What Is It, Symptoms, Treatment and More
Author: Michail Mavrogiannis, MD
Illustrator: Abbey Richard
Copyeditor: Joy Mapes
What is a TORCH infection?
A TORCH infection, also known as TORCH syndrome, is an infection of the developing fetus or newborn that can occur in utero, during delivery, or after birth. It can be caused by any one of a group of infectious agents indicated in the acronym TORCH:
Herpes simplex virus (HSV)
In general, TORCH infections are responsible for 2 to 3% of all congenital disorders, or disorders present at birth. These infections can cause a variety of complications, including preterm birth, delayed development of the fetus (i.e., intrauterine growth restriction), physical malformations (e.g., deafness, patent ductus arteriosus), and sometimes, loss of the pregnancy.
What are the signs and symptoms of a TORCH infection?
Signs and symptoms of TORCH infections vary depending on the specific underlying infection. Regardless, TORCH infections can share some non-specific signs and symptoms. Early signs in the fetus or newborn may include fever, development of a small head (i.e., microcephaly), low birth weight, lethargy or sleepiness, cataracts, hearing loss, and congenital heart disease. Additionally, some newborns may present with hepatosplenomegaly, or the enlargement of the liver and spleen. Infected newborns can also appear to have reddish-brown spots on their skin (i.e., petechiae or purpura), a yellowish pigmentation of the skin and eyes (i.e., jaundice), or the "blueberry muffin" rash, which appears as bluish or purplish marks on the baby’s body. Late signs, usually occurring after the age of 2, may include vision impairment or loss, intellectual disability, deafness, and seizures.
What causes a TORCH infection?
TORCH infections can be transmitted to a newborn during a variety of stages. During pregnancy, the mother can transmit the infection to the fetus through the placenta, the organ that provides oxygen and nutrients from the mother to the developing fetus. During childbirth, the infant may catch the infection from the mother while passing through the birth canal. After birth, the mother can pass an infection to the infant through breast milk. The mothers initially become infected through a variety of different means that depend on the specific type of infection.
Toxoplasma gondii is a protozoan parasite that is primarily transmitted through consumption of undercooked meats or exposure to cat feces. It can result in toxoplasmosis, which may present as fever and fatigue in the mother. If passed to a fetus or infant, toxoplasmosis may cause inflammation of the choroid and retina in the eye (i.e., chorioretinitis), a buildup of fluid in the brain (i.e., hydrocephalus), rash, and intracranial calcifications.
In the case of rubella, a mother may become infected if they are exposed to the rubella virus through direct contact with infected saliva, mucus, or air droplets. In the mother, rubella may present with mild symptoms: swollen lymph nodes (i.e., lymphadenopathy), polyarthritis, or rashes. However, rubella that is transmitted to a developing fetus during pregnancy can result in congenital rubella syndrome, which is characterized by deafness, clouding of the eyes (i.e., cataracts), rash, and heart defects.
Like rubella, cytomegalovirus (CMV) can be transmitted through direct contact with infected bodily fluids, including saliva, tears, mucus, semen, and vaginal fluids. Although symptoms of CMV are generally mild for adults, a congenital CMV infection in a developing fetus can present with rashes, deafness, inflammation of the eye (i.e., chorioretinitis), seizures, an unusually small head (i.e., microcephaly), and intracranial calcifications.
The herpes simplex virus (HSV) is very contagious, and the two types of the virus can be transmitted in two ways. HSV-1, also called oral herpes, can be transmitted through the exchange of oral secretions (e.g., kissing, sharing utensils, sharing drinks, etc.), while HSV-2 is a sexually transmitted disease. HSV usually infects a newborn during passage through the birth canal. In infants, HSV can cause blisters and inflammation of the brain, known as meningoencephalitis.Other agents that can cause TORCH infections include Treponema pallidum, varicella zoster virus (VZV), parvovirus B19, and human immunodeficiency virus (HIV). Treponema pallidum is the bacterium that causes syphilis. When transmitted to the fetus during pregnancy, the resulting congenital syphilis can lead to fetal death. If the fetus survives, congenital syphilis may cause craniofacial malformations, rash, and deafness. Treponema pallidum can also pass from mother to infant during vaginal delivery. VZV, the virus responsible for chickenpox, can cause congenital varicella syndrome in a developing fetus. Meanwhile, severe reduction in red blood cells is a symptom of parvovirus B19, which can lead to anemia in an infected newborn. The majority of HIV infections in young children occur during delivery or breastfeeding. Newborns with HIV may present with low birth weight and hepatosplenomegaly, and they may develop recurrent bacterial infections, such as meningitis and pneumonia. In addition to these agents, Zika virus, which is carried by mosquitoes, is a recent addition to the list of infectious diseases that can cause a congenital infection.
Can a TORCH infection cause a miscarriage?
Yes, a TORCH infection can cause a miscarriage, specifically, the loss of a pregnancy during the first 20 weeks. However, the majority of miscarriages are not attributed to TORCH infections. A TORCH infection can also cause a stillbirth, defined as the loss of a pregnancy after 20 weeks of gestation. Moreover, a TORCH infection can lead to intrauterine growth restriction (IUGR), characterized by the delayed development of the fetus, and sometimes, a preterm birth.
How is a TORCH infection diagnosed?
A history of maternal infections during pregnancy is key for the early detection of a TORCH infection. Imaging and tests can also be key to prenatal diagnosis. A prenatal ultrasound can indicate unusual fetal findings, such as the enlargement of the ventricles in the fetus’ brain (i.e., ventriculomegaly), intracranial calcifications, and fetal growth restriction or retardation. Prenatal diagnosis of congenital toxoplasmosis, congenital syphilis, and parvovirus B19 infection can be confirmed through a polymerase chain reaction (PCR) test, which evaluates DNA samples usually obtained from the amniotic fluid surrounding the fetus during pregnancy. Congenital CMV can be diagnosed prenatally by a viral culture, DNA detection on a PCR test, or by CMV-specific immunoglobulin M (IgM) antibody measurement. Similarly, prenatal diagnosis of rubella is usually based on positive rubella-specific IgM testing. Finally, HSV infection can be detected prenatally through viral cultures or PCR testing.
Diagnosis of infection after the infant is delivered, or postnatally, is primarily based on physical examination of the infant and a review of signs and symptoms. Similar to prenatal diagnosis, specific diagnoses can be confirmed through viral cultures, PCR testing, and antibody measurement.
Additional tests that can be performed include brain computed tomography (CT) scans to look for brain lesions, hydrocephalus, and intracranial calcifications. Eye tests can reveal cataracts or other eye problems, and hearing tests can investigate for hearing loss.
How is a TORCH infection treated?
Treatment is highly dependent on the specific agent responsible for the infection. Infants with toxoplasmosis can be treated with pyrimethamine, an antiparasitic medication, and sulfadiazine, which is an antibiotic. If it is suspected that a mother has toxoplasmosis in the early stages of the pregnancy, spiramycin, an antibiotic and antiparasitic, may be prescribed to prevent transmission to the fetus. In all suspected cases of HSV, infection may be treated aggressively with acyclovir, an antiviral agent. Acyclovir can also treat VZV. For congenital CMV infection, treatment usually includes antiviral medications, like ganciclovir, which can reduce the risk of hearing loss and facilitate head growth. While there is no specific antiviral therapy for rubella, supportive treatment may involve screening for hearing and vision issues, as well as surgery to correct any heart defects. Because Treponema pallidum is a bacterium, penicillin, an antibiotic, can treat syphilis. Fetuses with parvovirus B19 may need intrauterine blood transfusion. Treatment for Zika virus focuses on managing symptoms by getting plenty of rest, hydrating adequately, and using medications, like acetaminophen, to reduce pain and fever. Notably, nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, should be avoided for individuals with Zika virus.
What are the most important facts to know about TORCH infections?
TORCH infections are a group of congenital infections that are passed from mother to child at some time during pregnancy, during delivery, or after birth. TORCH is an acronym representing infections caused by Toxoplasma gondii, other agents, rubella, cytomegalovirus (CMV), and herpes simplex virus (HSV). “Other agents” includes Treponema pallidum, varicella zoster virus (VZV), parvovirus B19, and Zika virus. TORCH infections may cause miscariage, stillbirth, or intrauterine growth restriction. In addition, they can cause non-specific signs and symptoms in the fetus or infant, such as microcephaly, lethargy, cataracts, hearing loss, and congenital heart diseases. Other signs include hepatosplenomegaly, petechiae or purpura, jaundice, vision loss, intellectual disability, deafness, and seizures. Each infection agent, however, usually presents with additional, specific signs and symptoms. Prenatal diagnosis is primarily based on the history of the mother’s infections during pregnancy and any fetal abnormalities apparent in a prenatal ultrasound, like ventriculomegaly, intracranial calcifications, or fetal growth restriction. Diagnosis can be confirmed, either prenatally or postnatally, via PCR testing, viral cultures, or antibody testing. Treatment is highly dependent on the specific agent responsible for the infection and may include antibiotics or antiviral agents, as well as supportive measures, such as adequate rest and hydration.
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Related linksCongenital TORCH infections: Pathology review
Congenital cytomegalovirus (NORD)
Resources for research and reference
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