Definition TORCH is an acronym fora group of perinatal inf jat can be transmitted transplacentally from mother to fetus and lea to congenital anow ee complications. T- eee R- Rubella C- Cytomegalovirus (CMV) H - Herpes Simplex Virus (HSV) Common Features of TORCH Infe jaundice - Anemia ‘Thrombocytopenia Sensorineural hearing loss ‘ongenital malformations + Intrauterine Growth Restriction (IUGR) + Microcephaly = + Hepatosplenomegaly + Chorioretinitis + Intracranial calcifications Cause: om + Protozoan parasite - Toxoplasma gond Transmission: ~ —— + Ingestion of oocysts (from undercooked meat or cat feces) + Transplacental (maternal primary infection > fetus). Effect of Gestational Age: < + Early pregnancy infection: Low transmission (40-25%), ‘but severe fetal damage + Late pregnaney infection: High transmission ( 60-90%), but milder fetal disease Classic Triad in Congenital infection: = + Chorioretinitis - inflammation of retina + blindness + Hydrocephalus - fluid accumulation in brain ~ + Intracranial caleifications - usually diffuse, scattered a Other Features: » Seizures, hepatosplenomegaly, jaundice, anemia, thrombocytopenia o Diagnosis: + Maternal: IgM antibodies, PCR fram amniotic fluid + Neonatal: IgM in cord blood, CSF analysis Management: aes a + Spiramycin during pregnancy (prevents transmission) If fetal infection confirmed: Pyrimethamine + Sulfad1. Syphilis. Causative agent: Treponema poildam (a type of spiral shaped bacteria callede spirochete) Transmission: + Mostly transplacental, especially ater 20 weeks + Incveases risk of 1UFD, stilbrth, and congenital syphilis Clinical Features: A. Early Congenital Syphilis (<2 years}: + Souffle nasal discharge containing the bacteria) and + ash, hepatosplenomegaly (enlargement of iver spleen), anemia (low red blood cells) + Skeletal aonormalities tke: = Saber shins (curved tibia bones| ~ Periostits inflammation ofthe bone layerceled periosteum) B. Late Congenital Syphilis (+2 years}: Hutchinson's Tried: + Hutchinson teeth (notched, peg,-shaped central incisors) + Interstitial keratitis inflammation of the cornea ‘ausingvision problems) + Sensorineural deainess (heering loss due to inner ‘ear/nerve damage) oe Diagnosis: + VORL (Venereal Disease Research Laboretory test eR (Rapid Plasira Ragin) - screening + Confirm with FTA-ABS (Fluorescent Treponemal Antibooy Abcorption test) Treatment: 4. Zika Virus Causative agent: Zika vinis fo Flovvirus) i Transmission: + Asdes mosquite bite + Sexual transmission + Transplacental mother fetus) Effects on fetus: + Migrocephaly(smallnzad and brain size) + Intracranial ealeifications + Ocular detects (e.g. macular scarring, ‘chor oretinalatropiy) + Athrogryposis joint contractures stf, bent joints) + Selzures, ventiiculomiegaly Diagnosis: "HT PaR Rese spe amerse in Reaction detects vis RNA) ie rf jantivodies in mother or fetus + Fetal ultrasound (USG) - may show bra eas 2. Varicella-Zoster {Causes chickenpoxin primary infection) Causative agent: Varicella-zoster Virus Transmission: Risky if mother develops primary varicella (chickenpox) in early pregnancy, especially. m0 Wook Congenital varicella Syndrome (CVS): . Limb hypoplasia underdeveloped limbs) uitareous scaring (skin scars following nerve pattems ~dermatomes) = Oculardefects (:g, cataracts, chorioretinits- inflammation of retinafchorcid) icrocephaly ‘smali head size), cortical atrophy (shrinkage brain sueace 213) Prevention: + Varicella vaccine be%ore pregnancy + ¥21G (uaticella-Zoster immune Globulit) exposed ducing pregrancy + Aeyclovir =antiviat treatment for maternal infection _ 3. Parvovirus B19 = Destroys entra precusors (cellethat form red blood cele > lead to fetal + Can caus Nen-ImmuneHycrops Fetalis (abnormal fluid accumulator HP Dingnosis: — Nateral gt antbodes, eta US6 shows hycraps 6. Hepatitis B Virus (HBV) Transmission: + Mainly perinatal during childbirth) Risk Foctors: + Mother HBeAg positive (Hepatitis Benvelone antigen ~ indicates high infectivity) + High HBV DNA levels Effects on fetus: High tisk of chronic HBV infection in neonate Diagnosis: Maternal HBsAg (Hepatitis B surface antigen), HBeAg Prevention : Give HaV vaccine + HAIG (Hepatitis mmunogiobulin) within 12 hrs of bith + Tlective “hoa Treatment:fae Pet Cause: Rubella virus (RNA virus} Transmission: + Transplacental, especially in 1st trimester + Greatest fetal risk before 11 weeks gestation Congenital Rubella Syndrome: Classic Triad: Other Signs: 1. Sensorineural deafness (most common) + “Blueberry muffin rash” (extramedullary 2. Cataracts ~~ hematopoiesis) = 3. Congenital heart defects - PDA, pulmonary + Hepatosplenomegaly. artery stenosis + Microcephaly, intellectualdelay Diagnosis: z : se = + Maternal IgM, fetal USG + Neonatal igM, virus isolation Management: = = + MMR vaccine (live attenuated), contraindicated during pregnancy + Vaccinate at least 1 month before conception Transmission: + Sexual contact, salivasurine Transmission: Effects: S _+ Usually perinatal (during vaginal delivery) + Most 6ommon congenital viral infection Hereby rarsplacental » Periventricular calcifications + Microcephaly * Sensorineural deatness - + Localized (Skin, eye, mouth} - vesicular lesions + Hepatosplenomegaly, jaundice CNS form - seizures, lethargy, encephalitis : = isseminated form - liver failure, pneumonia, Diagnosis: 5 sepsis-like + Maternal: IgM, PCR 5 + Neonatal Virus culture from urine or saliva within 3 weeks "Management:-Hemolysis high bil -> jaundice #/- kemicterus Vertically transmitted infections “Extramedullary hematopoiesis —» hepatasplenomegaly, lymphadenopathy, widespread purpura (oluebery mufin baby) -Low platelets — petechiae Infection: Symptoms / signs /findings: _ Diagnosis: Riskihow did) Maternal | Screening ! mom get it? symptoms: prevention: ‘Dice inacranil caleneabons (tay in) Pyrinetnamine, | 8888, 1 ayer, malaise, cervical Tospiamons Daal gmgs) crorortnts ryseeprake/ | Toxpesma sutra,” | #0 RO" RS | Toxo actos jasmosis yentculomegalyselzures; HSM. FGR, visual Serology OrPCR folnlc acd / | yp 4POMES, | macsopapuar ash: | 1s master dour developmen Sy icovan | néaskeron aces stars steoatcular destruction fg Hutchinson a a ae enn cron Sempcamcctn eatin, nm pany aro onan aa eee ee tabes, AR pupils (3°) _—+ desensitize) taacts(ukocoi [vit pupil rolex, [Rube (Geman nat etecs (POA. VSO) SNL exerci SOI (0H an eases) hematopoiesis (bvebery mun baby) IUGR avy i). 5 and storon fa ret eee eel re a are Aan cin a Lael ‘arthralgias, arthritis SU'ing Pregnancy) Biltoral periventricular ealefications; cr eat via) “Cytomegalovirus __deatness (SNHL), thrombocytopenia, ty (rest commen) chorretntis petechae;buebery muffin HSM: ‘Contacts uring / Valgancidowr; salva: work w fen aeymptoic, of eee | ee ceed memati, temas, " ee ee an eae aes |e ae eerie | ee eas se ae eae Seen ess saen re estar Cae eee se ee eas Renate alge eel ceeecey ee cee a Vasestezete Transmxn: Chickenpox contacts —+ aerosolized droplots ‘Sx: Limb hypoplasia, vosicuar eruption -- cutaneous scars, chorioretinits, corical atrophy, cataracts, fever, systemic (hepatitis, pneumonia, meningitis, encephalitis “Tx: Acyclovir. + PEP: if mom exposed on DOB-5d to DOB*24, give VZIG ‘Screoniprevent: 1st rmostor seroen; MMRV vaccine (not during pregnancy) Listeria monocytogenes: Transmxn: food —> bacterial invasion of intestinal thelium —+ transplacental to fotus ‘Sx: neonatal febrile gastroenteritis —- invasive disease (sepsis, meningitis). Multiple abscesses and granulomas, a.k.a. Granulomatosis infantsoptica x: Gram* rods on culture Tr: gastroenteritis gets supportive care; invasive dz gets abx ‘Screeniprevent: pregnant moms avoid raw meatsiveggies, unpasteurized dairy, deli meats, decaying vegetation