What systems can TORCH (Toxoplasmosis, Other, Rubella, Cytomegalovirus, Herpes simplex virus) infections affect in newborns or individuals with compromised immune systems?

Systems Affected by TORCH Infections

TORCH infections cause multisystem disease affecting primarily the central nervous system, eyes, hematopoietic system, hepatobiliary system, cardiovascular system, and auditory system in newborns and immunocompromised individuals. 1

Central Nervous System (CNS)

The CNS is one of the most severely affected systems in TORCH infections, with potentially devastating long-term consequences:

• Structural brain abnormalities include hydrocephalus, intracerebral calcifications (diffuse in toxoplasmosis, paraventricular in CMV), microcephaly, ventriculomegaly, intraventricular adhesions, and subependymal cysts 2, 1, 3
• Neurologic impairment manifests as seizures, intellectual disability, developmental delays, and reduced alertness 2, 1
• Toxoplasma encephalitis presents with focal neurological deficits (most common), though diffuse CNS disease can occur, particularly in HIV-infected children 4
• Herpes simplex virus causes CNS disease in 35% of neonatal infections, with encephalitis occurring in 60-75% of infants with disseminated disease 2

Ocular System

Eye involvement is a hallmark feature across TORCH infections:

• Chorioretinitis is characteristic of congenital toxoplasmosis, appearing as white retinal lesions with minimal hemorrhage and potential visual loss 2, 1
• Retinopathy occurs in congenital rubella 5
• Visual impairment develops in the majority of asymptomatic infants with congenital toxoplasmosis as a late sequela, with onset ranging from months to years 2, 6
• Conjunctivitis is seen in 40% of neonates with localized herpes simplex virus infection 2

Auditory System

Hearing loss represents a major long-term complication:

• Sensorineural hearing loss (SNHL) is a leading consequence of congenital CMV infection, accounting for up to 10% of SNHL cases in newborns, both unilateral and bilateral 7
• Hearing impairment occurs as a late sequela in congenital toxoplasmosis 2, 6
• Deafness is a significant clinical sign in congenital rubella 5
• The hearing loss may be present at birth or develop later with progressive deterioration 7, 8

Hematopoietic System

Blood and bone marrow involvement causes multiple cytopenias:

• Thrombocytopenia with bleeding and bruising is common across TORCH infections 1, 5, 8
• Anemia occurs in congenital toxoplasmosis 2
• Neutropenia is seen in toxoplasmosis 2
• Petechiae and purpura are cutaneous manifestations of hematologic involvement in toxoplasmosis, rubella, and CMV infections 5

Hepatobiliary System

Liver involvement produces characteristic clinical findings:

• Hepatosplenomegaly is a common finding in generalized TORCH infections 2, 1, 5
• Jaundice occurs in newborns with congenital infections 2, 1, 5
• Liver dysfunction and hyperbilirubinemia are documented complications 8
• Hepatitis can occur in reactivated chronic toxoplasmosis among HIV-infected children 2

Cardiovascular System

Cardiac involvement varies by pathogen:

• Congenital heart disease is a significant complication of congenital rubella 5, 8
• Myocardial impairment occurs in TORCH infections 8
• Cardiomyopathy/myocarditis is a less frequently observed presentation in HIV-infected children with reactivated toxoplasmosis 2

Dermatologic System

Skin manifestations provide important diagnostic clues:

• Maculopapular rash occurs in congenital toxoplasmosis and as a mononucleosis-like syndrome in acquired infection 2
• Vesicular lesions are present in approximately 80% of neonates with localized HSV disease but only 60% with CNS or disseminated disease 2
• Dermal erythropoiesis is commonly seen in toxoplasmosis, rubella, and CMV infections 5
• Oral ulcers characterize primary HSV gingivostomatitis 2

Lymphatic System

Lymph node involvement is characteristic:

• Generalized lymphadenopathy occurs in congenital toxoplasmosis 2
• Cervical lymphadenopathy is seen in acquired toxoplasmosis, often presenting as a mononucleosis-like syndrome 2
• Tender submandibular lymphadenopathy accompanies primary HSV gingivostomatitis 2

Respiratory System

Pulmonary complications occur less frequently:

• Pneumonitis is a less common presentation in HIV-infected children with reactivated toxoplasmosis 2
• Lung involvement can occur in disseminated HSV with visceral disease 2

Gastrointestinal System

GI manifestations include:

• Failure to thrive and diarrhea are presenting features in severe congenital infections 2
• Esophagitis can occur in HIV-infected children with severe immunocompromise from HSV 2

Renal and Adrenal Systems

Visceral involvement in disseminated disease:

• Kidney, spleen, and adrenal involvement occur in disseminated HSV among immunocompromised children 2

Clinical Pitfall

The majority (70-90%) of infants with congenital TORCH infections are asymptomatic at birth, yet most will develop severe late sequelae affecting multiple organ systems. 2, 6, 1 This underscores the critical importance of serologic screening during pregnancy and systematic evaluation of at-risk newborns, even in the absence of clinical symptoms at birth.