Infections acquired in utero or during the birth process are a significant cause of fetal and neonatal mortality and an important contributor to early and later childhood morbidity. The original concept of the TORCH perinatal infections was to group five infections with similar presentations, including rash and ocular findings . These five infections are:
- Other (syphilis)
- Cytomegalovirus (CMV)
- Herpes simplex virus (HSV)
The TORCH acronym is well recognized in the field of neonatal/perinatal medicine . However, there are other well-described causes of in utero infection, including enteroviruses, varicella zoster virus, and parvovirus B19. Thus, broadening the “other” category to include additional pathogens has been proposed [3,4].
Given the increasing numbers of pathogens responsible for in utero and perinatal infections, the validity of indiscriminate screening of neonates or infants with findings compatible with congenital infection with “TORCH titers” has been questioned [5-8]. An alternate approach involves testing of infants with suspected congenital infections for specific pathogens based upon their clinical presentation (table 1) [3,4]. Timely diagnosis of perinatally acquired infections is crucial to the initiation of appropriate therapy. 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 of congenital infection.
An overview of the clinical features of specific TORCH infections and an approach to the infant with suspected intrauterine infection will be provided below. The individual TORCH infections are discussed in more detail separately: