Remember to screen for TORCH in babies who present in the newborn period with pathology
Remember to screen for TORCH in babies who present in the newborn period with pathology: Excerpt from Avoiding Common Pediatric Errors
Author:
Ellen Hamburger, MD
What to Do - Gather Appropriate Data
Perinatal infections are a significant cause of fetal and neonatal mortality and an important contributor to early and later childhood morbidity.
The TORCH acronym originally grouped five pathogens with similar clinical findings. TORCH refers to toxoplasmosis, other agents, (syphilis, etc.),
rubella, Cytomegalovirus (CMV), and herpes simplex virus (HSV). Over
time, many microbes, including human immunodeficiency virus (HIV), parvovirus B19, and enteroviruses, have been placed into the TORCH acronym.
Although the term is useful in generating a differential diagnosis, the indiscriminate use of TORCH "titers" or battery as a diagnostic tool has limited
utility due to low yield, difficulty in interpreting single serum samples. Furthermore,moresensitiveandspecificmethodsnowexisttodiagnoseperinatal
infections. In one study of almost 1,200 TORCH screens, only 1.4% were
positive and only 0.7% were associated with confirmed disease.
The sole reliance on antibody response for diagnosis is difficult because
maternal immunoglobulin (Ig)G can cross the placenta, leading to a falsely
positive test, and neonatal IgM is technically difficult to perform, leading
to a falsely negative test. In patients where perinatal infection is highly
suspected, the clinician should consider cultures, polymerase chain reaction
(PCR) methods, as well as specific serologic tests to confirm a diagnosis.
Organ-specifictests,suchasheadcomputedtomography,funduscopicexam,
and auditory tests, may provide important diagnostic information.
Neonatal infections with CMV, Toxoplasma, rubella, HSV, and syphilis
present a diagnostic dilemma because their clinical features overlap and initially may be indistinguishable. Some infants may be infected without overt
symptoms. Additionally, infection is subclinical in >95% of mothers with
CMV, toxoplasmosis, hepatitis B, Parvovirus B19, and herpesvirus type 6.
SymptomssuggestiveofaperinatalinfectionfromoneoftheTORCHorganisms include intrauterine growth retardation, anemia, neutropenia, thrombocytopenia, petechiae, purpura, ocular signs (chorioretinitis, cataracts,
keratoconjunctivitis, glaucoma, or microphthalmos), and central nervous
system signs (microcephaly, hydrocephaly, intracranial calcifications). Other
organ system involvement may include pneumonia, myocarditis, nephritis, hepatitis with hepatosplenomegaly, jaundice, and nonimmune hydrops.
Once suspected, specific tests for each potential pathogen should be considered. For some infections, such as syphilis, a presumptive diagnosis with
initiation of treatment prior to isolation of the organism is warranted. Specific therapies for many TORCH pathogens now exist, including ganciclovir
for CMV, acyclovir for HSV, and penicillin for syphilis.
Suggested Readings
Cullen A, Brown S, Cafferkey M, et al. Current use of the TORCH screen in the diagnosis of
congenital infection. J Infect. 1998;36(2):185–188.
Newton ER. Diagnosis of perinatal TORCH infections. Clini Obstet Gynecol. 1999;42(1):59–70.
Book Source Details
- Book Title: Avoiding Common Pediatric Errors
- Author(s): Anthony D Slonim MD, DrPH; Lisa Marcucci MD
- Year of Publication: 2008
- Copyright Details: Avoiding Common Pediatric Errors, Copyright © 2008 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: Avoiding Common Pediatric Errors
Authors: Anthony D Slonim MD, DrPH; Lisa Marcucci MD
Publisher: Lippincott Williams & Wilkins
Copyright: 2008
ISBN: 0-7817-7489-6
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» Next page: Severe clinical presentations of diseases usually highlight important opportunities for aggressivediagnostic testing and treatment (Avoiding Common Pediatric Errors)
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