TORCH syndrome
Overview
TORCH Syndrome: Infection of a fetus by any of a group of infectious agents which have been transmitted from the mother through the placenta. The infections include toxoplasmosis, rubella, cytomegalovirus, herpes virus, hepatitis and syphilis. The severity and nature of symptoms is determined by the type of infection.
Symptoms
* Enlarged liver * Enlarged spleen * Chorioretinitis * Fetal malformations * Jaundice * Low blood platelet level * Central nervous system abnormalities * Asymptomatic manifestations may occur later in life * Brain infection * Infection of membrane around brain * Small head * Heart malformations * Cataracts * Hearing loss * Mental retardation * Hemorrhagic skin spots * Fetal death * Bleeding diathesis
Causes
CMV has been found in the saliva, urine, semen, breast milk, feces, blood, and vaginal and cervical secretions of infected people. The virus is usually transmitted through contact with these infected secretions, which can harbor the virus for months or even years. It may be transmitted by sexual contact and can travel across the placenta, causing a congenital infection. Immunosuppressed patients, especially those who have received transplanted organs, run a 90% chance of contracting CMV infection. Recipients of blood transfusions from donors with positive CMV antibodies are at some risk. About four out of five people older than age 35 have been infected with CMV, usually during childhood or early adulthood. In most of these people, the disease is so mild that it's overlooked. However, CMV infection during pregnancy can be hazardous to the fetus, possibly leading to stillbirth, brain damage, and other birth defects or to severe neonatal illness. About 1% of all neonates have CMV.
Treatment
Treatment aims to relieve symptoms and prevent complications. In the immunosuppressed patient, CMV may be treated with acyclovir, ganciclovir, valganciclovir, cidofovir and, possibly, foscarnet. Most important, parents of children with severe congenital CMV infection need support and counseling to help them cope with the possibility of brain damage or death.Treatment of acute disease consists of drug therapy with sulfonamides, pyrimethamine, folinic acid, clindamycin, or co-trimoxazole. In patients who also have acquired immunodeficiency syndrome, treatment continues indefinitely. No safe, effective treatment exists for chronic toxoplasmosis or toxoplasmosis occurring in the first trimester of pregnancy.