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Intrauterine Infections (TORCHS and others)


Many infections (viruses, bacteria, etc.) can pass through the placenta and infect the fetus - this occurs when the mother has an infection caused by a specific infective agent, such as a virus. However, there are only five main pathogens that can cause fetal damage. These organisms are known by the acronym TORCHS - Toxoplasma, Rubella (German measles), Cytomegalovirus (CMV), Herpes virus, Syphilis.

Rubella (German measles)

In the past, out of all the infective agents, an intrauterine infection with this virus caused the most fetal damage. The main signs were a reduced head circumference, defects in the structure of the eye, etc. In recent years, since the introduction of mass immunization against rubella in the population, intrauterine rubella infection is rarely seen. Every woman is tested for rubella antibodies in her blood - if she has not been immunized, she is given the vaccine. It is preferable to do this before pregnancy, but vaccination at the beginning of pregnancy with an attenuated virus that cannot damage the fetus can prevent the mother from being infected with the actual live virus.

Cytomegalovirus (CMV)

See separate information sheet.

Toxoplasma

Infection with this pathogen usually results from contact with infected cats or from eating raw meat.

It is expressed in humans as a febrile disease with or without swollen lymph nodes (lymphadenopathy).

In the fetus, the disease manifests as a disorder of brain development with typical calcifications (hardenings), intrauterine growth retardation, enlarged spleen and liver (hepatosplenomegaly), and many other abnormalities.

The mother's blood antibody level can be measured to check whether she has immunity against this pathogen and whether she has been infected during pregnancy.
In cases of suspected infection during pregnancy, the fetus must also be examined for the presence of infection. This is done by performing amniocentesis to set up a culture and also to perform a PCR (polymerase chain reaction) test. The amniocentesis must be performed in the morning and the amniotic fluid sent there in fresh condition in the afternoon.

Herpes

If the mother has a herpes infection that involves the uterine cervix and appears as vesicles (small blisters) on the cervix, the infant can be infected as it passes through the birth canal during the birth process. The infection in the infant manifests as a severe diffuse disease with vesicles on the skin, for which specific treatment must be given. Delivery by caesarian section can prevent the infant from becoming infected.

Syphilis

This venereal disease used to be common, and was a common cause of congenital defects in the fetus. All pregnant women in Israel routinely undergo a blood test to screen for immunity to this pathogen.

These are the main intrauterine infections; however there are others that can also affect the fetus.

What are the intrauterine infections other than TORCHS?

Chickenpox (varicella)

For many years, it was thought that this virus did not damage the fetus. However, it has recently been found that there is a 2% increase in fetal defects (in excess of the regular risk) in fetuses exposed to this infection in utero. The main defect consists of scarified pigmented spots that cover a limited area on the skin, with or without a shortening of the limb below this area. Eye defects such as reduced eye diameter and defects in the structure of the head such as a reduced head circumference associated with ventriculomegaly may also occur. Most women are immune to this virus because of childhood illness, even if they were unaware at the time that they were infected. However, if a pregnant woman comes into contact with a child with chickenpox and it is not known for certain that she had the illness in childhood, her antibody level must be checked urgently. If she is not immune, she is given a booster shot of antibodies that protect her from infection. If the mother contracts chickenpox during pregnancy, testing for fetal infection can be considered and should be discussed during genetic counseling. This is done by performing amniocentesis to set up a culture or by testing for antibodies in the fetal blood. In all such cases a directed ultrasound scan of the limbs, head and ventricles of the brain, kidneys, heart and eyeballs is recommended.

Parvovirus

Fetal infection involving this virus is rare, and it usually manifests as transient fetal edema without causing permanent damage.

Other pathogens may rarely infect the fetus and cause damage, but the probability is very low. These are not usually tested for unless an ultrasound scan shows suspicious signs such as ventriculomegaly, etc.
 
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Comments (1)


Sunday, March 18, 2012 12:13 PM
(1) Felipe  says:


TORCHS

Good job, thanks for info.





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