This document discusses congenital infections from TORCHES pathogens that can infect newborns. TORCHES is an acronym that stands for Toxoplasmosis, Other (HIV, Hepatitis B), Rubella, Cytomegalovirus, Herpes, Ebstern-Barr Virus, and Syphilis. The document outlines the clinical features of infection from these pathogens, including growth restriction, jaundice, pneumonia, eye and heart abnormalities. It provides details on findings that can suggest specific diagnoses, such as the triad of deafness, heart disease, and eye abnormalities often seen in congenital rubella syndrome. Laboratory and imaging investigations for diagnosing TORCHES infections are also discussed.

1. PAEDIATRICS AND CHILD HEALTH
• NEONATOLOGY
• Congenital Infections
Dr. Chongo Shapi (BSc.HB, MBChB, CUZ)
- Medical Doctor.
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2. Introduction
• Newborns are not usually highly susceptible to
overwhelming viral infections perinatally
• But in utero infection with viruses and other agents of the
acronym TORCHES is fairly common
• TORCHES:
- Toxoplasmosis
- Other (HIV, Parvovirus, Hepatitis B, VZV)
- Rubella
- Cytomegalovirus (CMV)
- Herpes simplex virus (HSV)
- Ebstern-Barr Virus (EBV), Enteroviruses
- Syphilis
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3. Clinical Features
• IUGR
• Hydrops fetalis
• Hepatosplenomegaly
• Microcephaly
• Hydrocephalus
• Anaemia, thrombocytopenia, petechiae
• Jaundice (especially conjugated hyperbilirubinemia)
• Pneumonia
• Cardiac malformations, myocarditis
• Eye abnormalities (chorioretinitis, cataracts)
• Bone abnormalities (osteochondritis, periotitis)
NB: TORCHES don’t cause low set ears or clinidactyly
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4. Clinical Findings Suggesting A Specific Diagnosis
• Rubella:
- Eye: bilateral cataracts, cloudy cornea, pigmented
retina
- Ear: sensorineural deafness
- Heart: PDA, PS
- Bone: microcephaly, vertical striation,
micrognathia
- Thrombocytopenic purpura (blueberry muffin
rash)
- Hepatomegaly
- Metal retardation
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5. Congenital Rubella Syndrome
Triad of:
1. Sensorineural deafness (58%)
2. Congenital heart disease (PDA + PS) – (50%)
3. Eye abnormalities (43%)
- Bilateral cataracts
- Retinopathy
- Microphthalmia
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6. Clinical Findings Suggesting A Specific Diagnosis
• CMV:
- Periventricular calcifications which can lead to
hydrocephalus, inguinal hernias in the male,
petechiae, thrombocytopenia
• Toxoplasmosis: Diffused intracranial calcifications,
chorioretinitis
• Syphilis :
- Osteochondritis, periotitis, eczematous skin rash,
mucocutaneous lesions (snuffles), fits in SGA,
pulmonary stenosis
• Herpes: skin vesicles, keratoconjunctitis, acute CNS
findings
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7. Investigations
• Laboratory
- FBC/DC: anaemia, thrombocytopenia, leukocytosis, increased Hct
- VDRL, RPR for Syphilis
- Hepatitis antibodies/antigens
- IgM specific CMV and Rubella
- Other serological tests to detect antigens/antibodies for other
specific TORCHES infections
- HIV DNA PCR
- Urine exam:
a. Culture for Rubella and CMV
b. Urine reducing substances : use urine Clinitest tablets (CuSO4),
dipstick is for glucose
• Imaging
- Skull X-ray (Diffused or periventricular calcifications)
- EEG if seizures present
- Skull CT and MRI
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8. Thanks
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