TORCH INFECTION

Reporter: Zhao Meiling (Alice)

Date : April.10.2019
 Overview Of TORCH Infections
TORCH COMPLEX

 TORCH complex is a medical acronym for a set of perinatal infections (i.e.

infections that are passed from apregnant woman to her fetus).

 The TORCH infections can lead to severe fetal anomalies or even fetal loss.

 They are a group of viral, bacterial, and protozoan infections that gain access to
the fetal blood stream transplacentally via the chronic villi.

 Hematogenous transmission may occur at any time during gestation or

occasionally at the time of delivery via maternal-to-fetal transfusion.
 The capitalization "TORCH” consists of

 T=Toxoplasmosis
 O=Other (syphilis, Varicella zooster, parvovirus B19,Hep B)
 R=Rubella
 C=Cytomegalovirus (CMV)
 H=Herpes simplex virus-2(HSV)
 Toxoplasmosis

Toxoplasmosis is a disease caused by an

intracellular parasite TOXOPLASMAGONDII.
Toxoplasmosis
Causative Organism – Toxoplasma gondii.
Human acquisition of the infection occurs by:

 Oocyst contaminated soil, salads, vegetables.

 Ingestion of raw or undercooked meat containing tissue cysts

(Sheep,pigs and rabbits are the most common meat sources).

 Out breaks of toxoplasmosis have also been linked to the consumption of

unfilteredwater
Primary maternal infection in pregnancy:

 Infection rate higher with infection in 3rd trimester.

 Fetal death higher with infection in 1st trimester.
Toxoplasmosis-Signs and Sympoms
 Infected Pregnant women: usually no clinical manifestation.
 Although some may have a mild mononucleosis-like
syndrome, regional lymphadenopathy, or occasionally
chorioretinitis.
 Similarly, infected neonates are usually asymptomatic at birth.
Toxoplasmosis-Signs and Sympoms

Manifestations may include:

 Prematurity
 Intrauterine growth restriction
 Jaundice
 Hepatosplenomegaly
 Myocarditis
 Pneumonitis
 Various rashes
 anemia, thrombocytopenia,
 and abnormal CSF findings (Mononuclear CSF pleocytosis or elevated CSF protein)
Toxoplasmosis-Signs and Sympoms
If the infection crosses the placenta, the infant may be born with the
following problems:
 First Trimester – often results in death
 Second Trimester – classic triad
a. Hydrocephalus
b. Intracranial calcifications
c. Chorioretinitis
 Third Trimester – often asymptomatic at birth
Toxoplasmosis-Diagnosis

 Serial IgG measurement (for maternal infection)

 Amniotic fluid PCR (for fetal infection)
 Serologic testing, brain imaging, CSF analysis and
ophthalmologic evaluation (for neonatal infection),
 PCR testing of various body fluids or tissues
Toxoplasmosis-Treatment
In pregnant women with an established recent infection, Spiramycin
(3g daily in divided doses) should be given until term.
In neonates:
 Pyrimethamine: 50mg twice daily for 2 days then 50mg daily.
PLUS
 Sulfadiazine: 75mg/kg/daily in two divided doses for 2 days then
50mg/kg/twice daily
PLUS
 Folinic Acid: 10-2omg daily
Toxoplasmosis-Prevention
 Women should be advised to use these precautions to avoid infection anytime:
 Cook meat thoroughly to an internal temperature of at least 160 degree Fareheight or as
high as 180 degree Fareheight.
 Wash all kitchen surfaces that come into contact with uncooked meat.
 Do not use the same utensils or cutting board for raw meat and raw procedure.
 Wash the hands thoroughly after handling raw meat.
 Wash fruits and vegetables before eating.
 Avoid contact with materials that are possibly contaminated with cat feces when
pregnant (cat litter boxes, sandboxes, garden soil).
 Wash hand well after working with soil or handling animals.
Rubella
Rubella
 It is caused by rubella virus, Rubivirus genus and family Togaviridae.
 Intrauterine infection with rubella virus is referred to as congenital
rubella infection (CRI) or syndrome.
 Infection with rubella earlier in pregnancy(1st trimester) cause worse
prognosis and neonatal complications.
 The virus can be transmitted to the fetus through the placenta and is
capable of causing serious congenital defects, abortions, and stillbirths.
Rubella
In the baby
 Infection in weeks 8-10 of pregnancy results in damage in up to go% of surviving
infants.Multiple defects are then common.
 The risk of damage reduces to 10-20% if the infection is in weeks 11-16 of pregnancy.
 Fetal damage is rare over 18 weeks of gestation.
 Transmission to the fetus occurs via maternal nematogenous spread to the placenta.
 It typically occurs 5-7 days after maternal inoculation.
 After the virus invades the placental barrier, it spreads throughout the fetus via their
vascular system.
 The congenital defects that result from infection is secondary to the cytopathical
damage ensued to the blood vessels.
 This in turn results in ischemia of the affected organs.
Rubella-Clinical Manifestations
Maternal symptoms

 cold-like symptoms, such as a runny

 nose, sore throat or cough
 Rashes
 Low grade fever
 Lymphoadenopathy
 Joint pain
 Headache
 Conjunctivitis
 Rubella-Clinical Manifestations
Infants symptoms
Transient:
 Intrauterine growth restriction.
 Thrombocytopenic purpura (25% - 'blueberry skin").
 Haemolytic anaemia.
 Hepatosplenomegaly.
 Jaundice (common).
 Radiolucent bone disease (20%).
 Meningoencephalitis (25%) +/-neurological sequelae.
Rubella-Clinical Manifestations

Infants symptoms
Developmental:

 Sensorineural deafness 80%

 General learning disability (55%).
 Insulin-dependent diabetes (20%, immune mediated
but often delayed to adolescence or adulthood)
 Late-onset' disease at 3-12 months with rash,
diarrhoea, pneumonitis and high mortality.
Rubella-Clinical Manifestations
Infants symptoms
Permanent:
 Congenital heart disease (commonly patent ductus arteriosus or
peripheral pulmonary artery stenosis).
 Eye defects including cataracts, congenital glaucoma, pigmentary
retinopathy (50%-so called 'salt and pepper'), severe myapia,
microphthalmia.
 Microcephaly.
Rubella-Diagnostic
 Serologic test
+ serologic test for rubella IgM antibody
 Detection of rubella virus specific nucleic acid by PCR

Rubella virus specific IgM antibodies are present in people recently

infected by Rubella virus but these antibodies can persist for over a year
and a positive test result needs to be interpreted with caution.
The presence of these antibodies along with, or a short time after, the
characteristic rash confirms the diagnosis.
 Rubella-Management
 Infants who are born to mothers who had rubella during pregnancy should be
isolated fro other newborns as the neonate may be capable of transmitting the
disease after birth.
 Supportive care and surveillance is the only recommended option available at
this time.
 Close monitoring within the first 6 to 12 months of life is recommended;
particularly for the evaluation of hearing impairment.
 Prevention. The best management for rubella is to prevent its occurrence. All
pregnant women should avoid contact with children with rashes.Preventive
measures include recommended immunizations, testing of pregnant women
for rubella immunity and proper counseling regarding avoiding exposure.
Cytomegalovirus
 Cytomegalovirus
 CMV is a double-stranded DNA herpes virus and represents the most
common congenital viral infection.
 The CMV seropositivity rate increases with age.
 Geographic location, socioeconomic class, and work exposure are other
factors that influence the risk of infection.
 CMV infection requires intimate contact through saliva, urine, and/or other
body fluids.
Cytomegalovirus- Transmission
Causative Organism – Human herpesvirus 5
Possible routes of transmission include:
 sexual contact
 organ transplantatio
 transplacental transmission
 transmission via breastmilk
 blood transfusion(rare).
Cytomegalovirus- Symptoms and signs
Maternal symptoms

 Fever
 Weakness
 Swollen glands
 Joint stiffness
 Muscle ache
 Lymphadenopathy.
Cytomegalovirus- Symptoms and signs

Fetal symptoms
Transplacental infection can result in:
intrauterine growth restriction
Sensorineural hearing loss
Intracranial calcifications
Jaudice
Petichiae
Microcephaly
Hydrocephalus
Hepatosplenomegaly
Delayed psychomotor development
Thrombocytopenia
Chorioretinitis
Cytomegalovirus- Diagnostic
DiagnosticDiagnostic
Diagnosis of congenital cmv infection in foetus:
 Amniocentesis - viral culture and PCR
 Ultrasound
Cytomegalovirus- Diagnostic

Diagnosis of Congenital CMV Infections

 Isolation of CMV from urine or other ody fluid (CSF, blood,
saliva) in the first 21 days of life is considered proof of
congenital infection
 Serologic tests are unreliable; IgM tests currently
available have both false positive and false negative
results
 PCR may be useful in selected cases
Cytomegalovirus- Treatment

 Ganciclovir 5mg/kg IV every 12 hours for 14 days OR

 Valganciclovir 900mg PO daily for 3-6 months OR
 CMV-specific hyperimmune globulin (200 units/kg of
body weight)
ManagementManagement
Cytomegalovirus- Prevention

 Women can reduce their risk of CMV by practicing universal precautions

and careful hand washing, especially after any contact with saliva,
urine,feces, blood and mucous.
 Avoid sharing glasses or eating utensils.
 Medical or day care workers may consider being tested prior to pregnancy
to determine if they have had CMV, as they would then have little causefor
concern.


Other infections
THANKS