He TORCH syndrome Refers to a broad group of pathologies that may cause infectious processes during pregnancy or at the time of birth (Obstetrics and Gynecology Department, HJJAB-IGSS, 2014).
Specifically, the acronym TORCH includes 5 types of infections (Obstetrics and Gynecology Department, HJJAB-IGSS, 2014):
- T : Toxoplasmosis
- OR : Other -Syphilis, chicken pox, etc.-
- R : Rubeola.
- C : Cytomegalovirus
- H : Simple herpes.
The clinical manifestations will depend on the type of congenital infection that develops in the affected one (Diaz Villegas, 2016).
However, there are some common signs and symptoms: generalized growth retardation, fever, hepatosplenomegaly, anemia, petechiae, Hydrocephalus , Calcifications, etc. (Díaz Villegas, 2016).
Diagnostic suspicion is usually made based on clinical findings. However, a serological study is essential to identify the origin of the infection (Cofré, Delpiano, Labraña, Reyes, Sandoval and Izquierdo, 2016). In this syndrome the most common is to use the diagnostic profile of TORCH (Kim, 2015).
Treatment of TORCH syndrome will be specific to each individual and depends on the type of infection that you have. Medical specialists often resort to the use of classical approaches in each pathology.
Characteristics of TORCH syndrome
TORCH syndrome refers to a set of pathologies that can cause congenital infectious processes (National Organization for Rare Disorders, 2016).
Congenital infections are defined as being medical conditions that are transmitted from mother to child during gestation or at the time of birth (Salvia, Álvarez, Bosch, Goncé, 2008).
Usually, these types of infectious processes are to be acquired during the first, second or third trimester of pregnancy (Diaz Villegas, 2016).
However, it is also possible that the infection is contracted by the fetus through the birth canal (Díaz Villegas, 2016).
In the case of this syndrome, its name is based on the acronym of the most common congenital infections: T (toxoplasmosis), R (rubella), C (cytomegalovirus) and H (H) (Salvia, Álvarez, Bosch and Goncé, 2008 ).
O, usually refers to other infectious processes including syphilis, varicella, malaria, tuberculosis, papillomavirus, among others (Salvia, Álvarez, Bosch, Goncé, 2008).
Each type of infection will generate a differential clinical course: presentation time, signs and symptoms, medical complications, treatment, etc.
As noted by authors like Salvia, Álvarez, Bosch and Goncé (2008) all present some common characteristics:
- Transmission of the pathological agent from the mother to the child can occur through direct contact during birth or through the placental route during gestation.
- The origin of the infectious process may be associated with viral, bacteriological or parasitic agents.
- In the mother, the infection does not usually cause significant symptoms, so they tend to go unnoticed.
- The diagnosis includes in all cases a serological, molecular biological or cell culture study.
- The clinical course may be similar in many of the infections, however, they are widely variable.
- The pathological agent that contracts before 20 weeks of gestation causes important medical complications, such as the development of physical malformations.
- Infection at later stages of gestation usually causes prematurity, low birth weight or some alterations of the central nervous system.
- Infections contracted during labor usually cause pneumonitis, hepatosplenomegaly, sepsis, anemia , among others.
- Some of the pathologies may remain asymptomatic during the neonatal period. They usually generate neurosensory sequels in later moments.
About us
TROCH syndrome and infectious processes of congenital origin are frequent pathologies (Díaz Villegas, 2016).
Its incidence reaches about 2.5% of all newborns each year (Diaz Villegas, 2016).
Not all sufferers have significant medical complications. A large percentage presents an asymptomatic clinical course (Díaz Villegas, 2016).
What are the most common infections associated with TROCH syndrome?
Infectious processes categorized into the TROCH syndrome include: toxoplasmosis, rubella, cytomegalovirus, herpes simplex and other less common ones such as varicella-zoster, syphilis, parvovirus, papillomavirus, etc. (Department of Obstetrics and Gynecology of the HJJAB-IGSS, 2014, Díaz Villegas, 2016, Salvia, Álvarez, Bosch, Goncé, 2008, Ticona Apazza and Vargas Poma, 2011):
Toxoplasmosis
The Toxoplasmosis Is an infection caused by a protozoan. It is usually contracted through ingestion of some poorly washed or undercooked foods.
In most cases, the affected mothers do not usually present a significant symptomatology, but transmit the infection to the embryo during gestation.
Congenital toxoplasmosis is usually considered a rare disease in the general population. Epidemiological studies estimate their incidence in 1 case per 1,000 deliveries.
The infectious process usually manifests itself in the fetus during gestation or in the neonatal stage.
Although the signs and symptoms may vary among those affected, the most common include: chorio-retinitis, splenomegaly, cerebral calcifications, epilepsy, anemia, febrile episodes, alterations of cerebrospinal fluid, etc.
The definitive diagnosis of this pathology is usually based on the results of the serological analyzes.
On the other hand, the treatment used in the pregnant woman is oriented toward prevention of transmission. The most commonly used drugs are antimicrobials.
In the case of treatment of the infected fetus, administration of pyrimethamine and sulfadiazine, together with a thorough medical check-up, is most common.
Rubella
The rubella Is another of the congenital infections classified under the name of TORCH syndrome. The contraction of the rubella virus is usually associated with direct contact or nasopharyngeal secretions.
It has an incubation period of about 18 days and can cause significant damage to the fetus when the mother contracts the infection during or before the fourth month of pregnancy.
Although not very frequent in the general population, rubella can generate a significant amount of pathologies.
The most frequent alterations are associated with the presence of cardiac pathologies. They are usually present in more than 70 of the cases and are characterized by:
- Ductus arteriosus.
- Pulmonary artery stenosis.
- Arterial necrosis.
- Septal and / or ventricular abnormalities.
- Loss of striation.
Other common medical complications are hypoacusis, microcephaly, cataracts, ocular hypoplasia, microphthalmos, retinopathies, etc.
The diagnosis of rubella is usually made based on the identification of some of the clinical signs noted above. In addition, an analysis of pharyngeal secretions is performed.
The final diagnostic confirmation usually depends on virus isolation and immunological results.
A specific therapeutic approach has not been designed for rubella of congenital origin. The most common is immunization against this virus before pregnancy.
Vaccines are usually given to women of childbearing potential, at least one month before conception. Its use during pregnancy is contraindicated.
Cytomegalovirus
He Cytomegalovirus Is a pathological agent belonging to the family of Herpesviridae and is exclusive to the human being.
It is the most common congenital infection in the general population. It is usually transmitted through direct contact with body fluids such as blood.
Much of the infection is asymptomatic or subclinical in the affected women. However, during gestation the fetus may develop the infection through a reactivation of the process or primary infection of the pregnant woman.
This type of infectious process can cause important lesions in the fetus: optic atrophy, microcephaly, ventricular calcifications, hepatosplenomegaly, ascites or growth retardation.
In addition, a smaller percentage of affected individuals may also develop febrile episodes, encephalitis, respiratory involvement, cutaneous purpura, hepatitis or generalized psychomotor developmental delay.
The diagnosis of cytomegalovirus infection requires confirmation through laboratory tests. Isolation of the virus is necessary in the blood or amniotic fluid during gestation.
In addition, several experimental studies are examining the efficacy of drugs such as gancyclovir for the treatment of this pathology. Immunoglobulin administration is usually not indicated in these cases.
Simple herpes
Cases of virus infections simple herpes Usually reach high figures in many of the developed countries, giving rise to 1 diagnosis for every 3,500 deliveries.
This type of virus is usually contracted through a carrier with lesions in cutaneous or mucosal areas through excretion by various body fluids such as saliva, semen or vaginal secretions.
Although most infections are asymptomatic, the herpes simplex virus has the ability to remain in a latent state in the body and can be reactivated sporadically.
In the case of pregnant pregnant mothers, this virus can be transmitted to the fetus at the time of delivery as it passes through the vaginal canal.
Although some cases remain asymptomatic, medical complications due to neonatal herpes infection are associated with the development of disseminated disease (respiratory failure, hepatic, encephalitis, CNS anomalies, etc.), central nervous system disorders (seizures, irritability, thermal alterations , Disorders of consciousness , etc.). Or ocular, cutaneous and / or oral pathologies.
Identification of this infectious process requires various laboratory tests. Cell culture is usually performed from a sample of genital lesions, cutaneous lesions of the newborn or body fluids.
The treatment of herpes simplex is based on the administration of antiviral medication, such as acyclovir.
In addition, it is important to isolate the fetus during delivery through a cesarean delivery.
Varicella-Zoster
The virus of the chickenpox Is one of the most contagious. It is exclusive to the human species and has an incubation period of about 10 or 20 days.
At present, more than 80% of pregnant women are immune to this virus thanks to advanced vaccination techniques. However, its frequency reaches 2 or 3 cases per 1,000 pregnant women.
Fetal infection usually occurs before the 20th week of gestation through a transparent route.
In cases of maternal infection on or near postpartum days, the risk of neonatal infection is high and severe.
During gestation, this type of infection can cause skin lesions, musculoskeletal disorders, neurological and ophthalmologic lesions.
In contrast, if the infection occurs in the neonatal phase, a varicella with severe mulsystematic involvement may appear.
The diagnosis in the case of the pregnant woman is clinical and is based on the symptomatic identification and the serological analysis. In the case of fetal examination, an amniocentesis is usually performed to isolate the virus.
Breast-feeding usually requires the administration of varicella-zoaster immunoglobulin. While treatment of the newborn requires specific or non-specific gamma-globulin.
Syphilis
The syphilis Is an infectious prisoner caused by the virus Treponema pallidum. Any affected and untreated pregnant woman can transmit this pathology during gestation or the time of delivery.
The embryonic and neonatal manifestations of syphilis can be very broad: meningitis, coryza, hepatosplenomegaly, adenopathy, pneumonitis, anemia, prematurity, generalized growth retardation, bone alterations, etc.
Despite the fact that many sufferers present an asymptomatic course for many years, syphilis can cause some late manifestations: convulsive episodes, deafness or intellectual disability, among others.
This condition requires urgent medical intervention. When the mother has been treated penicillin is usually used, whereas if it has not been treated, other types of treatments are usually used.
Parvovirus
Infection by Parvovirus B19 , Produces several skin alterations among which are infectious erythema.
It is not a common pathology, but it can lead to spontaneous abortion in 10% of cases. Although the infection occurs in the later stages of gestation, the clinical course is associated with the development of hydrops, thrombocytopenia, myocarditis, liver lesions, etc.
The treatment of this medical condition usually focuses on the treatment of symptoms and medical complications. In the case of severe alterations during pregnancy, intrauterine transfusion may be used.
Papillomavirus
He Papillomavirus Is another of the exclusive pathological agents of the human species. Fetuses and embryos are often affected by infectious processes generated by transplacental pathways or by passage through the birth canal.
The clinical course of this medical condition is fundamentally characterized by the development of respiratory alterations.
Medical interventions focus on maintaining the opening of the airways and monitoring medical complications.
References
- [Links] TORCH. Text of the Chair of Pediatrics .
- IGSS, G. d.-O. (2014). Management of TORCH in Pregnancy. Evidence-Based Clinical Practice Guidelines .
- NORD. (2016). TORCH Syndrome . Retrieved from the National Organization for Rare Disorders.
- Salvia, M., Álvarez, E., Bosch, J., & Goncé, A. (2008). Congenital infections. Spanish Association of Pediatrics .
- Ticona Apaza, V., & Vargas Poma, V. (2011). TORCH SYNDROME. Clinical Update Magazine .