TORCH

TORCH syndrome is a group of symptoms caused by Toxoplasmosis, Rubella, Cytomegalovirus, Herpes simplex, and other organisms including syphilis, Varicella zoster, and parvovirus.

1. PRESENTED BY: SANDHYA KUMARI M.Sc NURSING AMITY COLLEGE OF NURSING AMITY UNIVERSITY, HARYANA TORCH

2. TORCH TORCH infection can be a misleading term as it sounds like a single illness. However, the term is an acronym of five infections caused due to pathogens. These can cause some serious problems for the unborn foetus and the mother if it is not diagnosed at the right moment. These pathogens are transferred from the expectant mother to her foetus during pregnancy or at childbirth. TORCH consists of the following five infections.

3. TORCH T oxoplasmosis O ther agents (including  HIV ,  syphilis , varicella , and  fifth disease ) R ubella C ytomegalovirus H erpes simplex

4. T- Toxoplasmosis Causative Organism: Toxoplasma gondii Oocyst excreted in cats feces is the source of infection to humans -: Contaminates in soil, water & raw meat Transmission: Vertical transmission can occur in utero or during vaginal delivery & risk of fetal transmission is 25% in 1st Trimester 75% in 3rd Trimester 90% during last few weeks prior delivery.

5. Effects of Torch on Pregnancy The following are the effects of TORCH infection: Birth defects like bad eyesight, loss of hearing, diabetes at a young age, heart defects, cataract and mental retardation are noticed in babies where their mothers were detected with rubella in the first trimester. A direct result of TORCH infection during pregnancy is a miscarriage. If the mother is infected with TORCH during 11 to 20 weeks of pregnancy, there is a huge risk of congenital rubella syndrome affecting the baby. The baby may also get meningitis, anaemia and pneumonia. The infection leads to many severe complications like premature delivery, stillbirth, spontaneous abortions, congenital anomalies and intrauterine foetal death.

6. CLINICAL FEATURES Most infected newborns are asymptomatic at birth IUGR Fever Maculopapular rash Anemia Jaundice Seizure Hepatospleenomegaly Thrombocytopenic purpura Chorioretinitis Diffuse Nodular Intracranial calcifications Hydrocephalus

7. DIAGNOSIS A blood test is done to check the pregnant woman for Toxoplasmosis, syphilis, parvovirus, varicella zoster, rubella, cytomegalovirus and herpes. Monitoring of foetal growth after a positive result is an important part of this diagnosis. The diagnosis of toxoplasmosis is typically made by  Serologic   testing. A test that measures immunoglobulin G ( IgG ) is used to determine if a person has been infected. By direct observation of the parasite in stained tissue sections, Cerebrospinal fluid (CSF).  

8. O- OTHER Syphilis.  Pregnant women in the first or second stage of this  sexually transmitted disease  ( STD ) pass it to their babies 75% of the time if it’s not treated. Syphilis is caused by bacteria and can create serious problems during a baby’s development. Many babies who get it before birth won’t survive full term, or will die shortly after they’re born. Almost half of babies will be stillborn.

9. R- RUBELLA AKA german measels . Caused by rubella virus ,a togavirus has single stranded RNA genome. Transmitted by droplet infection. Virus has teratogenic properties can cross the placenta where it stops cell development and leads cell death. Risk of developing fetal anomalies is directly associated with maternal gestational age.

10. Incidences 1st trimester- 50% major fetal anomalies. 2nd trimester- 25% 3rd trimester- 10% Spontaneous abortions occur upto 20% of cases. If infection occur within 20 wks of gestation.

11. Clinical manifestations Maternal symptoms- Same as other flu- Rashes Low grade fever Lymphoadenopathy ( suboccipital , posti cervical) Joint pain Headache Conjunctivitis

12. Congenital rubella syndrome It is characterized by- Cochlear- sensorineural defects. Cardiac – septal defects, pulmonary arterial hypoplasia . Neurological diseases- with a broad range of presentation from behaviors to memingoencephalitis . Ostitis Hepatosplenomegaly . Microcephaly IUGR Cataracts Thrombocytopenia – blue berry muffin lesions.

13. Diagnostic evaluation Serological test to detect rubella specific antibodies. Routine rubella IgG is done in the first trimester Rubella IgM is done in suspected case. Presence of antibodies + rash = confirm the diagnosis.

14. Treatment Prevention by active immunization. No such treatment available. Self limiting disease. Maternal screening should be performed in early pregnancy. In infection is present in pregnancy, mother could not be vaccinated because the rubella vaccine contained live virus which can cross the placenta and affect the fetus. Infact women should not be vaccinated 28 days before conception.

15. CYTOMEGALOVIRUS CMV is a member of the herpes virus species. Double strained DNA virus. The virus most frequently passed on to fetus during pregnancy. Acc to American academy of pediatrics about 1% of babies are born with the infection, a condition called congenital CMV. Transmission- direct person to person contact (saliva, milk, urine, semen, tears, stools, blood, cervical and vaginal secretions).

16. Clinical manifestations Maternal symptoms- Fever Weakness Swollen glands Joint stiffness Muscle ache Loss of appetite. Fetal symptoms- 90% are asymptomatic at birth jaundice Chorioretinitis Periventricular calcifications. IUGR, hearing loss Microcephaly Delayed psychomotor development Heart block

17. Diagnostic evaluations Serological testing- IgM are detected Amniocentesis Cordocentesis USG Fetal MRI ( rarely)

18. Treatment No definitive Rx. Pregnancy termination Antiviral drugs- Gangciclovir Foscarnet Cidofovir Most effective drugs- hyper immune globulin.

19. HERPES SIMPLEX VIRUS-2 INFECTION Most common STD worldwide. DNA virus belongs to alpha herpes virinae family Primary infection to mother can lead severe illness to mother in pregnancy. The most common infection during pregnancy is primary genital HSV infection.

20. Effect on pregnancy Transplacental infection is not usual. Fetus become infected by virus shed from the cervix and vagina during vaginal delivery. In utero transmission may occur in rupture of membranes. Increased risk of abortion is inconducive . IUGR if infection acquired in 3rd trimester.

21. Neonatal infections- Chorioretinitis MR Seizures Microcephaly Deaths.

22. Treatment CS indicated in primary HSV infection. Suppressive viral therapy from 36 weeks untill delivery, it includes- Valacyclovir 500 mg PO bd Acyclovir 400mg po tds . ( drug of choice)

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