Congenital TORCH infections: Pathology review

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Congenital TORCH infections: Pathology review



Congenital TORCH infections: Pathology review

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A 6-day-old male infant is brought to the emergency department after an episode of generalized seizure. He has also experienced lethargy and poor feeding. The mother had limited access to prenatal care. The patient was delivered at home by a midwife. During the third trimester of pregnancy, the mother developed multiple painful genital lesions that persisted until labor. Temperature is 40.1°C (104.2°F), blood pressure is 70/50 mmHg, pulse is 140/min, and respiratory rate is 37/min. Weight is at the 20th percentile, and head circumference is at the 40th percentile. The anterior fontanelle is open, and facial features appear normal. Ulcerative lesions are present over the tongue and oral mucosa. Examination of the skin is shown below. A lumbar puncture is performed, and cerebrospinal fluid analysis is notable for mononuclear pleocytosis and an elevated protein level. Which of the following agents is most likely responsible for this patient's presentation?
   Image reproduced from CDC Public Health Library 


At the clinic, two mothers came in with their babies. The first baby is an 11 month old girl called Cecile, who is brought by her parents, who are immigrants, for a routine visit. You immediately noticed that she doesn’t react when you call her name, as if she can’t hear you at all. Upon eye examination, you find that Cecile has bilateral clouding of the lens. Then, upon cardiac auscultation, you hear a continuous rumbling murmur. Upon further questioning, Cecile’s mother tells you that, during the first trimester of pregnancy, she developed a rash that mainly involved her head and neck, as well as swollen lymph nodes behind the ears.

After Cecile, comes a 6 month old baby boy named Arthur with his mother, who is concerned because Arthur has developed multiple purple marks on his skin. Upon physical examination, you noticed that Arthur has an unusually large head for his age. Then, on fundoscopy, his eyes show white and yellow scars that look like cotton. You decide to order a CT scan of the brain, which reveals scattered calcifications. Upon further questioning, Arthur’s mother admits to handling her cat’s litter while she was pregnant, despite her doctor’s advice against it.

All right, now both Cecile and Arthur seem to have a congenital TORCH infection. TORCH is an acronym that stands for infections caused by Toxoplasma gondii; Other agents, such as syphilis, parvovirus B19, varicella zoster virus, and listeria; then there’s Rubella; Cytomegalovirus, and finally Herpes simplex virus-2 or HSV-2.

All these infections are lumped together because they can be vertically transmitted, which means that a pregnant individual can transmit the infection to their child either before birth via the placenta, or during and after birth via blood, body fluids, or breast milk.

Now, keep in mind that TORCH infections may share some non-specific signs and symptoms, including delayed growth, and hepatosplenomegaly or enlarged liver and spleen, which can lead to jaundice or yellow skin, and thrombocytopenia or low platelet count. So for your exams, it’s important that you’re able to distinguish the different TORCH infections based on additional characteristics.


  1. "Robbins Basic Pathology" Elsevier (2017)
  2. "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
  3. "Pathophysiology of Disease: An Introduction to Clinical Medicine 8E" McGraw-Hill Education / Medical (2018)
  4. "TORCH Infections" Clinics in Perinatology (2015)
  5. "TORCH (toxoplasmosis, rubella, cytomegalovirus, and herpes simplex virus) screening of small for gestational age and intrauterine growth restricted neonates: efficacy study in a single institute in Korea" Korean Journal of Pediatrics (2018)

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