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TORCH infections

TORCH is an acronym for a special group of infections. These may be acquired by a woman during pregnancy. "TORCH" stands for the following infections: What is going on in the body? 
All of the TORCH infections can affect people of any age or sex. However, the term TORCH is only used when it applies to pregnant women and their unborn or newborn children. As a group, the TORCH infections represent a common cause of birth defects. They can also cause stillbirth, the delivery of a dead baby.

The infection usually causes few, if any, symptoms in the pregnant woman. On the other hand, babies risk serious birth defects if they catch one of these infections during pregnancy or delivery. Babies are usually most severely affected when the mother gets the infection in the first trimester, or first three months of pregnancy. This is the time of pregnancy when the baby's organs are first starting to form.

What are the signs and symptoms of the infection? 
The mother often has a mild infection with few symptoms. However, the TORCH infections may have serious effects on the baby, including:
  • mental retardation
  • learning, behavioural, or emotional problems
  • microcephaly, or small head and brain size
  • jaundice, or an abnormal yellow colour of the skin and eyes
  • anaemia, or low red blood cell counts
  • low birth weight or poor growth inside the womb
  • blindness or other vision problems, such as cataracts, a clouding of the lens of the eye
  • deafness
  • congenital heart disease, or heart defects that are present at birth
  • skin rash or scarring
Other symptoms and signs are also possible.

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: 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.

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 can be prevented by making sure the mother is immune (by testing her blood). Cytomegalovirus can rarely be prevented, but safer sex practices can help prevent some cases. Cases due to Syphilis, herpes, and hepatitis B can also often be prevented by safer sex.

A woman who has not had chickenpox or hepatitis B is usually advised to get these vaccines before trying to get pregnant. Women who have active herpes lesions at the time of delivery are often advised to have a caesarean section. This is thought to lower the risk of passing the infection on to the baby during delivery.

How is the infection diagnosed? 
Unfortunately, the diagnosis of a TORCH infection is usually made 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 common causes. 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. Skin tests may also be useful for herpes and syphilis.

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.

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 behavioural, 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.

What are the risks to others? 
All of the TORCH infections can be spread to other persons.

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 that helps protect the mother or child after an exposure to the infection. For example, this treatment may be helpful for some pregnant women who are exposed to chickenpox. It is also used for babies that are delivered by women with hepatitis B.

Some affected infants can be given antibiotics, such as those with syphilis, herpes, or toxoplasma infections.

What are the side effects of the treatments? 
Vaccines may cause pain at the site of an injection if a pill form is not available. Allergic reactions may occur with vaccines and immune globulin. Antibiotics may sometimes cause allergic reactions, stomach upset, or liver or kidney damage.

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 behavioural or emotional problems.

How is the infection monitored? 
Children affected by one 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.

Author: Adam Brochert, MD
Reviewer: eknowhow Medical Review Panel
Editor: Dr John Hearne
Last Updated: 6/1/2005
Potential conflict of interest information for reviewers available on request

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