TORCH SYNDROME: SYMPTOMS, CAUSES, TREATMENT - GEOGRAFÍA - 2024

The syndrome TORCH refers to a large group of diseases that can cause infectious processes during pregnancy or at the time of birth. Specifically, the acronym TORCH comprises 5 types of infections: T (oxoplasmosis), O (other - syphilis, chickenpox, etc.), R (rubella), C (cytomegalovirus), H, (herpes simplex).

The clinical manifestations will depend on the type of congenital infection that develops in the affected person. However, there are some common signs and symptoms: generalized growth retardation, fever, hepatosplenomegaly, anemia, petechiae, hydrocephalus, calcifications, etc.

Diagnostic suspicion is usually based on clinical findings. However, a serological study is essential to identify the source of the infection. In this syndrome, the most common is to use the TORCH diagnostic profile.

Treatment of TORCH syndrome will be specific to each individual and depends on the type of infection you have. Medical specialists usually resort to the use of classic approaches in each pathology.

Characteristics of TORCH syndrome

TORCH syndrome refers to a group of pathologies that can cause congenital infectious processes. Congenital infections are defined as medical conditions that are transmitted from mother to child during pregnancy or at the time of birth.

Normally, these types of infectious processes tend to be acquired during the first, second or third trimester of pregnancy. However, it is also possible that the infection is contracted as the fetus passes through the birth canal.

In the case of this syndrome, its name is based on the acronym for the most common congenital infections: T (toxoplasmosis), R (rubella), C (cytomegalovirus) and H (H).

The O usually refers to other infectious processes, including syphilis, chickenpox, malaria, tuberculosis, and papillomavirus, among others.

Each type of infection will generate a differential clinical course: moment of presentation, signs and symptoms, medical complications, treatment, etc.

As authors such as Salvia, Álvarez, Bosch and Goncé (2008) point out, they all have some common characteristics:

• The transmission of the pathological agent from the mother to the child can occur through direct contact during birth or through the placental route during pregnancy.
• The origin of the infectious process can be associated with viral, bacteriological or parasitic agents.
• In the mother, the infection does not usually cause significant symptoms so they often go unnoticed.
• The diagnosis includes in all cases a serological, molecular biological or cell culture study.
• The clinical course can be similar in many of the infections, however, they are widely variable.
• The disease agent that is contracted before 20 weeks of gestation causes important medical complications, such as the development of physical malformations.
• Infection in later stages of gestation usually causes prematurity, low birth weight, or some central nervous system disorders.
• Infections contracted during childbirth usually cause pneumonitis, hepatosplenomegaly, sepsis, anemia, among others.
• Some of the pathologies can remain asymptomatic during the neonatal period. They usually generate neurosensory sequelae at later times.

Statistics

TROCH syndrome and infectious processes of congenital origin are frequent pathologies. Its incidence reaches a figure close to 2.5% of all newborns each year.

Not all those affected have significant medical complications. A large percentage have an asymptomatic clinical course.

What are the most common infections associated with TROCH syndrome?

The infectious processes categorized within the TROCH syndrome include: toxoplasmosis, rubella, cytomagalovirus, herpes simplex and other less frequent such as varicella-zoster, syphilis, parvovirus and papillomavirus.

Toxoplasmosis

Toxoplasmosis is an infection caused by a protozoan. It is usually contracted through the ingestion of some poorly washed or undercooked foods. In most cases, affected mothers do not usually present significant symptoms, but transmit the infection to the embryo during pregnancy.

Congenital toxoplasmosis is usually considered a rare disease in the general population. Epidemiological studies estimate its incidence at 1 case per 1,000 deliveries. The infectious process usually manifests in the fetus during pregnancy or in the neonatal stage.

Although the signs and symptoms may vary among those affected, the most common include: chorio-retinitis, splenomegaly, cerebral calcifications, epilepsy, anemia, febrile episodes, cerebrospinal fluid alterations, etc.

The definitive diagnosis of this pathology is usually based on the results of serological tests.

For its part, the treatment used in the pregnant woman is oriented towards the prevention of transmission. The most used drugs are antimicrobials. In the case of the treatment of the infected fetus, the most common is the administration of pyrimethamine and sulfadiazine, together with a thorough medical control.

Rubella

Rubella is another of the congenital infections classified under the name TORCH syndrome. The contraction of the rubella virus is usually associated with direct contact or nasopharyngeal secretions.

It has an incubation period of about 18 days and can cause significant harm to the fetus when the mother contracts the infection during or before the fourth month of pregnancy.

Although it is not very common in the general population, rubella can cause a significant number of pathologies. The most frequent alterations are associated with the presence of cardiac pathologies. They are usually present in more than 70 of the cases and are characterized by:

• Ductus arteriosus.
• Pulmonary artery stenosis.
• Arterial necrosis.
• Septal and / or ventricular abnormalities.
• Loss of striation.

Other frequent medical complications are hypoacuisa, microcephaly, cataracts, ocular hypoplasia, microphthalmos, retinopathy, etc.

The diagnosis of rubella is usually made based on the identification of some of the clinical signs noted above. In addition, an analysis of the pharyngeal secretions is performed.

Final diagnostic confirmation usually depends on virus isolation and immunological results. No specific therapeutic approach has been designed for congenital rubella. The most common is immunization against this virus before pregnancy.

The vaccines are usually given to women of childbearing age, at least one month before conception. Its use during pregnancy is contraindicated.

Cytomegalovirus

Cytomegalovirus is a pathological agent belonging to the Herpesviridae family and is exclusive to humans. It is the most common congenital infection in the general population. It is usually transmitted by direct contact with body fluids such as blood.

Many of the infections are asymptomatic or subclinical in affected women. However, during gestation the fetus can develop the infection through a reactivation of the process or primary infection of the pregnant woman.

This type of infectious process can cause significant lesions in the fetus: optic atrophy, microcephaly, ventricular calcifications, hepatosplenomegaly, ascites, or growth retardation.

Furthermore, a smaller percentage of those affected may also develop febrile episodes, encephalitis, respiratory involvement, skin purpura, hepatitis, or generalized delay in psychomotor development.

The diagnosis of cytomegalovirus infection requires confirmation through laboratory tests. It is necessary to isolate the virus from the blood or amniotic fluid during pregnancy.

In addition, several experimental studies are examining the efficacy of drugs such as ganciclovit for the treatment of this pathology. Immunoglobulin administration is not usually indicated in these cases.

Simple herpes

Cases of herpes simplex virus infections tend to be high in many developed countries, resulting in 1 diagnosis for every 3,500 deliveries.

This type of virus is usually contracted through a carrier with lesions in skin or mucous areas through its excretion by various bodily fluids such as saliva, semen or vaginal secretions.

Despite the fact that most infections are asymptomatic, the herpes simplex virus has the ability to remain in a latent state in the body and can be reactivated sporadically.

In the case of carrier pregnant mothers, this virus can be transmitted to the fetus at the time of delivery when it passes through the vaginal canal.

Although some cases remain asymptomatic, medical complications from neonatal herpes infection are associated with the development of disseminated disease (respiratory and liver failure, encephalitis, CNS abnormalities, etc.), central nervous system pathologies (seizures, irritability, thermal alterations, disorders of consciousness, etc.) or eye, skin and / or oral pathologies.

Identification of this infectious process requires various laboratory tests. A cell culture is usually performed from a sample of genital lesions, newborn skin lesions, or body fluids.

Herpes simplex treatment is based on the administration of antiviral medication, such as Acyclovir. In addition, it is important to isolate the fetus during delivery through a cesarean-assisted delivery.

Varicella zoster

The chickenpox virus is one of the most contagious. It is exclusive to the human species and has an incubation period of about 10 or 20 days.

Currently, more than 80% of pregnant women are immune to this virus thanks to advanced vaccination techniques. However, its frequency reaches 2 or 3 cases per 1,000 pregnant women.

Fetal infection usually occurs before the 20th week of gestation through a transparent route. In cases of maternal infection in days close to or after delivery, the risk of neonatal infection is high and serious.

During pregnancy, this type of infection can cause skin lesions, musculoskeletal disorders, neurological and ophthalmological injuries. On the other hand, if the infection occurs in the neonatal phase, chickenpox with severe mulsystemic involvement may appear.

The diagnosis in the case of the pregnant woman is clinical and is based on symptomatic identification and serological analysis. For the fetal exam, an amniocentesis is usually done to isolate the virus.

Maternal pulling usually requires the administration of variecela-zoaster immunoglobulin. While the treatment of the newborn requires specific or non-specific gamma-globulin.

Syphilis

Syphilis is an infectious prisoner caused by the Treponema pallidum virus. Any affected and untreated pregnant woman can transmit this pathology during pregnancy or at the time of delivery.

The embryonic and neonatal manifestations of syphilis can be very broad: meningitis, coryza, hepatosplenomegaly, adenopathy, pneumonitis, anemia, prematurity, generalized growth retardation, bone alterations, etc.

Despite the fact that a large part of those affected have an asymptomatic course for many years, syphilis can cause some late manifestations: seizures, deafness or intellectual disability, among others.

This pathology requires urgent medical intervention. When the mother has been treated, penicillin is usually used, while if she has not been treated, other types of treatments are used.

Parvovirus

Infection by parvovirus B19 produces various skin changes, including infectious erythema.

It is not a frequent pathology, but it can cause spontaneous abortion in 10% of cases. Although if the infection occurs in the late stages of pregnancy, the clinical course is associated with the development of hydrops, thrombocytopenia, myocarditis, liver lesions, etc.

Treatment of this medical condition often focuses on addressing the symptoms and medical complications. In the case of severe alterations during pregnancy, intrauterine transfusion can be used.

Papillomavirus

Papillomavirus is another of the unique pathological agents of the human species. Fetuses and embryos are often affected by infectious processes generated by transplacental routes or by passage through the birth canal.

The clinical course of this medical condition is mainly characterized by the development of respiratory disorders. Medical interventions focus on maintaining open airways and monitoring for medical complications.

References

1. Díaz Villegas, M. (2016). TORCH. Text of the Chair of Pediatrics.
2. IGSS, G. d.-O. (2014). Management of TORCH in Pregnancy. Evidence-Based Clinical Practice Guidelines.
3. NORD. (2016). TORCH Syndrome. Obtained from National Organization for Rare Disorders.
4. Salvia, M., Álvarez, E., Bosch, J., & Goncé, A. (2008). Congenital infections. Spanish Association of Pediatrics.
5. Ticona Apaza, V., & Vargas Poma, V. (2011). TORCH SYNDROME. Journal of Clinical Update.