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TORCH infections

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🌸 Certain infections in pregnancy can have devastating consequences for the fetus. Early recognition, appropriate investigations, and timely management are crucial.

🦠 Toxoplasmosis

Clinical: Maternal infection may be mild or asymptomatic. Fetal risks include microcephaly, hydrocephalus, chorioretinitis, seizures, and developmental delay.
Investigations: Maternal serology (IgM, IgG), amniocentesis with PCR, fetal ultrasound for hydrocephalus/structural anomalies.
Treatment: Spiramycin to reduce fetal transmission (especially early pregnancy). If confirmed fetal infection → pyrimethamine + sulfadiazine in 2nd/3rd trimester.

🤒 Rubella

Clinical: First-trimester infection → high risk of Congenital Rubella Syndrome (CRS): PDA, VSD, cataracts, microcephaly, hepatosplenomegaly, myocarditis, interstitial pneumonia. Later pregnancy infection is less severe.
Investigations: Maternal serology (IgM, IgG), fetal ultrasound for congenital abnormalities.
Treatment: No specific therapy during pregnancy. Prevention via pre-pregnancy vaccination. Neonates: supportive care.

🧬 Cytomegalovirus (CMV)

Clinical: Can cause microcephaly, chorioretinitis, intracranial calcifications, developmental delay, haemolytic anaemia, hepatitis.
Investigations: Maternal serology, amniotic fluid PCR, fetal ultrasound for microcephaly/calcifications.
Treatment: No definitive treatment during pregnancy. Symptomatic neonates may receive antivirals (e.g., ganciclovir).

🧪 Herpes Simplex Virus (HSV)

Clinical: Active infection during delivery → neonatal herpes (risk of severe neurological damage). May cause abortion, prematurity, or congenital herpes.
Investigations: Viral cultures/PCR of lesions, fetal ultrasound for severe cases.
Treatment: Acyclovir in late pregnancy to reduce recurrence. C-section recommended if active genital lesions at delivery.

🌍 HIV

Clinical: Vertical transmission risk during delivery. Untreated neonates develop immunosuppression and opportunistic infections.
Investigations: Maternal serology (HIV antibody/PCR), CD4 count, viral load. Neonatal HIV PCR post-delivery.
Treatment: Antiretroviral therapy (e.g., zidovudine) in pregnancy, labour, and for neonates. C-section may reduce transmission risk.

Cases — TORCH Infections

Case 1 — Toxoplasmosis 🐱: A 24-year-old pregnant woman owns several cats and ate undercooked lamb. At 28 weeks, ultrasound shows ventriculomegaly and intracranial calcifications. Baby is born with chorioretinitis, seizures, and hydrocephalus. Diagnosis: congenital toxoplasmosis. Managed with maternal spiramycin during pregnancy and pyrimethamine–sulfadiazine after birth.
Case 2 — Syphilis (Other) 🧬: A 30-year-old woman is diagnosed with untreated syphilis during pregnancy. Her newborn has hepatosplenomegaly, snuffles, maculopapular rash on palms/soles, and periostitis on X-ray. Diagnosis: congenital syphilis. Managed with IV penicillin.
Case 3 — Rubella 🎀: A 22-year-old unimmunised woman develops fever, lymphadenopathy, and a maculopapular rash in the first trimester. Baby is born with cataracts, congenital heart defect (PDA), and sensorineural deafness. Diagnosis: congenital rubella syndrome. Prevention: maternal vaccination pre-pregnancy.
Case 4 — Cytomegalovirus (CMV) 🦠: A 29-year-old woman develops mild flu-like illness in the second trimester. Ultrasound: intrauterine growth restriction and periventricular calcifications. Newborn is small for gestational age, with petechiae, jaundice, and sensorineural hearing loss. Diagnosis: congenital CMV infection. Managed with antivirals (ganciclovir) in symptomatic neonates.
Case 5 — Herpes Simplex Virus (HSV) 💋: A 26-year-old woman with a history of genital herpes has active lesions at delivery. Her baby develops seizures, vesicular skin lesions, and encephalitis within the first week. Diagnosis: neonatal HSV infection. Managed with IV aciclovir.

Teaching Point 🩺: TORCH infections are congenital infections causing growth restriction, CNS damage, hepatosplenomegaly, rash, and eye/ear anomalies. Key associations: - 🐱 Toxoplasmosis → triad: hydrocephalus, intracranial calcifications, chorioretinitis. - 🧬 Syphilis → snuffles, rash, periostitis. - 🎀 Rubella → cataracts, deafness, PDA. - 🦠 CMV → periventricular calcifications, sensorineural deafness. - 💋 HSV → skin–eye–mouth disease, encephalitis. Prevention is critical: antenatal screening, vaccination (rubella), maternal infection control.

PLEASE NOTE LEGAL ADVICE: The contents are under continuing development and improvements and may contain errors of omission or fact. Feedback vital and always welcome at drokane at gmail.com. This is not to be used for the assessment, diagnosis or management of patients. It should not be regarded as medical advice. It is only for educational purposes. Please adhere to your local protocols. If you are unwell please seek healthcare advice from your doctor. This does not replace senior or specialist advice. If you do not accept this then please do not use the website. If you need medical advice, please consult a doctor or other appropriate medical professional. If you are a medical professional and you need advice then speak to your senior or colleagues.

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