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Torch Infections

Definition

TORCH is an acronym for a special group of infections that may be acquired by a woman during pregnancy.

What is going on in the body?

Risks

What are the causes and risks of the infection?

Only a minority of pregnant women who catch a TORCH infection give birth to a child with birth defects. Each of the TORCH infections has its own causes:
  • Toxoplasmosis may be caused by exposure to raw meat or cats, which sometimes carry the disease.
  • Because of population-wide immunization requirements, rubella is rarely seen in the U.S. today, but women who have never had the infection before, and have not been immunized, are at high risk if they should become exposed to rubella virus.
  • Cytomegalovirus, or CMV, is easily spread from person to person, either through the saliva, blood transfusions, or sex.
  • Herpes simplex and syphilis are sexually transmitted infections.
  • Varicella-zoster infection is only a problem if the mother gets chickenpox. Women who had chickenpox as children or who are vaccinated against chickenpox are at a significantly reduced risk. Chickenpox is highly contagious. Coughing, sneezing, or contact with the chickenpox rash usually spreads this disease.
  • Hepatitis B is usually spread through sex or by sharing drug injection equipment.
In general, for the baby to be affected, the woman must get one of these infections for the first time during the pregnancy. The exception is herpes, which the baby can acquire as he or she goes through the birth canal. With TORCH infections, the severity of the mother's illness often has little to do with how severely the baby is affected.

Prevention

What can be done to prevent the infection?

Prevention is related to the specific infection. Avoiding cats and raw meat can help prevent most cases of toxoplasmosis. Rubella and Chickenpox can be prevented by making sure the mother is immune (by testing her blood). Cytomegalovirus can rarely be prevented, but safest sex practices will prevent most cases and safer sex practices may help prevent some cases.
Safer sex practices can reduce, but not eliminate, the risk of syphilis, herpes, and hepatitis B (although safest sex practices can virtually eliminate any risk).
A woman who has not had chickenpox or hepatitis B should receive these vaccines before trying to become pregnant. Women who have active herpes lesions at the time of delivery are advised to have a Cesarean birth in order to lower the risk of passing the infection on to the baby during delivery.

Diagnosed

How is the infection diagnosed?

Pregnancy ultrasound may be used to look for birth defects. This is an imaging test that uses sound waves to look at the baby inside the womb. The exact risk of having a child with birth defects depends on the specific TORCH infection. It also depends on when during the pregnancy the mother was infected. The healthcare professional will discuss the results in the event of a positive test.
Unfortunately, however, the diagnosis of a TORCH infection is usually made only after the child is born. Diagnosis of a TORCH infection can sometimes be made using blood tests. A TORCH screen checks to see if the baby has been infected by any of the responsible organisms.
A culture of different body fluids may also be done. A culture involves taking a sample of tissue or body fluid, such as nasal secretions or the urine. This tissue or fluid is put in special containers to try and get the infection-causing organism to grow. If the organism grows, it can be identified.
Various x-ray tests may be done to determine the types of birth defects present. For example, a cranial CT scan may be done to look for brain damage. Formal hearing and vision tests may be done to check these senses. An ultrasound of the heart, called an echocardiogram, may be done if a heart defect is suspected.

Long Term Effects

What are the long-term effects of the infection?

TORCH infections can cause serious, permanent birth defects. They can leave a child with severe mental retardation or learning disorders. Some children appear normal at birth, only to have behavioral, emotional, or learning problems arise later in life. Hepatitis B can cause severe, ongoing liver damage in some cases and may increase the risk of liver cancer.

Other Risks

What are the risks to others?

All of the TORCH infections can be spread to other persons.

Treatments

What are the treatments for the infection?

A treatment called immune globulin can be given to the mother or child in certain settings. This is a protein mixture specific to a given infection that helps protect the mother or child after an exposure to that infection. For example, varicella-zoster immune globulin (VZIG) may be helpful for some pregnant women who are exposed to chickenpox.
Hepatitis B immune globulin (HBIG) and hepatitis B vaccine are used for babies that are delivered by women with hepatitis B. Some affected infants, such as those with syphilis, herpes, or toxoplasma infections, can be given medications to fight the infectious agents involved.

Side Effects

What are the side effects of the treatments?

Vaccines may cause pain at the site of an injection. Allergic reactions may occur with vaccines and immune globulin. Antibiotics may sometimes cause allergic reactions, stomach upset, or liver or kidney damage.

After Treatment

What happens after treatment for the infection?

If TORCH infections are not prevented, then further treatment is aimed at any specific birth defects that are present. For example, eye surgery may help with vision problems, such as cataracts. Open-heart surgery can correct many defects caused by congenital heart disease. Other children may need special education or treatment for behavioral or emotional problems.

Monitor

How is the infection monitored?

Children affected by any of the TORCH infections need close monitoring. This allows any problems that occur later in childhood to be caught early so that treatment can be started. For example, children with learning disabilities may benefit from early placement into special education classes.

Sources

Rudolph's Fundamentals of Pediatrics, 1998, Rudolph et al.

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