TORCH Infections

ICU Nursing
 TORCH
 To - Toxoplasmosis
 R - Rubella
 C - Cytomegalovirus
 H - Herpesvirus type 2 (Genital Herpes)
 Toxoplasmosis
 Caused by protozoan Toxoplasma gondii
contracted by eating raw or poorly cooked meat
or by contact with the feces of infected animals.
 If toxoplasmosis is diagnosed before 20 weeks of
gestation damaged to the fetus is more severe if
the disease is acquired later. The incidence of
abortion, stillbirths, neonatal deaths, and severe
congenital anomalies is high.
 Signs and Symptoms
 Asymptomatic initially
 Myalgia
 Malaise
 Rash
 Spleenomegaly
 Posterior cervical lymphadenopathy
 Diagnostics
 IgM and IgG Fluorescent Antibody Test
› Elevate IgM titers are detectable 5 days after infection
and may remain elevated for one year or more.
 UTZ
› Severe fetal infection such as ascites,
ventriculomegaly, microcephaly, and growth
restriction
 Serologic Test (Sabin-Feldman-dye test)
 Treatment
 Sulfadiazine
 Pyrimethamine
 Leucovorin calcium
 Spiramycin
› The combination therapy should not be started until
after 16 weeks’ gestation of the teratogenic effects of
pyrimethamine.
› Sulfadiazine and erythromycin may be used during
the first half of pregnancy.
Nursing Responsibility
 Discuss methods of prevention of Toxoplosmosis
with the child-bearing woman.
 Must understand the importance of avoiding poorly
cooked or raw meat especially pork, beef, lam, and
caribou.
 Avoid contact with the cat litter box.
 Discuss the importance of woman’s wearing gloves
when gardening and avoiding garden areas
frequented by cats.
 Rubella
 The period of greatest risk for the teratogenic
effects of rubella on the fetus is during the first
trimester. If between the third and seventh week
of pregnancy, damage usually results in death.
 If infection occurs early in the second trimester,
the resulting feta effects is most often permanent
hearing impairment.
 Rubella
 Leukemia in childhood has been noted. Thus,
infected newborns often die early in pregnancy
 Signs and Symptoms
 Asymptomatic
 Maculopapular rash
 Lymphadenopathy
 Muscular achiness
 Joint pain
 Diagnostics
 IgM Antirubella Antibody
› Elevated for approximately 1 month following
infection
 Therapy
 The best therapy for rubella is prevention. Live
attenuated vaccine is available and should be
given to all children.
 It is recommended that women of childbearing
age be tested for immunity and vaccinated if
susceptible and if established that they are not
pregnant.
Nursing Responsibility
 Nursing support and understanding are vital for
the couple contemplating abortion due to a
diagnosis of rubella.
 Cytomegalovirus
 Belongs to the herpesvirus group and caused both
congenital and acquired infections referred to as
cytomegalic inclusion disease.
 The virus has the ability to be transmitted by
asymtomatic women across the placenta to the
fetus or by the cervical route during delivery. The
virus can be found in urine, saliva, cervical
mucus, semen, and breast milk.
 Cytomegalovirus
 The principal tissues and organs affected are the
blood, brain, and liver. All organs are
potentially at risk.
 Signs and Symptoms
 Hemolysis leads to anemia and
hyperbilirubinemia.
 Thrombocytopenia, with subsequent petechiae
and ecchymosis.
 Hepatomegaly
 Encephalitis lethargy or hypactivity and
convulsion.
 Cerebral palsy may develop.
 Diagnostics
 Rise in IgM levels
› It is only detectable in only 80% of people with acute
infection.
 Urinalysis
› CMV in the urine
 UTZ
› It may include growth restriction, hydramnios,
cardiomegaly, and fetal ascites.
 Treatment
 Currently no effective therapy exists to manage
this infection.
 Herpesvirus type 2
 Also called Genital herpes
 There is a 20%-50% rate of spontaneous
abortion if infection occurs during the first
trimester. Infection after the 20th week of
gestation leads to incidence of premature birth
but not teratogenic defects. The neonate can
acquire the infection. Survivors have permanent
visual damage and impaired psychomotor and
intellectual development.
 Signs and Symptoms
 Genital irritation and itching
 Vaginal and urethral discharge (may be copious
and foul-smelling)
 Enlarge tender lymph nodes and dysuria
 Begins with reddened papules which become
itchy pustular vesicles that break and form
painful wet ulcers, which then dry and develop
crust.
 Treatment
 Treatment is aimed at relieving the woman’s
vulvar pain. Bacterial infections may be treated
with cream containing sulfonamide. The client
may be most comfortable in bed at the peak of
the infection.
 Therapy
 Acyclovir (Zovirax)
 Famcyclovir
 Valacyclovir
› At this time, acyclovir is the only drug for herpes that
has been studied during pregnancy.
› Currently, there is no evidence that there are any
adverse fetal effects related to exposure to any of
these drugs during any trimester.
 Diagnostics
 When infection is suspected in the pregnant
woman, amniocentesis can be performed to
determine if there is fetal involvement.
 Herpesvirus type 2
 If the mother has no history of genital lesions and
present genital lesions, vaginal delivery is
preferable. However if there are active lesions,
cesarean birth is recommended.
Nursing Responsibility
 Client education is a must.
 Women should be informed about what herpes is,
how it is spread, and preventive measures.
 Women should also receive information bout the
association of genital herpes with spontaneous
abortion, neonatal mortality and morbidity,
cervical cancer and the possibility of cesarean
birth.
Nursing Responsibility

 Woman should inform hr future health care

providers of her infection so, history taking is
a must.
 Counseling to clients who wants to have a family
and wants to express anger, shame, and
depression which is often experienced by women
with herpes.
THANK YOU FOR
LISTENING
Prepared by:
Carlo Jed A. Mamaril