TORCH syndrome is a group of symptoms caused by Toxoplasmosis, Rubella, Cytomegalovirus, Herpes simplex, and other organisms including syphilis, Varicella zoster, and parvovirus.

1. PRESENTED BY:
SANDHYA KUMARI
M.Sc NURSING
AMITY COLLEGE OF NURSING
AMITY UNIVERSITY, HARYANA
TORCH

2. TORCH
TORCH infection can be a misleading term
as it sounds like a single illness. However, the
term is an acronym of five infections caused
due to pathogens. These can cause some
serious problems for the unborn foetus and
the mother if it is not diagnosed at the right
moment. These pathogens are transferred
from the expectant mother to her foetus
during pregnancy or at childbirth. TORCH
consists of the following five infections.

3. TORCH
 Toxoplasmosis
 Other agents (including HIV, syphilis, varicella,
and fifth disease)
 Rubella
 Cytomegalovirus
 Herpes simplex

5. T- Toxoplasmosis
Causative Organism: Toxoplasma gondii
 Oocyst excreted in cats feces is the source of
infection to humans -: Contaminates in soil, water
& raw meat
 Transmission: Vertical transmission can occur in
utero or during vaginal delivery & risk of fetal
transmission is
 25% in 1st Trimester
 75% in 3rd Trimester
 90% during last few weeks prior delivery.

6. Effects of Torch on Pregnancy
The following are the effects of TORCH infection:
 Birth defects like bad eyesight, loss of hearing,
diabetes at a young age, heart defects, cataract and
mental retardation are noticed in babies where their
mothers were detected with rubella in the first
trimester.
 A direct result of TORCH infection during pregnancy is
a miscarriage.
 If the mother is infected with TORCH during 11 to 20
weeks of pregnancy, there is a huge risk of congenital
rubella syndrome affecting the baby.
 The baby may also get meningitis, anaemia and
pneumonia.
 The infection leads to many severe complications like
premature delivery, stillbirth, spontaneous abortions,
congenital anomalies and intrauterine foetal death.

7. CLINICAL FEATURES
Most infected newborns are asymptomatic at birth
 IUGR
 Fever
 Maculopapular rash
 Anemia
 Jaundice
 Seizure
 Hepatospleenomegaly
 Thrombocytopenic purpura
 Chorioretinitis
 Diffuse Nodular Intracranial calcifications
 Hydrocephalus

8. DIAGNOSIS
 A blood test is done to check the pregnant
woman for Toxoplasmosis, syphilis, parvovirus,
varicella zoster, rubella, cytomegalovirus and
herpes. Monitoring of foetal growth after a
positive result is an important part of this
diagnosis.
 The diagnosis of toxoplasmosis is typically made
by Serologic testing. A test that measures
immunoglobulin G (IgG) is used to determine if a
person has been infected.
 By direct observation of the parasite in stained
tissue sections, Cerebrospinal fluid (CSF).

9. O- OTHER
 Syphilis. Pregnant women in the first or second
stage of this sexually transmitted disease (STD)
pass it to their babies 75% of the time if it’s not
treated.
 Syphilis is caused by bacteria and can create
serious problems during a baby’s development.
Many babies who get it before birth won’t survive
full term, or will die shortly after they’re born.
Almost half of babies will be stillborn.

10. R- RUBELLA
 AKA german measels.
 Caused by rubella virus ,a togavirus has single
stranded RNA genome.
 Transmitted by droplet infection.
 Virus has teratogenic properties can cross the
placenta where it stops cell development and
leads cell death.
 Risk of developing fetal anomalies is directly
associated with maternal gestational age.

11. Incidences
 1st trimester- 50% major fetal anomalies.
 2nd trimester- 25%
 3rd trimester- 10%
Spontaneous abortions occur upto 20% of cases.
If infection occur within 20 wks of gestation.

12. Clinical manifestations
Maternal symptoms- Same as other flu-
1. Rashes
2. Low grade fever
3. Lymphoadenopathy ( suboccipital, posti
cervical)
 Joint pain
 Headache
 Conjunctivitis

13. Congenital rubella syndrome
It is characterized by-
 Cochlear- sensorineural defects.
 Cardiac – septal defects, pulmonary arterial
hypoplasia.
 Neurological diseases- with a broad range of
presentation from behaviors to memingoencephalitis.
 Ostitis
 Hepatosplenomegaly.
 Microcephaly
 IUGR
 Cataracts
 Thrombocytopenia – blue berry muffin lesions.

14. Diagnostic evaluation
 Serological test to detect rubella specific
antibodies.
 Routine rubella IgG is done in the first trimester
 Rubella IgM is done in suspected case.
 Presence of antibodies + rash = confirm the
diagnosis.

15. Treatment
 Prevention by active immunization.
 No such treatment available.
 Self limiting disease.
 Maternal screening should be performed in early
pregnancy.
 In infection is present in pregnancy, mother could
not be vaccinated because the rubella vaccine
contained live virus which can cross the placenta
and affect the fetus.
 Infact women should not be vaccinated 28 days
before conception.

16. CYTOMEGALOVIRUS
 CMV is a member of the herpes virus species.
 Double strained DNA virus.
 The virus most frequently passed on to fetus
during pregnancy.
 Acc to American academy of pediatrics about 1%
of babies are born with the infection, a condition
called congenital CMV.
 Transmission- direct person to person contact
(saliva, milk, urine, semen, tears, stools, blood,
cervical and vaginal secretions).

18. Clinical manifestations
Maternal symptoms-
 Fever
 Weakness
 Swollen glands
 Joint stiffness
 Muscle ache
 Loss of appetite.
Fetal symptoms- 90% are asymptomatic at birth
 jaundice
 Chorioretinitis
 Periventricular calcifications.
 IUGR, hearing loss
 Microcephaly
 Delayed psychomotor development
 Heart block

19. Diagnostic evaluations
 Serological testing- IgM are detected
 Amniocentesis
 Cordocentesis
 USG
 Fetal MRI ( rarely)

20. Treatment
 No definitive Rx.
 Pregnancy termination
 Antiviral drugs-
1. Gangciclovir
2. Foscarnet
3. Cidofovir
4. Most effective drugs- hyper immune globulin.

21. HERPES SIMPLEX VIRUS-2 INFECTION
 Most common STD worldwide.
 DNA virus belongs to alpha herpes virinae family
 Primary infection to mother can lead severe
illness to mother in pregnancy.
 The most common infection during pregnancy is
primary genital HSV infection.

22. Effect on pregnancy
 Transplacental infection is not usual.
 Fetus become infected by virus shed from the
cervix and vagina during vaginal delivery.
 In utero transmission may occur in rupture of
membranes.
 Increased risk of abortion is inconducive.
 IUGR if infection acquired in 3rd trimester.

23. Neonatal infections-
 Chorioretinitis
 MR
 Seizures
 Microcephaly
 Deaths.

24. Treatment
 CS indicated in primary HSV infection.
Suppressive viral therapy from 36 weeks untill
delivery, it includes-
 Valacyclovir 500 mg PO bd
 Acyclovir 400mg po tds. ( drug of choice)

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