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Focus on Diagnosis : Congenital Infections (TORCH) Jeannine Del Pizzo Pediatrics in Review 2011;32;537 DOI: 10.1542/pir.32-12-537

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Pediatrics in Review is the official journal of the American Academy of Pediatrics. A monthly publication, it has been published continuously since 1979. Pediatrics in Review is owned, published, and trademarked by the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village, Illinois, 60007. Copyright © 2011 by the American Academy ofPediatrics. All rights reserved. Print ISSN: 0191-9601.

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focus on diagnosis

Congenital Infections (TORCH)
Jeannine Del Pizzo, MD*

Introduction
TORCH is an acronym for a group of congenitally acquired infections that may cause significant morbidity and mortality in neonates. TORCH stands for thefollowing: Toxoplasmosis Other: syphilis, hepatitis B, varicellazoster virus (VZV), human immunodeficiency virus (HIV), parvovirus B19, enteroviruses, lymphocytic choriomeningitic virus Rubella Cytomegalovirus (CMV) Herpes simplex virus (HSV) Some experts consider the acronym TORCH outdated, largely due to the growing number of infections listed in the “other” category. However, use of the acronym mayaid in remembering the causative organisms. While each of the congenital infections possesses distinct clinical manifestations and sequelae, some of these infections share characteristics. It is important to think of one or more of these infections when a neonate presents with microcephaly, intracranial calcifications, rash, intrauterine growth restriction (IUGR), jaundice, hepatosplenomegaly,elevated transaminase concentrations, and thrombocytopenia. However, many congenital infections may be silent at birth, with symptoms manifesting years later. Also, some agents, such as VZV, are associated with infection in utero as well as infection during or after delivery, with differing effects depending on the time of infection. This article includes discussion of
*Division of EmergencyMedicine, Children’s Hospital of Philadelphia, Philadelphia, PA.

Author Disclosure Dr Del Pizzo has disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

true congenital infections that are present at the time of delivery as well as some transmitted during or after delivery. Whena congenital infection is suspected, a thorough maternal history should be obtained, including immunization status, past and recent infections, and exposures. A careful physical examination of the neonate is vital because different clinical findings may indicate a specific diagnosis. Diagnostic testing should be directed only toward those infections that fit the clinical and historical picture. Thesometimes employed TORCH titers should never be used as a single test to diagnose or rule out a congenital infection.

Toxoplasmosis
The causative agent in toxoplasmosis is the protozoan and obligate intracellular parasite Toxoplasma gondii. ROUTE OF INFECTION. T gondii is spread via the fecal– oral route. Oocysts of T gondii are excreted via cat feces and ingested by humans throughinadequately cooked meat, contaminated water and soil, and unpasteurized goat milk. Oocysts remain infectious for variable amounts of time, and after excretion can endure in damp soil for as long as 18 months. CLINICAL MANIFESTATIONS. Toxoplasmosis is transmitted to the fetus during a mother’s primary infection or if the mother is immunocompromised and has chronic infection. The risk of fetal transmission...