TORCH is an acronym that denotes a chronic nonbacterial perinatal infection. It stands for toxoplasmosis, other infections, rubella virus, cytomegalovirus (CMV), and herpes simplex virus (HSV). “Other” infections include syphilis, hepatitis B, coxsackievirus, Epstein-Barr virus, varicella-zoster virus (VZV), enteroviruses, human immunodeficiency virus (HIV), tuberculosis, and parvovirus B-19. Herpetic disease in the neonate does not fit the pattern of chronic intrauterine infection but is traditionally grouped with the others. This group of infections may present in the neonate with similar clinical and laboratory findings (ie, small for gestational age, hepatosplenomegaly, rash, central nervous system [CNS] manifestations, early jaundice, and low platelets), hence the usefulness of the TORCH concept. However, because the “other infections” category of responsible pathogens is growing and becoming diverse, the validity of indiscriminate screening of neonates presenting with findings compatible with congenital infection using “TORCH titers” has been questioned. Additionally, some of this serological testing yields both false-positive and false-negative results. An alternative approach involves testing of infants with suspected congenital infections for specific pathogens based on their clinical presentation (see Table 141–1 and individual chapters on each pathogen). A high index of suspicion for congenital infection and awareness of the prominent features of the most common congenital infections help to facilitate early diagnosis and possible therapy. Clinicians are getting away from the acronym TORCH; therefore, each of these chapters has been separated and listed as a single chapter. See Chapter 142 for toxoplasmosis, Chapter 128 for rubella, Chapter 90 for cytomegalovirus, Chapter 96 for herpes simplex viruses, and other disease-specific chapters. See Appendix F for isolation precautions for all infectious diseases, including maternal and neonatal precautions, breast-feeding, and visiting issues.
Table 141–1.SIGNS SUGGESTIVE OF A SPECIFIC CONGENITAL INFECTION IN THE NEONATE |Favorite Table|Download (.pdf) Table 141–1.SIGNS SUGGESTIVE OF A SPECIFIC CONGENITAL INFECTION IN THE NEONATE
|Toxoplasmosis ||Intracranial calcifications (diffuse), hydrocephalus, chorioretinitis |
|Syphilis ||Snuffles, maculopapular rash (on palms and soles), skeletal abnormalities (osteochondritis and periostitis) |
|Rubella ||Blueberry muffin lesions, eye findings (cataracts, congenital glaucoma, pigmentary retinopathy), congenital heart disease (most commonly patent ductus arteriosus), radiolucent bone disease |
|Cytomegalovirus ||Periventricular intracranial calcifications, microcephaly |
|Herpes simplex virus ||Mucocutaneous vesicles or scarring, conjunctivitis or keratoconjunctivitis, elevated liver transaminases |