TORCH is an acronym that denotes a chronic nonbacterial perinatal infection. It stands for toxoplasmosis, other infections, rubella virus, cytomegalovirus (CMV), herpes simplex virus (HSV). The Zika virus (ZIKV) infection during pregnancy results in a congenital infection syndrome in the fetus and the newborn similar to other TORCH infections; manifestations include fetal growth restriction (FGR), microcephaly, craniofacial disproportion, ventriculomegaly, intracranial calcification, optic nerve hypoplasia, and chorioretinal atrophy, among others. Thus, it has been suggested that ZIKV be added to the TORCH acronym to become TORCHZ. “Other” infections include syphilis, hepatitis B, coxsackievirus, Epstein-Barr virus, varicella-zoster virus (VZV), Enterovirus/Parechovirus, human immunodeficiency virus (HIV), tuberculosis, and parvovirus B19. HSV disease in the neonate does not fit the pattern of chronic intrauterine infection but is traditionally grouped with TORCH. This group of infections may present in the neonate with similar clinical and laboratory findings (ie, IUGR, hepatosplenomegaly, rash, central nervous system [CNS] manifestations including calcifications, early jaundice, and low platelets), hence the usefulness of the TORCHZ 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 serologic 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 148–1 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 TORCHZ; therefore, each of these chapters has been separated and listed as a single chapter. See Chapter 149 for toxoplasmosis, Chapter 145 for rubella, Chapter 132 for cytomegalovirus, Chapter 137 for herpes simplex viruses, Chapter 154 for ZIKV, 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 148–1.SIGNS SUGGESTIVE OF A SPECIFIC CONGENITAL INFECTION IN THE NEONATE |Favorite Table|Download (.pdf) Table 148–1. 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,a 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 |
|Zika virus ||Microcephaly, craniofacial disproportion, ventriculomegaly, intracranial calcification, optic nerve hypoplasia |
HM. Zika virus: reigniting the TORCH. Nat Rev Microbiol
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