TORCH infections are caused by pathogens that are transmitted from mom to baby either during delivery or pregnancy. When a pathogen is shared from mother to baby via the placenta or birth canal, we call this a “vertical transmission.” The acronym TORCH represents the pathogens that cause these congenital infections:
- Toxoplasma gondii
- Other (syphillis, listeria, varicella, parvovirus)
- Cytomegalovirus (CMV)
- Herpes simplex virus (HSV)
The reason we care so much about these infections is that they can cause serious problems for the fetus including spontaneous abortion, IUGR (intrauterine growth restriction) and pre-term birth along with developmental problems in the skeletal system, central nervous system, hearing or vision loss, the endocrine system and even cardiac defects. Let’s take a look at each one in a bit more detail.
Toxoplasmosis is at the highest risk of being passed on to the baby if it’s contracted in the third trimester, but it’s important to note that if mom does contract it earlier in pregnancy, the outcome for baby is typically far worse and can even result in a spontaneous abortion or a stillbirth. Babies that do survive often have pretty serious problems such as seizure disorder, severe eye infections that can lead to blindness and enlarged liver and spleen. Some babies only show the signs of infection later on with things like significant mental impairments or hearing loss. It’s classical features are something called a blueberry muffin rash, which is the presence of petechiae and purpura as well as a triad of symptoms (hydrocephalus, intracranial calcifications and chorioretinitis, which inflammation of the choroid and retina of the eye). Recall that petechiae are small flat lesions caused by capillary bleeding under the skin, whereas purpura are larger and raised lesions that are caused by bleeding within the skin.
Though toxoplasmosis is treatable in both mom and the neonate, the best course of action is to prevent it from occurring. Moms can lower their risk of contracting toxoplasmosis by avoiding raw meat and turning over the litterbox duties to someone else in the household as cat feces. If mom has an active toxoplasmosis infection, she can take spiramycin to help keep it from spreading to the festus.
Congenital Varicella Syndrome is the condition that occurs in the infant when the mother has a varicella zoster infection during pregnancy. These infants are often born at a low birthweight due to premature birth or IUGR. They also often tend to have areas of the skin that are thick and red, the limbs can be underdeveloped (hypoplastic limbs) and they can have CNS abnormalities as well.
The best prevention is for mom to get immunized prior to getting pregnant. If mom is already pregnant, then varicella zoster immunoglobulin (VZIG) is given as soon as possible after the exposure. And then once baby is born, he gets VZIG right away and may also need acyclovir, an antiviral medication.
Congenital syphilis occurs when the infection is passed from mom to baby in utero and symptoms may not appear for weeks or even years after birth. Some of the more serious consequences of syphilis in children are aseptic meningitis, anemia, hepatosplenomegaly, mental retardation, skeletal abnormalities, vision problems, facial deformities and deafness.
The treatment is penicillin both prenatally and after birth.
Parvovirus B19 in neonates can cause aplastic anemia, fetal demise and hydrops fetalis, which is an abnormal fluid collection such as ascites, pericardial effusion or pleural effusion. In utero it can cause placental edema or polyhydramnios. Intrauterine anemia can be so severe that the fetus requires a blood transfusion. The best way to prevent parvovirus B19 (also called Fifth Disease) is through good hand hygiene, not sharing food/drink with others, and avoid close contact with individuals who are sick.
The last of the “other” category we’re focusing on is listeriosis. This infection, though uncommon, can cause serious sepsis and meningitis in neonates as well as spontaneous abortion and preterm birth. It is treated with antibiotics, and prevented by mom avoiding unpasteurized dairy and deli meats.
Congenital rubella syndrome (CSV) occurs in infants when mom is infected with the rubella virus during pregnancy. It can cause spontaneous abortion, stillbirth and severe birth defects including developmental delay, congenital heart disease, cataracts, and hearing impairments. There is no cure for rubella (also known as “German measles”) so the best course of action is to prevent it through pre-pregnancy immunization (at least three months prior to conception). Babies that are born with rubella are infectious and will be placed in isolation.
C: Cytomegalovirus (CMV)
Severe cases of Cytomegalovirus (CMV) can cause fetal demise, though most infections are not serious enough to cause significant health problems. These can be present at birth or develop later in infancy or childhood. If an infant is showing signs at birth, they will often be microcephaly, jaundice, rash, hepatosplenomegaly, seizures, retinitis and/or low birth weight.
Long-term health issues a child with CMV could face are hearing and/or vision loss, seizures, developmental delay and motor delays.
CMV is treated with antivirals such as ganciclovir and supportive care. As with many other neonatal infections, the best prevention is frequent handwashing and avoidance of infectious individuals and environments where risk of contamination is high (such as schools). It is shared person-to-erson through body fluids including saliva, urine, breast milk, semen, tears and blood.
H: Herpes simplex virus (HSV)
Herpes simplex is most often passed from mom to baby during vaginal birth, but it can also be due to the infection traveling through amniotic membranes (both ruptured and intact). Because it is often transmitted through the birth canal, many times a mom with an active or recent genital infection will have a C-section to avoid passing the virus along to the infant. If the infant does contract congenital herpes simplex virus, about 45% of cases are limited to the skin, eyes and/or mouth (referred to as SEM disease), though it can also affect the liver and lungs or the central nervous system, namely in the form of meningitis.
The treatment is typically acyclovir, an antiviral medication and supportive care.
Now that we’ve talked about each of these, let’s laser in on the KEY information you need to know about each one:
- Toxoplasma gondii – contracted by consuming raw or undercooked meat and is often found in cat feces; pregnant women should not clean the litter box and should wear gloves when gardening.
- Other – includes syphilis, listeria, varicella, parvovirus
- Rubella – baby will be infectious and need to be isolated; mom will need to wait 3 months after vaccination before getting pregnant
- Cytomegalovirus (CMV) – transmitted through body fluids (droplets)
- Herpes simplex virus (HSV) – mom will get C-section if recent or active genital infection
I hope this quick overview helps you in your maternal-newborn class and clinicals. What other topics would you like to see? Leave your ideas in the comments below!