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TORCH Infections Summary

Aug 20, 2025

Overview

This lecture covers the congenital TORCH infections, their causes, clinical features, diagnosis, and management. It summarizes the pathogens in the TORCH acronym and highlights key neonatal complications and screening strategies.

TORCH Infections Overview

  • TORCH infections are a group of perinatal infections causing congenital anomalies.
  • TORCH stands for Toxoplasmosis, Other (varicella, parvovirus B19, HBV, HIV, etc.), Rubella, Cytomegalovirus (CMV), Herpes simplex, and Syphilis.
  • Screening for TORCH infections is essential in prenatal care.

Toxoplasmosis

  • Caused by Toxoplasma gondii, a protozoan, often from cat feces or undercooked meat.
  • Mothers are often asymptomatic; rare lymphadenopathy may occur.
  • Neonatal signs: chorioretinitis, hydrocephalus, intracranial calcifications, deafness, hepatosplenomegaly, growth restriction.
  • Diagnosis: PCR.
  • Treatment: Pyrimethamine and sulfadiazine.

Rubella

  • An RNA virus (German measles).
  • Most dangerous in first 12–16 weeks gestation.
  • Classic neonatal triad: patent ductus arteriosus, cataracts, deafness.
  • Also causes pulmonary artery hypoplasia, glaucoma, blueberry muffin rash.
  • Diagnosis: PCR.
  • Prevention: MMR vaccine (live, not given during pregnancy).

Cytomegalovirus (CMV)

  • A DNA virus leading to intrauterine growth restriction, deafness, microcephaly, seizures, periventricular calcifications, and blueberry muffin rash.
  • Non-specific symptoms: hepatosplenomegaly, jaundice, thrombocytopenia.
  • Diagnosis: Urine viral culture, PCR.
  • Treatment: Ganciclovir.

Herpes Simplex Virus (HSV)

  • Usually HSV-2 via vertical transmission.
  • Neonatal symptoms: meningoencephalitis, sepsis, gingivostomatitis, herpes ophthalmicus.
  • Diagnosis: Tzanck smear, PCR, viral culture.
  • Treatment: Acyclovir.
  • Prevention: C-section if active lesions.

Syphilis

  • Caused by Treponema pallidum (spirochete).
  • Neonatal features: stillbirth, hydrops fetalis, saber shins, Hutchinson teeth, saddle nose, snuffles, blindness, deafness, hepatitis.
  • Diagnosis: Darkfield microscopy, VDRL/RPR (screening), FTA-ABS/MHA-TP (confirmation).
  • Treatment: Penicillin G.

Other Infections ("O" in TORCH)

  • Includes parvovirus B19, varicella-zoster, HBV, HIV, and gonorrhea.
  • Group B streptococcus: risk of neonatal sepsis, pneumonia, or meningitis; prevention and treatment with penicillin G.

Key Terms & Definitions

  • Chorioretinitis — inflammation of the choroid and retina of the eye.
  • Hydrops fetalis — abnormal accumulation of fluid in fetal compartments.
  • Patent ductus arteriosus — persistent opening between the aorta and pulmonary artery.
  • Blueberry muffin rash — purplish skin lesions due to extramedullary hematopoiesis.
  • Saber shins — anterior bowing of the tibia.
  • Hutchinson teeth — notched, widely spaced upper incisors seen in congenital syphilis.
  • Snuffles — persistent nasal discharge in congenital syphilis.

Action Items / Next Steps

  • Review the clinical presentations and diagnostic methods for each TORCH infection.
  • Memorize the classic triads and key features for exam preparation.
  • Study the prevention strategies, especially vaccine recommendations and indications for C-section.
  • Complete any assigned readings on perinatal infections and congenital disease syndromes.

Full transcript