TORCH complex (also known as STORCH, TORCHES or the TORCH infections) is a medical acronym for a set of perinatal infections (i.e. infections that are passed from a pregnant 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 bloodstream transplacentally via the chorionic villi. Hematogenous transmission may occur at any time during gestation or occasionally at the time of delivery via maternal-to-fetal transfusion.[1]
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The TORCH complex was originally considered to consist of four conditions,[2] with the "TO" referring to "Toxoplasma". The four-term form is still used in many modern references,[3] and the capitalization "ToRCH" is sometimes used in these contexts.[4]
Alternatively, the "O" is redefined as "other",[5] and the acronym is spelled out as follows:
The "other agents" included under O are Coxsackievirus, Syphilis, Varicella-Zoster Virus, HIV, and Parvovirus B19.
Hepatitis B may also be included among "other agents", but the hepatitis B virus is a large virus and does not cross the placenta, hence it cannot infect the fetus unless there have been breaks in the maternal-fetal barrier, such as can occur in bleeding during childbirth or amniocentesis.[6]
The acronym has also been listed as TORCHES, for TOxoplasmosis, Rubella, Cytomegalovirus, HErpes simplex, Syphilis.
The diseases present similarly, involving the heart, skin, eye, and CNS. They all cause chorioretinitis, microcephaly, and focal cerebral calcification.
Symptoms of a TORCH infection may include fever and poor feeding. The newborn is often small for gestational age. A petechial rash on the skin may be present, with small reddish or purplish spots due to bleeding from capillaries under the skin. An enlarged liver and spleen (hepatosplenomegaly) is common, as is jaundice. However, jaundice is less common in Hepatitis B because a newborn's immune system is not developed well enough to mount a response against liver cells, as would normally be the cause of jaundice in an older child or adult. Hearing impairment, eye problems, mental retardation, autism, and death can be caused by TORCH infections. The mother often has a mild infection with few or no symptoms.
It is possible for genetic conditions (Aicardi-Goutieres syndrome) to present in a similar manner.[7][8]
When physical examination of the newborn shows signs of the TORCH syndrome, the examiner may test blood, urine, and spinal fluid for evidence of the infections listed above. Diagnosis can be confirmed by culture of one of the specific pathogens or by increased levels of IgM against the pathogen.
Some of the TORCH infections, such as toxoplasmosis and syphilis, can be effectively treated with antibiotics if the mother is diagnosed early in her pregnancy. Many of the viral TORCH infections have no effective treatment, but some, notably rubella and varicella-zoster, can be prevented by vaccinating the mother prior to pregnancy.
If the mother has active herpes simplex (as may be suggested by a pap test), delivery by Caesarean section can prevent the newborn from contact, and consequent infection, with this virus.
Each type of TORCH infection has a different prognosis. The stage of the pregnancy at the time of infection also can change the effect on the newborn.
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