‫بسم الله الرحمن الرحیم‬

‫وزارت تحصیالت عالی‬

‫پوهنتون طبی چراغ‬
‫دیپارتمنت داخله اطفال‬

‫موضوع لکلچر ‪TORCH Infection:‬‬

‫لکچر دهنده ‪:‬دوکتور احمد ضیاء (حیدری)‬
‫تاریخ ارایه لکچر ‪13/10/1391:‬‬
‫صنف ‪:‬پنجم ‪B‬‬
Contents
• Definition
• Clinical features
• Toxoplasmosis
• Rubella
• Cytomegalo virus
• Herpes simplex virus
• summary
 TORCH Infections
• T=toxoplasmosis
• O=other (syphilis,varicell a,paravirus B19)
• R=rubella
• C=cytomegalovirus (CMV)
• H=herpes simplex (HSV)
Neonate may present with following features if infected with TORCH infection
 LBW
 Jaundice, rash
 Hepatosplenomegaly
 Thrombocytopenia
 Cataract
 Chorioretinitis
 Microcephaly
 CHD
 TOXOPLASMOSIS
Toxoplasma Gondi
Incidence 1/1000 to1/10000 life birth
 Pathophysiology
 Newly infected cats
 Unpasteurized milk
 raw meats
 Trimester III
 Infections earlier(abortion,stillbirth,sever disease)
 Visual impirament,learning disabilities(month,year)
 Clinical Manifestations
• Most (70-90%) are asymptomatic at birth
• Classic triad of symptoms:
– Chorioretinitis
– Hydrocephalus
– Intracranial calcifications
• Other symptoms include fever, rash, HSM,
Microcephaly, seizures, jaundice, thrombocytopenia,
lymphadenopathy
Chorioretinitis of congenital toxoplasmosis
 Diagnosis
 Direct isolation(body fluids or tissues,
placenta)
 Serologic test:
• IGM(1-2w)
• IgM IgG+(active infection)
• IgA>95%(acute infection)
 Treatment
 Pyrimethamin+sulfadizene+folic acid
 Corticosteroid(ocular and acute CNS infection)
Prevention
 Women should avoid eating:
 Raw meat
 Eggs
 Avoid exposure to the cat faces
 RUBELLA
 Viral infection
 Chronic intrauterine infection
 Damage to developing fetus
 0.1% to 2%
 Infected from respiratory secretion
 Maternal infection during first trimester(90%)
 Clinical manifestation
• IUGR
• Microcephaly
• Microphthalamia
• Cataract ,Glaucoma, Chorioretinitis
• jaundice
• PDA
• Blueberry muffin rash
• Anemia,
• Asymptomatic at birth/present for 1 year
“Blueberry muffin” spots representing
extramedullary hematopoesis
 Diagnosis
Cultures
CSF EX( protein)
Serologic studies( IgM)
 Treatment
 There is no specific treatment
 Long term follow up(secondary to late onset
symptoms)
 CYTOMEGALOVIRUS(CMV)
 DNA virus
 Herps virus group
 Transmitted to fetus:
 transplacental
 during birth
 and by breast milk
 Secrition,blood,urin and by sexual contact
 Clinical features
 Sepsis
 IUGR
 Chorioretinitis
 Microcephaly
 Anemia,jaundice,hepatosplenomegaly
 Deafness, pneumonia
 Diagnosis
 Culture(urin,saliva)
 Serologic tests(IgM+)
 Radiologic studies,CT scan
(intracranial calcification)
Ventriculomegaly and
calcifications of
congenital CMV
 Treatment
• Ganciclovir x6wks in symptomatic
infants
• Treatment currently not recommended
in asymptomatic infants due to side
effects.
 HERPES SIMPLEX VIRUS(HSV)
 DNA virus
 1in1000 to 1in 5000 deliveries per years
 3/4(HSH-2)
 Can be intrautren,postnatal and aquired(80)
 Entry from skin,eye, mouth and respiratory tract
 HSV are disease localized to:
• skin,eye and mouth
• CNS and Disseminated disease
 Clinical manifestation
 Intrauterine infection
 Chorioretinitis
 Skin lesion
 Microcephaly
 Postnatal
 Encephalitis
 Skin vesicle
 keratoconjunctivitis
 Diagnosis
• Culture of maternal lesions if present at
delivery
• Cultures in infant:
– Skin lesions, oro/nasopharynx, eyes, urine,
blood, /stool, CSF
• PCR
• Serologic Test(IgM)
Presentations of congenital HSV
 TREATMENT
The first- line drug of choice is
Acyclovir
Second choice being
vidarabine
Which TORCH Infection Presents With…
• Chorioretinitis, hydrocephalus, and intracranial
calcifications?
– toxo
• Blueberry muffin lesions?
– rubella
• Periventricular calcifications?
– CMV
• No symptoms?
– All of them
Continue…
• CMV,HCV(culture/PCR)
• Toxoplasmosis(serologic test/PCR)
• Rubella ,syphilis(serologic method)
 Neonatal antibody titers are often difficult to
interpret because:
• IgG is required from the mother
• Determination of neonatal IgM titers to specific
pathogens is technically difficult to perform.
Continue…
 Neonatal infection with
CMV,HSV,toxoplasmosis,rubella and syphilis
present a diagnostic dilemma because:
• Clinical features
• Diseas may be in apparent
• Maternal infection is often asymptomatic
• Special laboroary studies needed
Continue…
 Systemic infection with CMV,HSV and
enteroviruses involve the liver(LFT)
 Neonatal HSV CNS disease maybe confirmed
by viral culture and PCR identification from
CSF
 reference
• Nelson Textbook of pediatrics(19th
Edition)”640-641”
• OP Ghai(7th Edition)
• Basis of pediatrics(7th Edition)
• Current pediatrics(new Edition)