Overview of TORCH infections
- Karen E Johnson, MD
Karen E Johnson, MD
- Associate Professor
- Baylor College of Medicine
- Section Editors
- Leonard E Weisman, MD
Leonard E Weisman, MD
- Section Editor — Neonatology
- Professor of Pediatrics
- Baylor College of Medicine
- Morven S Edwards, MD
Morven S Edwards, MD
- Section Editor — Pediatric Infectious Diseases
- Professor of Pediatrics
- Baylor College of Medicine
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:
- Epps RE, Pittelkow MR, Su WP. TORCH syndrome. Semin Dermatol 1995; 14:179.
- Maldonado YA, Nizet V, Klein JO, et al. Current concepts of infections of the fetus and newborn infant. In: Infectious Diseases of the Fetus and Newborn Infant, 7th ed, Remington JS, Klein JO, Wilson CB, et al (Eds), Elsevier Saunders, Philadelphia 2011. p.2.
- Stamos JK, Rowley AH. Timely diagnosis of congenital infections. Pediatr Clin North Am 1994; 41:1017.
- Kinney JS, Kumar ML. Should we expand the TORCH complex? A description of clinical and diagnostic aspects of selected old and new agents. Clin Perinatol 1988; 15:727.
- Khan NA, Kazzi SN. Yield and costs of screening growth-retarded infants for torch infections. Am J Perinatol 2000; 17:131.
- Cullen A, Brown S, Cafferkey M, et al. Current use of the TORCH screen in the diagnosis of congenital infection. J Infect 1998; 36:185.
- Garland SM, Gilbert GL. Investigation of congenital infection--the TORCH screen is not a legitimate test. Paediatric Infectious Diseases Group of the Australasian Society for Infectious Diseases. Med J Aust 1993; 159:346.
- de Jong EP, Vossen AC, Walther FJ, Lopriore E. How to use... neonatal TORCH testing. Arch Dis Child Educ Pract Ed 2013; 98:93.
- National Newborn Screening and Genetics Resource Center. National newborn screening status report. http://genes-r-us.uthscsa.edu/nbsdisorders.pdf (Accessed on July 20, 2011).
- Leland D, French ML, Kleiman MB, Schreiner RL. The use of TORCH titers. Pediatrics 1983; 72:41.
- van der Weiden S, de Jong EP, Te Pas AB, et al. Is routine TORCH screening and urine CMV culture warranted in small for gestational age neonates? Early Hum Dev 2011; 87:103.
- Coles FS. Viral Infections of the Fetus and Newborn. In: Avery's Diseases of the Newborn, 7th ed, Taeusch WH, Ballard RA (Eds), Saunders, Philadelphia 1998. p.471.
- Lazzarotto T, Varani S, Gabrielli L, et al. New advances in the diagnosis of congenital cytomegalovirus infection. Intervirology 1999; 42:390.
- Stagno S, Whitley RJ. Herpesvirus infections of pregnancy. Part I: Cytomegalovirus and Epstein-Barr virus infections. N Engl J Med 1985; 313:1270.
- Rousseau T, Douvier S, Reynaud I, et al. Severe fetal cytomegalic inclusion disease after documented maternal reactivation of cytomegalovirus infection during pregnancy. Prenat Diagn 2000; 20:333.
- Boppana SB, Fowler KB, Britt WJ, et al. Symptomatic congenital cytomegalovirus infection in infants born to mothers with preexisting immunity to cytomegalovirus. Pediatrics 1999; 104:55.
- Gratacap-Cavallier B, Bosson JL, Morand P, et al. Cytomegalovirus seroprevalence in French pregnant women: parity and place of birth as major predictive factors. Eur J Epidemiol 1998; 14:147.
- Demmler GJ. Infectious Diseases Society of America and Centers for Disease Control. Summary of a workshop on surveillance for congenital cytomegalovirus disease. Rev Infect Dis 1991; 13:315.
- Stagno S, Pass RF, Cloud G, et al. Primary cytomegalovirus infection in pregnancy. Incidence, transmission to fetus, and clinical outcome. JAMA 1986; 256:1904.
- Griffiths PD, Baboonian C. A prospective study of primary cytomegalovirus infection during pregnancy: final report. Br J Obstet Gynaecol 1984; 91:307.
- Yow MD, Williamson DW, Leeds LJ, et al. Epidemiologic characteristics of cytomegalovirus infection in mothers and their infants. Am J Obstet Gynecol 1988; 158:1189.
- Bodéus M, Hubinont C, Goubau P. Increased risk of cytomegalovirus transmission in utero during late gestation. Obstet Gynecol 1999; 93:658.
- American Academy of Pediatrics. Cytomegalovirus infection. In: Red Book: 2012 Report of the Committee on Infectious Diseases, 29th, Pickering LK (Ed), American Academy of Pediatrics, Elk Grove Village, IL 2012. p.300.
- Raynor BD. Cytomegalovirus infection in pregnancy. Semin Perinatol 1993; 17:394.
- Casteels A, Naessens A, Gordts F, et al. Neonatal screening for congenital cytomegalovirus infections. J Perinat Med 1999; 27:116.
- Stehel EK, Shoup AG, Owen KE, et al. Newborn hearing screening and detection of congenital cytomegalovirus infection. Pediatrics 2008; 121:970.
- Reynolds DW, Stagno S, Stubbs KG, et al. Inapparent congenital cytomegalovirus infection with elevated cord IgM levels. Casual relation with auditory and mental deficiency. N Engl J Med 1974; 290:291.
- Hanshaw JB, Scheiner AP, Moxley AW, et al. School failure and deafness after "silent" congenital cytomegalovirus infection. N Engl J Med 1976; 295:468.
- Melish ME, Hanshaw JB. Congenital cytomegalovirus infection. Developmental progress of infants detected by routine screening. Am J Dis Child 1973; 126:190.
- Peckham CS, Chin KS, Coleman JC, et al. Cytomegalovirus infection in pregnancy: preliminary findings from a prospective study. Lancet 1983; 1:1352.
- Stagno S, Reynolds DW, Amos CS, et al. Auditory and visual defects resulting from symptomatic and subclinical congenital cytomegaloviral and toxoplasma infections. Pediatrics 1977; 59:669.
- Saigal S, Lunyk O, Larke RP, Chernesky MA. The outcome in children with congenital cytomegalovirus infection. A longitudinal follow-up study. Am J Dis Child 1982; 136:896.
- Kumar ML, Nankervis GA, Jacobs IB, et al. Congenital and postnatally acquired cytomegalovirus infections: long-term follow-up. J Pediatr 1984; 104:674.
- Boppana SB, Fowler KB, Pass RF, et al. Congenital cytomegalovirus infection: association between virus burden in infancy and hearing loss. J Pediatr 2005; 146:817.
- Britt W. Cytomegalovirus. In: Infectious Diseases of the Fetus and Newborn Infant, 7th ed, Remington JS, Klein JO, Wilson CB, et al (Eds), Elsevier Saunders, Philadelphia 2011. p.706.
- Guerra B, Lazzarotto T, Quarta S, et al. Prenatal diagnosis of symptomatic congenital cytomegalovirus infection. Am J Obstet Gynecol 2000; 183:476.
- Kylat RI, Kelly EN, Ford-Jones EL. Clinical findings and adverse outcome in neonates with symptomatic congenital cytomegalovirus (SCCMV) infection. Eur J Pediatr 2006; 165:773.
- Boppana SB, Pass RF, Britt WJ, et al. Symptomatic congenital cytomegalovirus infection: neonatal morbidity and mortality. Pediatr Infect Dis J 1992; 11:93.
- Istas AS, Demmler GJ, Dobbins JG, Stewart JA. Surveillance for congenital cytomegalovirus disease: a report from the National Congenital Cytomegalovirus Disease Registry. Clin Infect Dis 1995; 20:665.
- Steinlin MI, Nadal D, Eich GF, et al. Late intrauterine Cytomegalovirus infection: clinical and neuroimaging findings. Pediatr Neurol 1996; 15:249.
- Noyola DE, Demmler GJ, Nelson CT, et al. Early predictors of neurodevelopmental outcome in symptomatic congenital cytomegalovirus infection. J Pediatr 2001; 138:325.
- Boppana SB, Fowler KB, Vaid Y, et al. Neuroradiographic findings in the newborn period and long-term outcome in children with symptomatic congenital cytomegalovirus infection. Pediatrics 1997; 99:409.
- Williamson WD, Demmler GJ, Percy AK, Catlin FI. Progressive hearing loss in infants with asymptomatic congenital cytomegalovirus infection. Pediatrics 1992; 90:862.
- Fowler KB, McCollister FP, Dahle AJ, et al. Progressive and fluctuating sensorineural hearing loss in children with asymptomatic congenital cytomegalovirus infection. J Pediatr 1997; 130:624.
- Coats DK, Demmler GJ, Paysse EA, et al. Ophthalmologic findings in children with congenital cytomegalovirus infection. J AAPOS 2000; 4:110.
- Nelson CT, Istas AS, Wilkerson MK, Demmler GJ. PCR detection of cytomegalovirus DNA in serum as a diagnostic test for congenital cytomegalovirus infection. J Clin Microbiol 1995; 33:3317.
- Demmler GJ, Buffone GJ, Schimbor CM, May RA. Detection of cytomegalovirus in urine from newborns by using polymerase chain reaction DNA amplification. J Infect Dis 1988; 158:1177.
- Bodéus M, Hubinont C, Bernard P, et al. Prenatal diagnosis of human cytomegalovirus by culture and polymerase chain reaction: 98 pregnancies leading to congenital infection. Prenat Diagn 1999; 19:314.
- Whitley RJ, Cloud G, Gruber W, et al. Ganciclovir treatment of symptomatic congenital cytomegalovirus infection: results of a phase II study. National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group. J Infect Dis 1997; 175:1080.
- Nigro G, Scholz H, Bartmann U. Ganciclovir therapy for symptomatic congenital cytomegalovirus infection in infants: a two-regimen experience. J Pediatr 1994; 124:318.
- Kimberlin DW, Lin CY, Sánchez PJ, et al. Effect of ganciclovir therapy on hearing in symptomatic congenital cytomegalovirus disease involving the central nervous system: a randomized, controlled trial. J Pediatr 2003; 143:16.
- Prober CG, Enright AM. Congenital cytomegalovirus (CMV) infections: hats off to Alabama. J Pediatr 2003; 143:4.
- Nigro G, La Torre R, Anceschi MM, et al. Hyperimmunoglobulin therapy for a twin fetus with cytomegalovirus infection and growth restriction. Am J Obstet Gynecol 1999; 180:1222.
- Wagner N, Kagan KO, Haen S, et al. Effective management and intrauterine treatment of congenital cytomegalovirus infection: review article and case series. J Matern Fetal Neonatal Med 2014; 27:209.
- Plotkin SA. Vaccination against cytomegalovirus. Arch Virol Suppl 2001; :121.
- Reef SE, Plotkin S, Cordero JF, et al. Preparing for elimination of congenital Rubella syndrome (CRS): summary of a workshop on CRS elimination in the United States. Clin Infect Dis 2000; 31:85.
- Cherry JD, Adachi K. Rubella virus. In: Feigin and Cherry’s Textbook of Pediatric Infectious Diseases, 7th ed, Cherry JD, Harrison GJ, Kaplan SL, et al (Eds), Elsevier Saunders, Philadelphia 2014. p.2195.
- Nickerson JP, Richner B, Santy K, et al. Neuroimaging of pediatric intracranial infection--part 2: TORCH, viral, fungal, and parasitic infections. J Neuroimaging 2012; 22:e52.
- SCREENING FOR TORCH INFECTIONS
- CLINICAL FEATURES OF TORCH INFECTIONS
- Congenital toxoplasmosis
- Congenital syphilis
- Congenital rubella
- Congenital cytomegalovirus
- - Epidemiology
- - Transmission
- - Clinical manifestations
- - Diagnosis
- - Treatment
- Herpes simplex virus
- Congenital varicella syndrome
- APPROACH TO THE INFANT WITH SUSPECTED INTRAUTERINE INFECTION
- Clinical suspicion
- Initial evaluation
- Specific evaluation
- INFORMATION FOR PATIENTS