Torch infections is a term given by us to a group of infectious diseases that can be transmitted from you to your baby during pregnancy, after birth, or at delivery. This shows that you are continuously at risk of many health disorders throughout your pregnancy.
So, it’s better to have basic knowledge about some of the health problems to prevent the health of your baby and yourself from certain adverse effects.
TORCH stands for
T – Toxoplasmosis
O – Other infections
R – Rubella
C – Cytomegalovirus
H – Herpes simplex virus
What are torch infections?
Touch infections are a group of bacterial, viral, and protozoan infections that gain access to the fetal bloodstream and hence cause complications in pregnancy.
Torch infections are a sum up of congenitally acquired infections that causes morbidity and mortality in neonates.
There are few infections that exist in a mother but the immune system of the mother is capable to fight these infections, when it gets transmitted to a newborn or during pregnancy and at that time, it doesn’t have a good immune system to fight this infection, hence suffer from many adverse effects which cause the death of a child.
How much your baby is sick, depends on the type of infection and for how long your baby is infected.
Usually, infections that occur earlier in the pregnancy result in adverse outcomes.
Icd 9 codes of Torch infections
- 052.0 post varicella encephalitis
- 055.0 post measles encephalitis
- 056.0 rubella with neurological complications
- 090.4 juvenile neurosyphilis
Icd 10 codes of torch infections
- A50.40 Late congenital neurosyphilis, unspecified
- A50.45 Juvenile general paresis
- B01.11 Varicella encephalitis and encephalomyelitis
- B05.0 Measles complicated by encephalitis
What are the Torch diseases?
The word TORCH stands for
- Toxoplasmosis
- Other infections like HIV, syphilis, varicella ( chickenpox and zika), parvovirus
- Rubella
- Cytomegalovirus
- Herpes simplex virus
How does an infant get torch infections?
A baby or an infant can get a torch infection in three different ways:
- After birth: infection can pass down to a baby through breastfeeding.
- During childbirth: a baby can get this infection while passing through a birth canal during his or her birth.
- Through the placenta: during pregnancy, the placenta provides nutrients, oxygen, and blood to the baby. Hence, certain diseases can transmit to the baby’s bloodstream through the placenta.
Key features of torch infections
Description
- It can lead to severe fetal anomalies or fetal loss.
- This is a congenital syndrome characterized by a variety of ventral nervous system (CNS), growth, cognitive, visual, and auditory deficits.
- Hepatitis B: goes from mother to fetus during birth, option for cesarean section to avoid contact.
- Varicella encephalitis and encephalomyelitis
General consideration
- Mild infections may go unnoticed in pregnant women by can cause devastating effects on the unborn child.
- The timing of prenatal exposure greatly impacts the long-term outcomes in an infant, like first-trimester exposure is tied to more severe deficits.
- There are various outcomes in a newborn due to different infectious organism
Associated disorders
- Intrauterine growth retardation results in an infant being small for gestational age.
- A child may suffer from congenital impairments ranging from mild deficits to severe mental retardation.
- Newborns may suffer from visual deficits.
- A child may suffer from auditory deficits secondary to eighth cranial nerve involvement.
- There may be skin lesions, eye lesions, and rash.
- Hepatosplenomegaly
- There may be impaired motor development due to damage to the brain while developing.
- Cardiac defects
- Seizures
Demographics
- It is recorded that the overall rate of 17.3 infants per 1000 births received antibiotics for suspected neonatal sepsis.
- CMV: 1 in 150 children is born with congenital CMV disease
- In the case of syphilis, when syphilis is untreated in pregnant women, 25% of pregnancies result in stillbirth and 14% in neonatal death, and overall perinatal mortality is about 40%.
- Rubella congenital syndrome is rare, as indicated by an incidence of fewer than 1 person in 2000.
- Toxoplasmosis: approximately 3500 infected children are born in the united states every year.
- Herpes simplex: approximately 2% of women acquire this virus during pregnancy
What are the sign and symptoms of torch infections?
- Poor eating
- Jaundice
- Petechial rash
- Hearing impairments
- Visual impairments
- Fever
- Hypo/hypertonia
- Persistence of developmental reflexes
- Hepatosplenomegaly
- Cataracts
- Purpura
- Patent ductus arteriosus
Impairments
- Visual impairment
- Hearing impairment
- It can be quite variable depending on the timing of exposure and the organism implicated
- Inability to sit
- Inability to crawl or creep
- Inability to roll
- Decreased strength
- Abnormality of tone
- Inability to ambulate
- Gait deviation is dependent upon muscle tone
Test and measure for torch infections
- Alberta infant motor scale
- Bayley scales of motor development
- Early intervention developmental profile
- Functional independence measure for children
- Gross motor function classification system
- Hearing test
- Movement assessment of infants
- Neonatal behavioral assessment scale
- Vision test
Torch infections treatment
It is a group of diseases so for their treatment, we need to individually target these diseases.
The word TORCH stands for
- T – Toxoplasmosis
- O – Other infections
- R – Rubella
- C – Cytomegalovirus
- H – Herpes simplex virus
Toxoplasmosis
Causative organism
- It is caused by Toxoplasma gondii
Transmission
- It can be transmitted through Fecal oral route
- Transplacental
- Oocysts excreted in cat feces
- It is found in undercooked meat, contaminated soil/water, and unpasteurized goat milk
Clinical manifestation
- In the case of the first trimester – it often results in death
- In case of second trimester – there is classic triad
- Hydrocephalus
- Intracranial calcification
- Chorioretinitis
- In the case of the third trimester – it is often asymptomatic at birth
- Its symptoms may also include fever, IUGR, microcephaly, seizure, hearing loss, maculopapular rash, hepatosplenomegaly, jaundice, anemia, and lymphadenopathy
Treatment
- Here are the suggestions, Sulfadiazine 100 mg/kg per day divided into two doses every day for one year
- you need to follow this, Pyrimethamine 2 mg/kg (maximum 50 mg/dose) once daily for two days; then 1 mg/kg (maximum 25 mg/dose) once daily for six months; then 1 mg/kg (maximum 25 mg/dose) every other day to do one year of therapy
- you can take Leucovorin 10 mg three times per week during and once a week after pyrimethamine therapy.
- In this case, Infants should be weighed weekly and dosages adjusted accordingly.
Syphilis
Causative Organism
- It is caused by Treponema pallidum
TRANSMISSION
- Transmission takes place through Transplacental
- Or from Sexual activity
CLINICAL MANIFESTATIONS
- The majority are symptomatic at birth
- Early Congenital Syphilis (symptoms at 1-2 months of age)
- Late congenital Syphilis (symptoms after 2 years of age)
- Hutchinson Teeth
- Mulberry Molars
- Perforated hard palate
- Rhagades (cracks or fissures in the skin around the mouth)
- Saber Shins
- Sensorineural hearing loss (CN VIII)
- Interstitial Keratitis
- Saddle Nose
DIAGNOSIS
- Darkfield microscopy
- FTA-Abs, RPR, VDRL
TREATMENT
- you can go for Penicillin
- For Infants less than one month of age, either as a single dose of benzathine penicillin G (50,000 units/kg, intramuscularly [IM]) or as a ten-day course (aqueous penicillin G 50,000 units/kg intravenously (IV) every 12 hours (for infants ≤7 days of age) and every 8 hours (for infants >7 days of age) for a total of 10 days, or Procaine penicillin G 50,000 units/kg intramuscularly (IM) as a single daily dose for 10 days
- In this case, Single-dose therapy is contraindicated for asymptomatic infants born to women with inadequate/suboptimal treatment unless the infant has undergone appropriate evaluation (CSF quantitative VDRL, cell count, and protein; CBC with differential and platelet count; and long-bone radiographs) and has completely normal results
Rubella
Causative Organism
- Togavirus
TRANSMISSION
- transmission takes place through the Transplacental way.
- Respiratory secretions
CLINICAL MANIFESTATIONS
- you may notice a “Blueberry Muffin” rash due to extramedullary hematopoiesis
- you may notice Cataracts
TREATMENT
- we need to provide Supportive care
cytomegalovirus
Causative Organism
- it is caused by Human herpesvirus 5
TRANSMISSION
- through Transplacental
- it can be transmitted through Perinatal (contact with the vagina during delivery or breast milk after delivery)
- when you come in contact with bodily fluids (urine/saliva)
- Transmission is possible through reactivation of latent virus (decreased risk of transmission)
CLINICAL MANIFESTATIONS
- The majority are asymptomatic at birth
- you may notice Periventricular calcifications
- Preterm infants may appear septic – apnea, bradycardia, intestinal distension)
- Postnatal infections are generally asymptomatic
DIAGNOSIS
- Culture (urine or pharyngeal secretions)
- PCR
TREATMENT
- it is shown in the studies that gancyclovir can improve hearing loss and neurodevelopmental outcomes. it is shown in our report that 6 mg/kg per dose administered IV for six weeks in newborns with severe congenital CMV disease and neurologic impairment showed protection against hearing loss and head circumference growth in the first 6 to 12 months of life.
- you can provide Supportive care
Herpes Simplex Virus
Causative Organism
- Human herpesvirus 1 & 2
TRANSMISSION
- transmission through Perinatal (contact with vagina during delivery)
- it occurs when you come in contact after rupturing of membranes
- Direct contact with affected areas
CLINICAL MANIFESTATIONS
- Vesicular lesions on an erythematous base
- Keratoconjunctivitis, cataracts, chorioretinitis
DIAGNOSIS
- PCR of CSF, IgM titers, HSV culture of a lesion
TREATMENT
- you need to take Acyclovir IV at a dose of 60 mg/kg per day IV divided every eight hours.
- Treatment for localized SEM disease should be for a minimum of 14 days if disseminated and CNS disease has been excluded.
Physical therapy intervention
- We can go for developmental activities to facilitate normal movement patterns and acquisition of motor milestones.
- You need to focus on minimizing impact of visual and auditory deficits on motor skill acquisition.
- We need to go for therapeutic exercises including strengthening exercises.
- Go for functional activities – gait training, stair climbing
REFERENCES
- TORCH Infections | Pediatrics Clerkship | The University of Chicago (uchicago.edu)
- The color atlas of physical therapy by eric shamus