TORCH Infections in Paediatrics
Definition
TORCH infections are a group of congenital infections transmitted from the mother to the fetus during pregnancy or delivery. These infections can cause serious fetal and neonatal morbidity and mortality.
TORCH acronym includes:
- T – Toxoplasmosis
- O – Other infections (e.g., Syphilis, Varicella-zoster, Parvovirus B19, HIV, Hepatitis B)
- R – Rubella
- C – Cytomegalovirus (CMV)
- H – Herpes simplex virus (HSV)
These infections are important in paediatrics because they cause congenital malformations, developmental delay, and neonatal illness.
1. Pathophysiology
Maternal infection during pregnancy leads to transplacental transmission or infection during delivery.
Main mechanisms:
- Transplacental spread
* Pathogens cross the placenta → infect fetal tissues.
* Causes organ damage during fetal development.
- Direct tissue destruction
* Viruses and parasites replicate inside fetal cells.
- Inflammatory damage
* Immune response leads to fibrosis, calcification, and organ dysfunction.
- Timing effect
* Early pregnancy infection → severe malformations.
* Late pregnancy infection → milder disease.
2. Causes / Organisms
Toxoplasmosis
Organism: Toxoplasma gondii
Transmission:
- Undercooked meat
- Cat feces
- Contaminated food
Other infections
Includes:
Syphilis
- Treponema pallidum
Varicella
- Varicella-zoster virus
Parvovirus B19
- Causes fetal anemia
HIV
Hepatitis B
Rubella
Virus: Rubella virus
Maternal infection in first trimester causes congenital rubella syndrome.
Cytomegalovirus (CMV)
Virus: Human cytomegalovirus
Most common congenital viral infection.
Transmission:
- Transplacental
- During delivery
- Breast milk
Herpes Simplex Virus (HSV)
Virus: HSV-1 and HSV-2
Transmission mainly occurs:
- During vaginal delivery
3. Risk Factors
- Maternal primary infection during pregnancy
- Lack of vaccination (rubella)
- Poor hygiene
- Raw meat consumption
- Exposure to cats
- Maternal immunosuppression
4. Clinical Features (Common TORCH Syndrome)
Classic neonatal findings:
General Features
- Intrauterine growth restriction (IUGR)
- Prematurity
- Hepatosplenomegaly
- Jaundice
- Microcephaly
- Hydrocephalus
- Developmental delay
Skin
- Petechiae
- Purpura
- “Blueberry muffin” rash
CNS
- Seizures
- Intracranial calcifications
- Intellectual disability
Eyes
- Cataracts
- Chorioretinitis
- Glaucoma
Hearing
- Sensorineural hearing loss
5. Characteristic Findings by Infection
Toxoplasmosis
Classic triad:
- Chorioretinitis
- Hydrocephalus
- Intracranial calcifications
Rubella
Congenital rubella syndrome triad:
- Cataracts
- Congenital heart disease (PDA)
- Sensorineural deafness
Other features:
- Blueberry muffin rash
- Microcephaly
CMV
Most common congenital infection.
Features:
- Periventricular calcifications
- Microcephaly
- Hearing loss
- Petechiae
- Hepatosplenomegaly
HSV
Neonatal herpes forms:
- Skin-eye-mouth disease
- CNS encephalitis
- Disseminated infection
Symptoms:
- Vesicular rash
- Seizures
- Lethargy
Syphilis
Features:
- Snuffles (nasal discharge)
- Rash on palms and soles
- Hepatosplenomegaly
Late findings:
- Hutchinson teeth
- Saddle nose
- Deafness
6. Investigations / Diagnosis
Maternal Screening
- TORCH antibody panel
IgM → recent infection
IgG → past infection
Neonatal Tests
Blood tests:
- TORCH IgM antibodies
- PCR for viral DNA
Other investigations:
- Cranial ultrasound
- CT/MRI brain
- Ophthalmologic examination
- Hearing screening
- Liver function tests
7. Differential Diagnosis
Conditions mimicking TORCH infections:
- Neonatal sepsis
- Genetic syndromes
- Metabolic disorders
- Birth trauma
- Congenital brain malformations
8. Management
Treatment depends on the organism.
Toxoplasmosis Treatment
Drug: Pyrimethamine
Indication
Congenital toxoplasmosis
Mechanism
Inhibits protozoal dihydrofolate reductase
Dose
Infants:
1 mg/kg/day with sulfadiazine
Pharmacokinetics
- Oral absorption
- Hepatic metabolism
Adverse Effects
- Bone marrow suppression
- Rash
Contraindications
- Folate deficiency
Monitoring
- CBC
Counselling
- Always give folinic acid to prevent marrow toxicity.
Drug: Sulfadiazine
Mechanism:
Inhibits folate synthesis in parasites.
Adverse effects:
- Crystalluria
- Hypersensitivity
CMV Treatment
Drug: Ganciclovir
Indication
Symptomatic congenital CMV
Mechanism
Inhibits viral DNA polymerase
Dose
6 mg/kg IV every 12 hours
Adverse effects
- Neutropenia
- Thrombocytopenia
Monitoring
CBC
Drug: Valganciclovir
Oral form of ganciclovir.
Used for 6 months therapy in infants.
HSV Treatment
Drug: Acyclovir
Indication
Neonatal herpes infection
Mechanism
Inhibits viral DNA synthesis
Dose
20 mg/kg IV every 8 hours
Duration:
- 14–21 days
Adverse effects
- Nephrotoxicity
- Neutropenia
Monitoring
- Renal function
Syphilis Treatment
Drug: Penicillin G
Indication
Congenital syphilis
Mechanism
Inhibits bacterial cell wall synthesis
Dose
50,000 units/kg IV
Adverse effects
- Allergy
- Jarisch-Herxheimer reaction
9. Non-Pharmacologic Management
- Supportive neonatal care
- Management of seizures
- Hearing rehabilitation
- Vision correction
- Developmental therapy
- Nutritional support
10. Prevention
Maternal Measures
- Rubella vaccination before pregnancy
- Avoid raw meat
- Avoid cat litter exposure
- Safe sexual practices
- Screening during pregnancy
Neonatal Prevention
- HSV infected mothers → Cesarean delivery
- CMV hygiene precautions
- Early screening
11. Prognosis
Depends on:
- Type of infection
- Timing during pregnancy
- Early treatment
Possible long-term complications:
- Deafness
- Intellectual disability
- Vision loss
- Epilepsy
If you want, I can also give:
- 25–30 MCQs on TORCH infections (paediatrics exams)
- FAQ JSON format
- Short exam revision notes for MBBS / NEET-PG / USMLE.
