TORCH Infections EXPLAINED | Toxoplasmosis, CMV, Rubella, HSV-2

Introduction to TORCH Infections

• TORCH is an acronym referring to infections that can cause congenital conditions if a fetus is exposed during pregnancy.

• T - Toxoplasmosis

• O - Other (includes Syphilis)

• R - Rubella

• C - Cytomegalovirus (CMV)

• H - Herpes Simplex Virus 2 (HSV2)

• Focus on TORCH infections with the exception of Syphilis, which is covered in a separate video.

Non-Specific Findings

• TORCH infections can present with overlapping signs and symptoms, complicating diagnosis.

• Common non-specific findings include:

  • Hepatomegaly

  • Jaundice

  • Generalized lymphadenopathy

  • Hemolytic anemia

  • Thrombocytopenia

Toxoplasmosis

• Caused by a protozoan parasite.

• Primary Infection Effects:

  • Chorioretinitis (inflammation of retina & choroid)

  • Hydrocephalus (enlargement of brain ventricles)

  • Intracerebral calcifications (noted as an "X" pattern on imaging)

  • Blueberry muffin rash (due to extra-medullary hematopoiesis)

Rubella

• Remember as "Can't see, can't hear":

  • Ocular Issues:

    • Congenital cataracts

    • Glaucoma (increased intraocular pressure)

    • Retinopathy

  • Hearing Issues:

    • Cochlear defects leading to bilateral sensorineural hearing loss

  • Cardiac Defects:

    • Patent ductus arteriosus (PDA)

    • Pulmonary artery stenosis

• Comparison with Toxoplasmosis:

  • Rubella: Microcephaly; Toxoplasmosis: Hydrocephalus

  • Both may present with blueberry muffin rash

  • Rubella presents cataracts, Toxoplasmosis presents chorioretinitis

Cytomegalovirus (CMV)

• Most common congenital viral infection.

• Characteristic Findings:

  • Periventricular calcifications (C pattern associated with "C" in Cytomegalovirus)

  • Blueberry muffin rash

  • Cochlear defects (leading to bilateral sensorineural hearing loss)

  • Sensory neural hearing loss is the most common sequela.

Herpes Simplex Virus 2 (HSV2)

• Three Basic Patterns:

  1. Skin, eye, and mouth disease:

     • Conjunctivitis, mouth ulcers, herpetic lesions ("dew drops on a rose petal")

  2. CNS involvement only:

     • Meningoencephalitis

  3. Disseminated disease:

     • Neonatal sepsis with multiple organ involvement

• Patterns have roughly equal frequency.

Practice Question Analysis

• Case study: Female neonate born to a mother with limited prenatal care, working at an animal shelter.

• At birth: jaundiced, hepatomegaly; ultrasound shows hydrocephalus and intracerebral calcifications.

• Identifying features:

  • Little prenatal care indicates risk factors.

  • Animal shelter work suggests potential exposure to Toxoplasmosis (via cat feces).

  • Hydrocephalus & calcifications support diagnosis of congenital Toxoplasmosis.

Conclusion

• Importance of understanding TORCH infections for medical studies.

• Encouragement to like or subscribe for continued education.

Introduction to TORCH Infections

TORCH is an acronym that signifies a group of infections known to cause congenital conditions or severe health impacts if a fetus is exposed during pregnancy. Understanding these infections is crucial for medical professionals as they can lead to significant developmental issues in newborns. The infections represented by TORCH include:

• T - Toxoplasmosis

• O - Other (which includes infections such as Syphilis)

• R - Rubella

• C - Cytomegalovirus (CMV)

• H - Herpes Simplex Virus 2 (HSV2)

While all TORCH infections are important, this note will focus on them, excluding Syphilis, which is covered in a separate video.

Non-Specific Findings

TORCH infections typically present with overlapping signs and symptoms, complicating the diagnostic process. Here are some common non-specific findings that may raise suspicion of a TORCH infection in a neonate:

• Hepatomegaly: Enlargement of the liver, which may indicate an underlying infection.

• Jaundice: Yellowing of the skin and eyes, often indicating liver dysfunction or hemolysis.

• Generalized lymphadenopathy: Swelling of lymph nodes throughout the body, indicative of an immune response.

• Hemolytic anemia: The destruction of red blood cells, potentially leading to further complications.

• Thrombocytopenia: Low platelet count, which can increase the risk of bleeding.

Toxoplasmosis

Toxoplasmosis is caused by the protozoan parasite Toxoplasma gondii. The effects of primary infection during pregnancy can lead to severe congenital manifestations:

• Chorioretinitis: Inflammation of the retina and choroid, which can impair vision.

• Hydrocephalus: Enlargement of the brain ventricles due to excessive cerebrospinal fluid, posing risks to brain development.

• Intracerebral calcifications: Often noted in imaging as an “X” pattern, signifying abnormal brain development.

• Blueberry muffin rash: A rash caused by extramedullary hematopoiesis, presenting as purplish spots on the skin.

Rubella

A significant congenital infection, rubella should be remembered by the phrase "Can't see, can't hear", describing its key ocular and auditory complications:

Ocular Issues:

• Congenital cataracts: Clouding of the lens of the eye, leading to vision impairment.

• Glaucoma: Increased intraocular pressure, which can damage the optic nerve.

• Retinopathy: Damage to the retina leading to vision problems.

Hearing Issues:

• Cochlear defects: These defects can lead to bilateral sensorineural hearing loss, significantly impacting communication and learning.

Cardiac Defects:

• Patent ductus arteriosus (PDA): A heart defect where a blood vessel that should close after birth remains open.

• Pulmonary artery stenosis: Narrowing of the pulmonary artery, which can obstruct blood flow to the lungs.

Comparison with Toxoplasmosis:

• Rubella may cause microcephaly, while Toxoplasmosis can lead to hydrocephalus. Both may present with a blueberry muffin rash. While rubella presents with cataracts, Toxoplasmosis is associated with chorioretinitis.

Cytomegalovirus (CMV)

CMV is recognized as the most common congenital viral infection, presenting with several characteristic findings:

• Periventricular calcifications: A distinct pattern of calcification associated with the letter "C" in Cytomegalovirus.

• Blueberry muffin rash: Similar to Toxoplasmosis, indicating extramedullary hematopoiesis.

• Cochlear defects: Leading to bilateral sensorineural hearing loss, which is the most common sequela of congenital CMV infection.

Herpes Simplex Virus 2 (HSV2)

HSV2 poses significant risks to neonates and manifests as:

• Skin, eye, and mouth disease: Including conjunctivitis, mouth ulcers, and herpetic lesions resembling "dew drops on a rose petal".

• CNS involvement only: Manifesting as meningoencephalitis, which can lead to severe neurological outcomes.

• Disseminated disease: This may present as neonatal sepsis affecting multiple organs, requiring immediate medical intervention.

Patterns and Frequencies:

The three basic patterns of HSV2 infections have roughly equal frequency, making careful monitoring essential for affected infants.

Practice Question Analysis

In a case study of a female neonate born to a mother with limited prenatal care and employment at an animal shelter, key identifying features were noted:

• At birth, the neonate was observed to be jaundiced and exhibited hepatomegaly; an ultrasound indicated hydrocephalus and intracerebral calcifications, which are consistent with congenital Toxoplasmosis.

The limited prenatal care presents risk factors for infection, while the mother's exposure to cats suggests potential Toxoplasmosis infection through cat feces. The identified conditions further support this diagnosis, emphasizing the importance of prenatal screening and education.

Conclusion

Understanding TORCH infections is vital for healthcare professionals and medical students, as early identification can lead to better health outcomes for affected neonates. Further education on these infections is encouraged, alongside subscribing for additional insights.