbidity and mortality in newborns, and early recognition and diagnosis are crucial for effective management 2, 3, 4, 5.
Causes and Epidemiology
The causes of TORCH syndrome include:
- Toxoplasma gondii
- Rubella virus
- Cytomegalovirus
- Herpes simplex virus, types 1 and 2
- Other pathogens, such as syphilis, varicella-zoster, parvovirus B19, and hepatitis viruses The epidemiology of these infections varies, with a higher incidence in low-income and middle-income countries 2, 3.
Clinical Manifestations
The clinical manifestations of TORCH syndrome can include:
- Cutaneous manifestations, such as petechiae, purpura, jaundice, and dermal erythropoiesis
- Extracutaneous signs and symptoms, such as diffuse intracerebral calcification, chorioretinitis, microcephaly, deafness, congenital heart disease, retinopathy, and brain calcification
- Hepatomegaly, splenomegaly, paraventricular calcification, and intrauterine growth retardation
- Localized or disseminated congenital herpes virus infection, often involving the central nervous system and the eye 5.
Diagnosis and Treatment
Diagnosis of TORCH syndrome is confirmed by:
- Culture and identification of species-specific immunoglobulin M within the first 2 weeks of life
- Histological examination
- TORCH screening using serum IgM, CMV urine culture, quantification of CMV DNA with real-time polymerase chain reaction, and rapid plasma reagin qualitative test for syphilis Treatment for TORCH syndrome includes:
- Pyrimethamine with sulfadiazine or trisulfapyrimidine for toxoplasmosis
- Acyclovir for congenital herpes simplex virus infection
- Supportive care for congenital rubella and cytomegalovirus infections 5, 6.