PEER PRESENTATION

ON
TORCH INFECTION
PRESENTED BY : RUPALI
ARIORA
MSC NURSING 2ND YEAR
 INTRODUCTION
TORCH infections Is an acronym for a group of five infectious diseases:
 • T=Toxoplasmosis
 • O=Other (Hepatitis B)
 • R=Rubella (German measles)
 • C=Cytomegalovirus (CMV)
 • H=Herpes Simplex Virus (HSV)
 • Each disease may be teratogenic
 • Each crosses the placenta
 • Each may adversely affect the developing fetus
 • The effect of each varies, depending on developmental stage at time of
exposure.
 DEFINITION
TORCH Syndrome refers to infection of a
developing foetus or newborn by any of a
group of infectious agents. “TORCH” is an
acronym meaning (T)oxoplasmosis, (O)ther
Agents, (R)ubella (also known as German
Measles), (C)ytomegalovirus, and (H)erpes
Simplex. Infection with any of these agents
(i.e., Toxoplasma gondii, rubella virus,
cytomegalovirus, herpes simplex viruses)
may cause a constellation of similar
symptoms in affected newborn .
 CAUSES OF TORCH

 During pregnancy
 Intra natal period
 Postnatal
 Herpes simplex virus
 Rubella virus
 Cytomegalovirus
 Other agents
 CLINICAL MANIFESTATION OF TORCH

 Prematurity
 Intrauterine growth restriction
 Jaundice
 Hepatosplenomegaly
 Myocarditis
 Pneumonitis
 Various rashes
 anemia,
 thrombocytopenia, and abnormal CSF findings (Mononuclear CSF
pleocytosis or elevated CSF protein)
 DIAGNOSTIC EVALUATION

 • serologic antibody testing

 • ELISA
 • Maternal IgG testing indicates past infection
 • Can be isolated in culture from placenta, umbilical
cord, infant serum ,
 • PCR testing on WBC, CSF, placenta
 • Not standardized
 • New born serologies with IgM/IgA
 TREATMENT OF TORCH

1. for pregnant women-

 Spiromycin 1 g orally every 8 hours
 If the amniotic fluid test result for T gondii is positive: 3 weeks
of pyrimethamine (50 mg/day orally) and sulfadiazine (3 g/day
orally in 2-3 divided doses) alternating with a 3-week course of
spiromycin 1 g 3 times daily for maternal treatment
OR
 •Pyrimethamine (25 mg/day orally) and sulfadiazine (4 g/day
orally) divided 2 or 4 times daily until delivery (this agent may
be associated with marrow suppression and pancytopenia)
 • Leucovorin 10-25 mg/day orally to prevent bone marrow
suppression
 Treatment of nonpregnant patients is
2.

described below
 The 6-week regimen is as follows:
 • Pyrimethamine (100mg loading dose orally followed by 25-50 mg/day) plus
sulfadiazine (2-4 g/day divided 4 times daily)
 OR• Pyrimethamine (100-mg loading dose orally followed by 25-50 mg/day)
plus clindamycin (300 mg orally 4 times daily)
 • Folinic acid (leucovorin) (10• -25 mg/day) should be given to all patients to
prevent hematologic toxicity of pyrimethamine
 • Trimethoprim (10 mg/kg/day) sulfamethoxazole (50 mg/kg/day) for 4 weeks
 • Sulfadiazine or clindamycin can be substituted for azithromycin 500 mg daily
or atovaquone 750 mg twice daily in immunocompetent patients or in patients
with a history of allergy to the former drugs
 PREVENTION

 • . Women planning a pregnancy may be tested before pregnancy.

 • If the test is positive there is no need to worry about passing a new infection to the
baby.
• Women who test negative can take precautions.
 • Wear gloves and wash hands carefully after handling soil.
 • Cook meat thoroughly (until no longer pink inside and juices run clear)
 • Wash hands and any equipment or surfaces that raw meat thoroughly with warm water
and soap.
 • Keep your cat inside and do not feed raw meat.
 • Avoid handling stray cats
 • or new kittens that may have eaten raw meat. Have someone else change the litter box.
 1. HEPATITIS B

 • Hepatitis B (HBV) is a serious viral disease

responsible for 4000 to 5000 deaths each year in the
U.S. due to cirrhosis and liver cancer.
 • Acute infection occurs in 1 to 2 pregnancies per
1000. Estimated that 300 million people worldwide are
chronically infected with HBV
 TRANSMISSION OF HEPATITIS B

Incubation usually 50-180 days

• Mode of transmission
 - Sexual contact
 - Perinatal
 - Transplacental
 - Contact with blood, stool and saliva
 Shared razors, toothbrushes, towels, and other
personal items.
 CLINICAL MANIFESTATION OF
HEPATITIS B
 • Low-grade fever
 • Nausea
 • Anorexia
 • jaundice
 • hepatomegaly
 • malaise.
 • Potential Maternal and Neonatal Effects
 a. Maternal – Premature labor and delivery, cirrhosis and liver cancer
 b. Neonatal – Stillbirth. Infants infected at birth have a 90% chance of
becoming chronically infected
 TREATMENT OF HEPATITIS B

 Maternal – Pregnant women who are exposed to HBV

should receive vaccine and HBIG.
 • Pregnant women who are already infected should
eat well, get sufficient rest, avoid stress and avoid
alcohol.
 • Alpha interferon and lamivudine are not
recommended during pregnancy.
 Neonatal - Infants of infected women should receive
HBV vaccine and HGIB
 PREVENTION OF HEPATITIS B

 Hepatitis B vaccination is the best prevention.

 • The proper and consistent use of latex condoms may prevent
sexual• transmission.
 • Do not use IV drugs. Never share needles, syringes, water or
“works”.
 • Do not share personal items that may have blood on them –
razors, toothbrushes.
 • Consider the risks before getting a tattoo or piercing
 .• Health care workers should use BSP and safe handling of
sharp
2. RUBELLA VIRUS INFECTION
CLINICAL FEATURES OF RUBELLA
 POST NATAL RUBELLA

 • Rash in adults may be quite pruritic.

 • The synonym "3-day measles" derives from the typical course of
rubella exanthem that starts initially on the face and neck and spreads
centrifugally to the trunk and extremities within 24 hours.
 • It then begins to fade on the face on the second day and disappears
throughout the body by the end of the third day.
 • Temperature, Fever is usually not higher than 38.5°C (101.5°F).
 • Lymph nodes- Enlarged posterior auricular and suboccipital lymph
nodes are usually found on physical examination.
 • Mouth• The Forchheimer sign may still be present on the soft palate.
 Diagnostic findings

 → ELISA
 →Isolation of virus from urine or endo cervical
secretions.
 →Fluorescent antibody (FA)
 →complement fixation (CF) test
 TREATMENT AND PREVENTION

• Maternal – Mild analgesics, rest and support.

• Neonatal - No specific treatment for congenital rubella treatment.

Eye or cardiac defects may be corrected or improved with surgery. Careful screening
for problems and special education are indicated.•
 Health Education
• Vaccination of non-immune women before pregnancy is the best prevention.
• The rubella and MMR (measles, mumps, rubella) vaccines are not recommended
during pregnancy.
• A woman should wait 28 days after vaccination to attempt conception (although
the risk to an inadvertent pregnancy during this time is very small).
• Breastfeeding women may be vaccinated.
• Pregnant women who are non-immune for rubella should avoid anyone with rubella
or the symptoms of rubella.
 3. CYTOMEGALOVIRUS{CMV}

 • Cytomegalovirus (CMV) is a double-stranded DNA

virus and is a member of the Herpesviridae family.
 • Risk factors individuals who attend or work at
daycare centers, patients who undergo blood
transfusions, persons who have multiple sex partners,
and recipients of CMV mismatched organ or bone
marrow transplants
 TRANSMISSION OF CMV

Incubation – unknown.
 CMV is very common in young children (perhaps 70% of children
between 1 and 3 years of age in childcare will be excreting (CMV).
 Transmission can occur through contact with saliva, urine, feces,
blood, and mucous.
 It can also be transmitted sexually and through transfusion and
organ donation.
 Transplacental transmission tends to be most serious.
 Infants who are infected during birth or from breastfeeding rarely
have serious problems from the infection.
 CLINICAL MANIFESTATIONS

Physical Findings – Sore throat, fever, body aches, fatigue and

hepatomegaly. .
 • Maternal – Most infections are asymptomatic
 • Neonatal – Infection is most likely to occur with primary maternal
infection. Approximate congenital infection rate of 1%. Of these, 10
%• will be symptomatic, of which 25 % will have fatal disease and
90% of the survivors will have serious sequelae- IUGR, microcephaly,
CNS abnormalities, hydrocephaly, periventricular calcification,
deafness,• blindness, and mental retardation. A small percentage of
newborns asymptomatic at birth will also develop late sequelae.
 DIAGNOSIS OF CMV
 Maternal - ELISA, fluorescent antibody (FA), complement fixation (CF),• seroconversion to
+IgM, and isolation of the virus by culture. Prenatal
 Affected infant’s may demonstrate the following ultrasound findings:
  microcephaly,
  hydrocephalus,
  necrotic cystic or calcified lesions in the brain, liver or placenta,
  IUGR, oligohydramnios,
  ascites, pleural or pericardial effusion,
  hypoechogenic bowel and hydrops.
  Amniocentesis with culture or DNA identification.
  Cordocentesis can be used to document presence and severity of disease.
 Newborn – virus isolation is the optimal method of documenting CMV infection. Specimens
can be taken from urine, naso pharnyx, conjunctiva and spinal fluid.
 TREATMENT

 Maternal – treat symptoms Ganciclovir , Valganciclovir

 • Neonatal - no satisfactory treatment available.
  Infant is contagious and should be isolated..
  Women can reduce their risk of CMV by practicing universal
precautions and careful hand washing, especially after any contact with
saliva, urine, feces, blood and mucous.
  Avoid sharing glasses or eating utensils.
  Medical or day care workers may consider being tested prior to
pregnancy to determine if they have had CMV, as they would then have
little cause for concern.
 4.HERPES SIMPLEX VIRUS {HSV}

 Herpes is caused by the herpes simplex viruses, which

are similar to the viruses that cause chickenpox and
shingles.
 After the initial infection, the herpes simplex viruses
can hide within nerve cells and later launch new attacks.
 There are 2 main kinds of herpes simplex virus (HSV):
 • type I→ which is usually associated with cold sores
around the mouth;
 type 2→ which is usually associated with genital sores.
However, either type can infect either the mouth or
genitals and both can be passed on to the newborn
CLINICAL MANIFESTATION OF HSV
 Diagnostics
 a. Tissue culture-swab specimen from vesicles
 b. Pap smear of lesion
 c. Visualization of a blister or ulcer-like, painful lesion by
experienced clinician.
Treatment
• Anti-viral drugs can shorten the duration of a herpes attack, alleviate
symptoms and reduce the number of attacks.
 • Oral acyclovir is sometimes used in late pregnancy to decrease the need
for cesarean birth.
 • Acyclovir and vidarabine are used to treat neonatal HSV – more
successful with localized infection than one that has spread to brain and
other internal organs
 PREVENTION OF HSV

Encourage women with a history of genital herpes to avoid “triggers”

(heat, friction, intercourse, peanuts, chocolate, fever or stress),
especially during the later part of pregnancy.
 Recommend condoms or abstinence in pregnant women without HSV
who have partners with HSV
 Encourage careful hand washing to prevent spread of HSV to others
or to other parts of the body
 People with active cold sore lesions should avoid kissing others,
especially newborns.
 Educate women of the importance of reporting prodromal
symptoms or lesions to their care providers with suspected labor or
ruptured.
 CONCLUSION

 TORCH Syndrome refers to infection of a developing fetus or newborn by any of a

group of infectious agents. “TORCH” is an acronym meaning (T)oxoplasmosis,
(O)ther Agents, (R)ubella (also known as German Measles), (C)ytomegalovirus, and
(H)erpes Simplex. Infection with any of these agents (i.e., Toxoplasma gondii,
rubella virus, cytomegalovirus, herpes simplex viruses) may cause a constellation
of similar symptoms in affected newborns. These may include fever; difficulties
feeding; small areas of bleeding under the skin, causing the appearance of small
reddish or purplish spots; enlargement of the liver and spleen
(hepatosplenomegaly); yellowish discoloration of the skin, whites of the eyes, and
mucous membranes (jaundice); hearing impairment; abnormalities of the eyes;
and/or other symptoms and findings. Each infectious agent may also result in
additional abnormalities that may be variable, depending upon a number of factors
(e.g., stage of fetal development).
 BIBLIOGRAPHY

 1. https://rarediseases.org/rare-diseases/torch-syndrome/
 2.
https://pubmed.ncbi.nlm.nih.gov/12150751/#:~:text=TORCH%2C%20whic
h%20includes%20Toxoplasmosis%2C%20Other,infections%20associated%2
0with%20congenital%20anomalies
.
 3. https://www.slideshare.net/sorokhan/torch-15349979