TORCH complex (also known as STORCH, TORCHES or the TORCH infections) is

a medical acronym for a set of perinatal infections.

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.
The original TORCH complex described clinically similar congenital infections
caused by Toxoplasma gondii, rubella virus, cytomegalovirus, and herpes simplex
virus, types 1 and 2.

Manifestations including petechiae, purpura, jaundice, and dermal

erythropoiesis, are commonly seen in toxoplasmosis, rubella, and cytomegalovirus

infections. In herpes simplex virus infections, 80% of symptomatic infants show
single or grouped cutaneous vesicles, oral ulcers, or conjunctivitis..

Diagnosis is confirmed by culture and identification of species-specific

immunoglobulin M within the first 2 weeks of life. Histological examination
contributes to the diagnosis in herpes simplex virus infection.

Treatment

for toxoplasmosis includes pyrimethamine with sulfadiazine or

trisulfapyrimidine
congenital herpes simplex virus infection is treated with acyclovir.
No specific therapy for congenital rubella or cytomegalovirus infections has
been established, and so treatment is primarily supportive.

Other sources says that TORCH stands for:

1. Toxoplasmosis
2. Other infections, namely Hepatitis B, Syphilis, and Varicella-Zoster Virus
3. Rubella
4. Cytomegalovirus
5. Herpes simplex virus

Toxoplasmosis protozoa is transmitted through raw meat handling litter of

infected cats.
The causative agent is Toxoplasma gondii. Cats are the definitive hosts. The
infection is carried to the infant through the mother's placenta and can cause
impairment of the infant's eyes (opthalmic impairment) and central nervous system
(neurological dysfunction). The organism can invade brain or muscle tissue and
form cysts. Toxoplasmosis early in pregnancy is more likely to cause miscarriage or
serious birth defects.

- Sx: symptoms are flu-like; woman may not experience symptoms for a few days
except for malaise and posterior cervical lymphadenopathy
- Dx: serologic tests, such as the Sabin-Feldman dye test.
- Tx: sulfadiazine and pyrimethamine. If toxoplasmosis is diagnosed before 20
weeks of gestation, damage to the fetus is more severe than if the disease is
acquired later.
- The incidence of abortion, stillbirths, neonatal deaths, and severe congenital
anomalies is high.

Other includes streptococcal infections, gonorrhea, hepatitis; increased risk for

spontaneous abortion and still birth and also syphilis.

Syphilis was added to the TORCH panel because of an increase in reported cases
after 1990. Syphilis can cause early delivery, miscarriage, and is a potentially lifethreatening infection for an affected fetus, often resulting in stillbirth. It is
transmitted among adults through sexual intercourse.

Rubella( German measles) - Maternal rubella associated with high risk of fetal

malformation.
It is highly teratogenic in first semester: cross placenta, death is usually the result if
acquired during the third and seventh weeks. I it occurs in the second
trimester, permanent hearing impairment is usually the result.
-Sx: mild rash and mild systemic illness in a woman; teratogenic effects on the
fetus includes hearing impairment, cognitive and mother challenges, cataracts,
cardiac defects (most commonly PDA and pulmonary stenosis), intrauterine growth
restriction, thrombocytopenic purpura, and dental and facial clefts such as cleft lip
and palate
-Dx: A rubella titer from a pregnant woman is obtained on the first prenatal visit. A
titer greater than 1:8 suggests immunity to rubella. A titer of less than 1:8 suggests
that a woman is susceptible to viral invasion. A titer that is greatly increase over a
previous reading or is initially extremely high suggests that a recent infection has
occurred.
- The best therapy for women is prevention. Women with titers should be vaccinated
at least 2 months before becoming pregnant. Live attenuated vaccine is available
and should be given to all children.

Cytomegalovirus (CMV) belongs to the herpesvirus group and causes both

congenital and acquired infections referred to as cytomegalic inclusion disease. It is

teratogen that can cause microcephaly
- Sx: flu-like, woman may not experience any symptoms, infant may be born severly
neurologically challenged (hydrocephalus, microcephaly, spasticity) or with eye
damage (optic atrophy, chorioretinitis), hearing impairment, or chronic liver disease;
childs skin may be covered in large petechiae (blue-berry muffin lesions)
-Dx: isolation of CMV antibodies in blood serum
-Tx: no treatment or vaccine
Prevention may be done by thorough handwashing before eating and avoiding
crows of young children at daycare or nursery settings.

Herpes Simplex virus is a teratogen that causes microcephaly and

microphthalmia.

Herpes virus infections are among the most common viral infections in humans;
gingivostomatitis (in children), pharyngitis, oral and lip lesions (recurrent herpes
simplex type 1), proctitis, (type 2) and genital herpes (type 2). The virus enters the
infant through its eyes, skin, mouth, and upper respiratory tract.
For women with a history of genital herpes and existing genital lesions, cesarean
birth is often advised to reduce the risk of this route of infection.
-Tx: Intravenous or oral acyclovir (Zovirax) can be administered to women during
pregnancy. The primary mechanism for protecting a fetus focuses on disease
prevention such as safe sex practices. Advising adolescents to obtain a vaccine
against HPV (Gardasil) should lessen the incidence of genital herpes infection in the
future.

References:
http://medical-dictionary-medical.com/index.php?
a=term&d=Medical+dictionary&t=TORCH+complex
http://dictionary.sensagent.com/torch+complex/en-en/
Maternal & Child Health Nursing: Care of the Childbearing & Childbearing Family Ed.
6 Vol. 1, A. Pillitteri, pg 288-290
General and Systematic Phatology, F.C.E Underwood, page 64-67

CASE REPORT

TORCH
Submitted to: Mr. Judy Domingo
Submitted by: Jennifer S. Buan
And
Ann Krisette Lacanilao
February 23, 2011