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Congenital Infections and TORCH Syndrome

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Overview

Congenital infections can have potentially severe long-term consequences for the developing foetus. Some maternal infections may be asymptomatic and go unnoticed. These infections can be passed from the mother to the baby (vertical transmission) at any point during pregnancy such as in utero, intrapartum, or postpartum. Potential complications include preterm delivery, intrauterine growth restriction, physical malformations, and pregnancy loss.

TORCH infections

TORCH infections (or TORCH syndrome) describe a group of infections that are passed from the mother to the baby during pregnancy.

The TORCH acronym describes these infections:

  • Toxoplasmosis
  • Other agents:
    • Syphilis,
    • Varicella zoster virus (chickenpox)
    • Parvovirus B19
    • Hepatitis B
    • HIV
  • Rubella
  • Cytomegalovirus (CMV)
  • Herpes simplex virus (HSV)

Zika virus has been proposed to be a new member of TORCH syndrome.

Transmission

Transmission may occur prenatally by passing through the placenta, perinatally by blood or vaginal secretions, or postnatally such as through breastmilk.

In general, the earlier the infection, the more severe congenital complications can be and postnatal infections tend to have less severe effects.

General Features

Overview

Many of the features seen in TORCH infections overlap. General features suggesting their presence are:

  • Rash – maculopapular, petechial, or purpuric
  • Microcephaly
  • Sensorineural hearing loss
  • Chorioretinitis
  • Hepatosplenomegaly
  • Congenital heart disease

Toxoplasmosis Infection in Pregnancy

Overview

Toxoplasmosis is due to infection by the parasite Toxoplasma gondii whose usual reservoir is the cat, although it may be carried in other animals.

The risk of transmission is highest in the third trimester. Earlier infection is associated with more severe complications. 

Complications

  • Intrauterine growth restriction and low birth weight
  • Hepatosplenomegaly
  • Chorioretinitis
  • Cerebral intraparenchymal calcifications
  • Anaemia
  • Hydrocephalus

Varicella Zoster Virus (Chickenpox) in Pregnancy

Overview

This is discussed more in Chickenpox and Pregnancy.

Parvovirus B19 in Pregnancy

Overview

Infection with parvovirus B19 in pregnancy can lead to complications in the neonate, particularly in the first and second trimesters.

Complications

  • Aplastic anaemia:
    • Due to the destruction of erythrocyte precursor cells by parvovirus B19 and haemolysis
  • Hydrops fetalis – abnormal accumulation of fluid in 2 or more foetal compartments
  • Foetal death

Hepatitis B in Pregnancy

Overview

This is discussed more in Hepatitis B and Pregnancy.

HIV in Pregnancy

Overview

This is discussed more in HIV and Pregnancy.

Rubella Infection in Pregnancy

Overview

This is discussed more in Rubella and Pregnancy.

Cytomegalovirus in Pregnancy

Overview

Cytomegalovirus (CMV) is the most common congenital infection in the UK. It can be transmitted through the placenta, birth canal, and breast milk.

The risk of vertical transmission is around 32% if a primary infection occurs during pregnancy compared to 1.4% in reactivation or reinfection with CMV.

Complications

  • Intrauterine growth restriction and low birth weight
  • Hepatosplenomegaly
  • Sensorineural hearing loss
  • Petechiae and/or purpura
  • Visual impairment
  • Learning disability
  • Seizures
  • Anaemia
  • Jaundice
  • Hydrops fetalis

Herpes Simplex in Pregnancy

Overview

Herpes simplex virus (HSV) can be transmitted to the foetus in utero (congenital herpes) or due to exposure during delivery (neonatal herpes).

Complications

Neonatal herpes is relatively rare but has serious mortality and morbidity. Congenital herpes is extremely rare. The risk of complications is higher in primary infection with HSV than recurrent infection. Features include:

  • HSV encephalitis – lethargy, seizures
  • Disseminated disease – severe skin lesions and hypotension
  • Skin, eyes, and mucous membrane disease – vesicular rashes

Chlamydia and Gonorrhoea in Pregnancy

Overview and complications

Infection with Chlamydia trachomatis or Neisseria gonorrhoeae during pregnancy can cause ophthalmia neonatorum (neonatal conjunctivitis). If untreated, this can lead to permanent blindness. This may present with:

  • Eye discharge
  • Eye erythema
  • Eyelid swelling
  • Eye pain

If ophthalmia neonatorum is suspected, refer for a same-day assessment by an ophthalmologist.

Syphilis in Pregnancy

Overview

Syphilis is transmitted through the placenta or via the birth canal. The risk of transmission is higher in recent maternal infections.

Complications

  • Skin lesions on the palms and soles
  • Hepatosplenomegaly
  • Jaundice
  • Nasal discharge
  • Umbilical cord inflammation (funisitis)
  • Sensorineural hearing loss
  • Saddle-shaped nose

Zika Virus in Pregnancy

Overview

Zika virus is spread by the Aedes genus of mosquitos, particularly the Aedes aegypti species, which also transmits yellow fever, dengue, and chikungunya fever.

Its routes of transmission include being bitten, sexual transmission, vertical transmission, and blood donation.

Complications

  • Microcephaly and other brain abnormalities such as brain atrophy, hydrocephalus
  • Retinal damage and macular scarring 

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