Infant TORCH Syndrome
Welcome to this video tutorial on the TORCH Syndrome.
TORCH Syndrome refers to an infection in a developing fetus or newborn of any one of a group of diseases.
The disease is passed from mother to child during pregnancy or childbirth.
TORCH is an acronym for the group of infections:
Toxoplasmosis
Other agents (syphilis, varicella, HIV)
Rubella
Cytomegalovirus
Herpes Simplex Virus
Once the mother is infected with a disease, the organism circulates in the mother’s blood and reaches the fetus by way of the placenta. In most cases, the maternal illness is mild, but the impact on the developing fetus can be severe enough to cause fetal loss or result in IUGR (intrauterine growth restriction), prematurity, or chronic postnatal infection.
TOXOPLASMOSIS
A disease caused by a protozoa that is parasitic – usually acquired by the pregnant woman eating raw or poorly cooked meat, raw eggs, or by contact with the feces of infected cats (such as improper handling of a cat litter box).
The fetus can contract toxoplasmosis through the placenta when the pregnant woman eats raw or poorly cooked meat, or by contact with the feces of infected cats.
The infant exposed prenatally may have:
Chorioretinitis – inflammation behind the retina, which can
progress to blindness (may not appear until adolescence)
Hydrocephalus – buildup of CSF in the brain
Intracranial calcifications – linked to mental retardation,
seizures, or motor and developmental delays
To avoid infection with toxoplasmosis, instruct the pregnant woman to:
Avoid poorly cooked or raw meat (especially pork, beef, lamb)
Wash fruits and vegetables thoroughly
Avoid contact with a cat litter box – make sure someone else is
cleaning it regularly
Wear gloves when gardening, and avoid garden areas frequented by cats
Diagnosis of congenital toxoplasmosis – by blood test
Treatment – antibiotics and/or antimalarial agent
Other agents - syphilis, varicella, HIV
SYPHILIS is a bacterial sexually transmitted infection that is transmitted from mother to fetus during pregnancy or at birth, resulting in congenital syphilis.
Untreated early syphilis results in miscarriage, premature birth, stillbirth, deformities, developmental delays, or seizures.
Newborns with congenital syphilis may develop:
“snuffles” - in which the mucus is highly infectious
palmar or solar rash.
As the child ages (after 2 yrs old) – Hutchinson’s teeth
(notched incisors or widely spaced pegged teeth)
Saddle nose (collapse of the bony part of nose)
Almost half of fetus’ infected with syphilis in utero do not make it to term or die soon afterwards. Most children born with syphilis do not show symptoms of the disease for several weeks or months after birth. If left untreated, the disease becomes severe and affects the neurological and cardiovascular systems.
A newborn with syphilis can be treated with antibiotics and if the mother is treated early in pregnancy, the infant is at minimal risk for infection.
VARICELLA VIRUS (chicken pox) – can be spread from a pregnant mother to her fetus through the bloodstream – there’s only a 2% chance that the baby will develop congenital varicella syndrome, but it does involve several different types of birth defects.
Congenital varicella syndrome birth defects:
Limb atrophy
Damage to the brain
Abnormally small head
Vision problems, cataracts
Psychomotor skill problems
Learning disabilities
Mental retardation
Congenital varicella syndrome is treated by giving the newborn varicella-zoster immune globin (VZIG) immediately after birth to lessen the severity of the disease.
A pregnant woman with varicella may be treated with an IV antiviral medication.
If the woman was immunized or previously infected with varicella before pregnancy, antibodies were formed, and will be transferred to the fetus. Neither the woman nor her fetus will become infected during the pregnancy.
HIV – Mothers with HIV may transmit the virus to their child during pregnancy, childbirth, or breastfeeding. With the appropriate antiretroviral therapy (ART), the risk of mother-to-child infection can be reduced to less than 1%, whereas the risk of transmission without treatment is 15-45%.
Approx 1.4 million HIV positive women become pregnant every year. Antiretroviral therapy can be used before, during, and after pregnancy.
Even if the woman is on ART, she should avoid breastfeeding because HIV can still be transmitted through breast milk.
Newborns should receive a 6-week course of AZT, and then be tested for HIV at 2-3 weeks of life, again at 4-8 weeks, and then at 4-6 months of age.
Most HIV babies appear healthy at birth, but if left untreated, the following signs or symptoms may develop within 2-3 months:
Poor weight gain
Repeated fungal mouth infections (thrush)
Enlarged lymph nodes
Multiple bacterial infections (pneumonia)
Neurological problems
RUBELLA
A disease also called German measles, caused by the virus, rubivirus.
It causes mild flu-like symptoms and a rash on the skin, or no symptoms at all.
Rubella can be passed from mother to fetus through the bloodstream during pregnancy.
Rubella can cause miscarriage, stillbirth, premature birth, or congenital rubella syndrome, which causes birth defects such as:
PDA – patent ductous arteriosus
cataracts
deafness
intellectual disabilities
bone or growth problems
liver or spleen damage
‘blueberry muffin rash’ (also seen in CMV)
Most damage is done to the developing fetus during the first trimester, whereas if the mother gets rubella towards the end of the 2nd trimester, it is less likely to harm the fetus. There is no cure for congenital rubella syndrome, so prevention is the key. Rubella can be prevented by getting the MMR (measles, mumps, rubella) vaccine – usually given in childhood. If the woman is non-immune, she may receive the vaccine at least 28 days prior to pregnancy or after delivery of the infant. Since it is a live virus, it cannot be given during pregnancy.
CYTOMEGALOVIRUS (CMV)
A virus that belongs to the herpes simplex virus group that may be inactive at times, but is an incurable, life-time infection. To the generally healthy adult, the virus normally produces no symptoms, and we have produced antibodies, which can be passed on to the fetus and protect the fetus. However, CMV is a major concern if a mother becomes first infected while pregnant because she has no antibodies to pass on to the fetus. Symptoms in the mother are similar to mononucleosis (fever, swollen glands, fatigue, tonsillitis, liver malfunction). The virus can be found in blood, saliva, urine, semen, cervical mucous, and breast milk, and can be transmitted from the infected mother across the placenta to the fetus or by the cervical route during birth or by breastfeeding.
Symptoms of congenital CMV may or may not be seen at birth, but can cause:
premature birth
low birth weight
blueberry muffin skin rash
liver or spleen enlargement
*microcephaly (small head)
*hearing loss
*mental retardation
seizures
A child with CMV may be treated with an anti-viral medication, which may reduce some of the effects of the infection.
Prevention is so important! The pregnant woman should practice good personal hygiene, especially handwashing after contact with diapers or saliva of toddlers (especially if they are in day care). Avoid sharing food or eating and drinking utensils. Avoid kissing young children on the mouth or putting their pacifier in your mouth – CMV can be transmitted by saliva.
HERPES SIMPLEX (HSV)
Herpes simplex virus infection can cause painful lesions in the genital area.
Women who contract their first herpes infection near the time of birth have the highest risk of transmission to the newborn.
Transmission of HSV to the fetus almost always occurs after the membranes rupture or during vaginal birth – placental transfer of infection is rare.
When HSV transfers to the newborn, it is evidenced by one or more forms:
Skin, eyes, and mouth (SEM) herpes – external lesions on
infant but no internal organ involvement
Disseminated herpes (DIS) – affects internal organs,
particularly the liver
Central nervous system (CNS) herpes – an infection of the
nervous system and brain – infant presents with seizures, tremors,
lethargy, irritability, poor feeding, unstable temperature, and
bulging fontanelles
Antiviral treatment reduces the morbidity and mortality of the infant.
As a nurse, educating your pregnant patient about how to prevent TORCH syndrome infections is vitally important to the health of the newborn.