Focus on Diagnosis: Congenital Infections (TORCH)

Abstract

1. Jeannine Del Pizzo, MD* 1. *Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, PA. * CDC: : Centers for Disease Control and Prevention CMV: : cytomegalovirus CNS: : central nervous system CSF: : cerebrospinal fluid HBsAg: : HBV surface antigen HBV: : hepatitis B virus HIV: : human immunodeficiency virus HSV: : herpes simplex virus IgG: : immunoglobulin G IgM: : immunoglobulin M IUGR: : intrauterine growth restriction PCR: : polymerase chain reaction VZV: : varicella-zoster virus TORCH is an acronym for a group of congenitally acquired infections that may cause significant morbidity and mortality in neonates. TORCH stands for the following: Toxoplasmosis Other: syphilis, hepatitis B, varicella-zoster virus (VZV), human immunodeficiency virus (HIV), parvovirus B19, enteroviruses, lymphocytic choriomeningitic virus Rubella Cytomegalovirus (CMV) Herpes simplex virus (HSV) Some experts consider the acronym TORCH outdated, largely due to the growing number of infections listed in the “other” category. However, use of the acronym may aid in remembering the causative organisms. While each of the congenital infections possesses distinct clinical manifestations and sequelae, some of these infections share characteristics. It is important to think of one or more of these infections when a neonate presents with microcephaly, intracranial calcifications, rash, intrauterine growth restriction (IUGR), jaundice, hepatosplenomegaly, elevated transaminase concentrations, and thrombocytopenia. However, many congenital infections may be silent at birth, with symptoms manifesting years later. Also, some agents, such as VZV, are associated with infection in utero as well as infection during or after delivery, with differing effects depending on the time of infection. This article includes discussion of true congenital infections that are present at the time of delivery as well as some transmitted during or after delivery. When a congenital infection is suspected, a thorough maternal history should be obtained, including immunization status, past and recent infections, and exposures. A careful physical examination of the neonate is vital because different clinical findings may indicate a specific diagnosis. Diagnostic testing should be directed only toward those infections that fit the clinical and historical picture. The sometimes employed TORCH titers should never be used as a single test to diagnose …