++
Congenital TORCH infections comprise a group of diseases that affect the fetus and the newborn. Classically, the term TORCH represented Toxoplasmosis, other, traditionally referring to syphilis, rubella, cytomegalovirus (CMV), and herpes simplex virus (HSV). Recent additions to the acronym have expanded its repertoire to include infections such as human immunodeficiency virus (HIV), enterovirus, parvovirus, and varicella. These congenital infections share many clinical manifestations. Consequently, the differential diagnosis of one TORCH infection includes the remaining TORCH infections. The prevalence of the TORCH infections is variable. Infection due to rubella and toxoplasmosis is rarely seen in the United States, while CMV is common, representing a significant public health concern. Table 50–1 lists the classically defined TORCH infections and their common manifestations weighted according to their prevalence among infected neonates. The following chapter will discuss the epidemiology, pathogenesis, clinical manifestations, diagnostic approaches, and management strategies for affected infants.
++
+++
Definitions and Epidemiology
++
Cytomegalovirus, a ubiquitous pathogen, is the most common cause of congenital viral infections. It is a double-stranded, species-specific DNA virus of the herpes family.1,2 Infection in the immunoincompetent, vulnerable fetus can have devastating effects. Congenital CMV infection is a leading cause of sensorineural hearing loss (SNHL) and neurodevelopmental disturbances resulting from central nervous system involvement.3
++
The incidence of primary CMV infection in pregnancies is estimated to range from 0.15% to 4%, with vertical transmission rates as high as 40%.2,4 Over 27,000 women per year in the United States experience a primary CMV infection during pregnancy. Primary infection in pregnancy is not evenly ...