Congenital Intrauterine TORCH Infections

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Congenital or perinatal infections and sepsis are common causes of neonatal liver cholestasis, hepatitis, and sometimes liver failure. A careful history and physical examination may suggest infection as an etiology of neonatal liver disease. For ill-appearing infants with cholestasis, a rapid evaluation for bacterial infection such as sepsis or urinary tract infection is recommended.

Judicial selection of antimicrobials must be considered, as several are known to exacerbate cholestasis by displacing bilirubin from albumin e.

In addition to common bacterial infections, TORCH infections toxoplasmosis, rubella, cytomegalovirus, herpes, and syphilis as well as infections with hepatitis B, parvovirus B19, adenovirus, or echoviruses can result in neonatal cholestasis and hepatitis. For more detail regarding diagnosis and specific treatments for congenital or neonatal infections, please refer to Section IX. Jennifer Louten, in Essential Human Virology , Congenital infections occur when a mother infects a fetus before its birth. Congenital infections occur via vertical transmission , meaning that the virus is spread from one generation to the next generation Fig.

In contrast, most viral infections exhibit horizontal transmission , meaning that direct host-to-host transmission occurs. Viruses with horizontal transmission rely upon a high rate of infection to sustain the virus population, while vertical transmission often leads to long-term persistence of the virus within the child. Figure 5.

TORCH Infections

Horizontal transmission versus vertical transmission. Horizontal transmission refers to the transmission of an infectious agent among individuals within a population. In vertical transmission, however, an infectious agent is transmitted from one generation to another through congenital infection. Congenital infection can occur when a virus crosses the placenta during pregnancy.


The blood of the mother is not mixed with the blood of the fetus; instead, the placenta is the interface between the mother and developing fetus Fig. Similarly, some viruses are able to pass through the placenta Table 5.

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Cytomegalovirus, a herpesvirus, is the most common cause of congenital infections, occurring in about 2. Several other viruses can be transmitted transplacentally, including variola smallpox , rubella, measles, Zika, and parvovirus B The effects can be severe, including miscarriage, low birth weight, intellectual deficiencies, hearing loss, and death of the infant.

The placenta is a fetal tissue that allows the transfer of oxygen, carbon dioxide, waste products, and nutrients between the mother and fetus A. Although maternal and fetal blood does not mix, the fetal arteries and veins come into close contact with material blood vessels in the placenta, allowing diffusion to occur B. Several viruses are able to travel from mother to fetus through the placenta. Vertical transmission of HIV most often occurs by intrapartum transmission, although breastfeeding can also transmit the virus via the gastrointestinal tract. Intrapartum transmission of HSV to the child is highest when the mother has active lesions or contracted a new HSV infection in her third trimester of pregnancy.

Antiviral drugs are used to reduce viral load, but a pregnant mother may be encouraged to deliver the child by C-section if there are active signs of maternal infection.

Update on TORCH Infections in the Newborn Infant

Victor Nizet, Jerome O. Signs of congenital infection can appear or be identified after discharge from the nursery. Hearing impairment caused by congenital rubella or cytomegalovirus infection can be noticed by a parent at home. Hydrocephalus with gradually increasing head circumference caused by congenital toxoplasmosis is apparent only after serial physical examinations. Chorioretinitis, jaundice, or pneumonia can occur as late manifestations of congenital infection.

A lumbar puncture may be performed in the course of a sepsis evaluation. CSF pleocytosis and increased protein concentration can be caused by congenital infection and warrant appropriate follow-up diagnostic studies. Jack S. Congenital infection with T. Toxoplasmosis occurs as an epizootic infection in pregnant ewes and causes early embryonic death, mummification of the fetus, abortion, stillbirth, or birth of weakened lambs with congenital infection. Embryonic death and stillbirth may result from fetal infection but occur most often as a result of the focal necrotic lesions present in the placental cotyledons.

In sheep as well, the placenta is invaded first and the fetus only some days later. In a series of studies on experimental congenital transmission of ovine toxoplasmosis, Jacobs and Hartley found that transmission occurred only in ewes infected during pregnancy, not before pregnancy. In ewes infected at 90 days of pregnancy, congenital transmission occurred frequently, but only a small proportion of these ewes aborted.

Abnormal Development - TORCH Infections

In studies of ewes with naturally acquired infection and antibodies before experimental challenge, Hartley noted substantial immunity, but he also observed congenital transmission and some abortions among these ewes. Beverley and colleagues reported similar results. In a trial with live, attenuated parasite vaccine, protection of sheep was manifested as increased live births of healthy lambs.

Drucilla J. Congenital infections occur in transplacental and ascending infections and are often lethal.

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The histopathologic features mirror the route of infection. Infected amniotic fluid involves the fetus by so-called aspiration, leading to aspiration pneumonia due to the presence of maternal neutrophils, with or without organisms, in the developing airways or, rarely, a true congenital pneumonia due to a response by the fetus. Both can result in sepsis Fig.

References: [7] [8] [9] [6] [10]. Treponema pallidum. Hutchinson triad : interstitial keratitis , sensorineural hearing loss , Hutchinson teeth. References: [11] [12] [13] [14] [15] [16] [17]. Listeria monocytogenes. Culture from blood or CSF samples pleocytosis. IV ampicillin and gentamicin for both mother and newborn.

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  • TORCH viral infections;
  • References: [18] [17] [19] [20] [21] [22] [23]. Varicella-zoster virus VZV. References: [24] [17] [25] [26]. Parvovirus B Intrauterine fetal blood transfusion in cases of severe fetal anemia. References: [27] [28] [29] [30]. Most mothers have been vaccinated, so congenital infection is rare. Rubella virus.

    TORCH infections

    Congenital toxoplasmosis may manifest with symptoms similar to those of congenital CMV infection! References: [40] [41] [42].

    A high index of suspicion is warranted in neonatal HSV. Skin, eye , and mouth disease has a good prognosis if detected and treated early! References: [43] [44] [45] [46]. Clinical science Congenital infections are caused by pathogens transmitted from mother to child during pregnancy transplacentally or delivery peripartum. TORCH infections : vertically transmitted infections that are capable of significantly influencing fetal and neonatal morbidity and mortality T oxoplasmosis O thers e. Fetus : PCR for T. Newborn : pyrimethamine , sulfadiazine , and folinic acid Prevention Avoid raw, undercooked, and cured meats.

    Inspite of hydrocephalus, it does not require cerebrospinal fluid CSF diversionary procedure due to lack of increased intracranial pressure. Conservative management for seizure disorder is the optimal therapy.

    Congenital Intrauterine TORCH Infections Congenital Intrauterine TORCH Infections
    Congenital Intrauterine TORCH Infections Congenital Intrauterine TORCH Infections
    Congenital Intrauterine TORCH Infections Congenital Intrauterine TORCH Infections
    Congenital Intrauterine TORCH Infections Congenital Intrauterine TORCH Infections
    Congenital Intrauterine TORCH Infections Congenital Intrauterine TORCH Infections
    Congenital Intrauterine TORCH Infections Congenital Intrauterine TORCH Infections

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