The Correlation Between TORCH Infections on Pregnant Women and The Effects on Their Children

CREATED BY: MILA WIDYASTUTI 030.08.162

ABSTRACT
TORCH infections is a

medical acronym for a set of perinatal infections. A group of viral, bacterial, and protozoan infections that gain access to the fetal bloodstream transplacentally via the chorionic villi. Hematogenous transmission may occur at any time during gestation or occasionally at the time of delivery via maternal-tofetal transfusion.

TORCH INFECTIONS
T : Toxoplasmosis O : other infections (Hepatitis B, Coxsackievirus, Syphilis,
Varicella-Zoster Virus, HIV, and Parvovirus B19)

R : Rubella
C : Cytomegalovirus H : Herpes Simplex Virus

INTRODUCTION
It can affect people of any age or sex. However, the

term TORCH is only used when it applies to pregnant women and their unborn or newborn children. Babies are usually most severely affected when the mother gets the infection in the first trimester, or first three months of pregnancy. This is the time of pregnancy when the baby's organs are first starting to form.(1) The exception is herpes, which the baby can acquire as he or she goes through the birth canal.

 The aim of this paper is to provide the reader with

more information in regards to TORCH infections on pregnant women and the effects on their children. By reading this paper, the reader will obtain facts regarding the etiology and treatment of TORCH infections and the sign and symptoms of this disease.

TOXOPLASMOSIS
Most common infectious diseases Caused by the protozoa Toxoplasma gondii.

Cyts full with toxoplasma gondii

TRIMESTER

1ST
14 % risk of infection 41 % in serious condition

2nd
29 % risk of infection 8 % in serious condition

3rd
59 % risk of infection 0 % in serious condition

 Signs of congenital toxoplasmosis :

Retinochoroiditis

Hidrocephaly/ Microcephaly

 cerebral Seizures

calcification

Lymphadenopathy Fever Hepatosplenomegaly Jaundice

jaundice

rash

The examination : Anti-Toxoplasma IgG, IgM

IgM +, IgG -

IgM +, IgG +

IgM -, IgG +

IgM -, IgG -

The beginning of infections/ IgM non specific

New infections

Maybe late infections

Resistance/ No infections Prevention and monitoring

Confirmation with IgG aviditas IgG aviditas < 30 IgG aviditas > 30

Confirmation after 20 days with new sample

Late infections

 Treatment :
drug

therapy :
3 x 500 mg 10 days/month during

Spiramycin

pregnancy Pyrimethamine + sulfadiazyn

No

safe, effective treatment exists for chronic toxoplasmosis or toxoplasmosis occurring in the first trimester of pregnancy.(10)

RUBELLA
commonly called German measles an acute, mildly contagious viral disease that

produces a distinctive 3-day rash and lymphadenopathy.(11) transmitted through contact with the blood, urine, stools, or nasopharyngeal secretions of infected people and, possibly, by contact with contaminated articles of clothing.

 Transplacental transmission first trimester of pregnancy : 100 % abortus 2nd and 3rd trimester most commonly cause hearing

loss

can cause serious birth defects

microcephaly

patent ductus arteriosus

glaucoma

Mental retardation Bone defects

 In adults, prodromal signs

and symptoms headache, malaise, anorexia, low-grade fever, lymphadenopathy and, sometimes, conjunctivitis are the first to appear Suboccipital, postauricular, and postcervical lymph node enlargement is a hallmark of this disease Low-grade fever may accompany the rash (37.2 to 38.3 C)(13)

Rubella Rash

 Because the rubella rash is self-limiting and only

mildly pruritic, it doesnt require topical or systemic medication. Treatment consists of aspirin for fever and joint pain. Bed rest isnt necessary, but the patient should be isolated until the rash disappears. The rubella vaccine should be given with measles and mumps vaccines at age 15 months to decrease the cost and number of injections. (14)

CYTOMEGALOVIRUS
caused by the cytomegalovirus, a deoxyribonucleic acid 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. 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. (15)

 Afffects the heart Most patients with CMV infection have mild,

nonspecific complaints or none at all Infected infants ages 3 to 6 months usually appear asymptomatic but may develop hepatic dysfunction, hepatosplenomegaly, spider angiomas, pneumonitis, and lymphadenopathy. (16)

 Congenital CMV infection is seldom apparent at

birth, although the neonates urine contains the virus. CMV can cause brain damage that may not show up for months after birth. It also can produce a rapidly fatal neonatal illness characterized by jaundice, petechial rash, hepatosplenomegaly, thrombocytopenia, hemolytic anemia, microcephaly, psychomotor retardation, mental deficiency, and hearing loss.(16)

Figure 1. Micrograph of cytomegalovirus (CMV) infection of the placenta The characteristic large nucleus of a CMV infected cell is seen off-centre at the bottom-right of the image. H&E stain.

 Treatment aims to relieve symptoms and prevent

complications. 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.

HERPES SIMPLEX
a recurrent viral infection caused by Herpesvirus

hominis (HVH) Herpes type I : transmitted by oral and respiratory secretions, affects the skin and mucous membranes, commonly producing cold sores. Herpes type II : primarily affects the genital area and is transmitted by sexual contact.(18) the second most common viral infection in pregnant women. It can pass to the fetus transplacentally and, in early pregnancy, may cause spontaneous abortion or premature birth.(19)

 In neonates, HVH symptoms usually appear 1 to 2

weeks after birth. They range from localized skin lesions to a disseminated infection of organs, such as the liver, lungs, or brain. Common complications include seizures, mental retardation, blindness, chorioretinitis, deafness, microcephaly, diabetes insipidus, and spasticity. Up to 90% of infants with disseminated disease die.(19)

 Typical lesions may

suggest HVH infection. However, confirmation requires isolation of the virus from local lesions and histologic biopsy. A rise in antibodies and moderate leukocytosis may support the diagnosis.

Figure 2. Micrograph of pap test showing changes assosiated with herpes simpelx virus

 No cure for herpes exists; however, recurrences tend to be

milder and of shorter duration than the primary infection. Generalized primary infection usually requires an analgesicantipyretic to reduce fever and relieve pain. Drying agents, such as calamine lotion, ease the pain of labial or skin lesions. Avoid petroleum-based ointments, which promote viral spread and slow healing. Topical corticosteroids are contraindicated in active infection Oral acyclovir may bring relief to patients with genital herpes. Foscarnet can be used to treat HVH thats resistant to acyclovir. Anti-viral agents similar to acyclovir are valacyclovir and famciclovir. These agents are more active than acyclovir.(20)

CONCLUSION
Pregnancy is the period of time when a fetus develops

inside a womans uterus and ends with the birth of the infant. Pregnancies typically involve a variety of clinical laboratory tests. The tests provide useful information from the time pregnancy is first considered through the initial days of the newborn's life. Now, the diagnosis for infectious diseases has been developed among others in the direction of immunological tests. The principle of this examination is the detection of anti-(antibody) specific to the bacteria causing the infection as the bodys response to the presence of a foreign body (the worst kuman. Antibodies can be immunoglobulin M (IgM) and immunoglobulin G (IgG).

 A treatment called immune globulin can be given to

the mother or child in certain settings. Prevention is related to the specific infection. Avoiding cats and raw meat can help prevent most cases of toxoplasmosis. rubella can be prevented by making sure the mother is immune (by testing her blood). Cytomegalovirus can rarely be prevented, but safer sex practices can help prevent some cases. Women who have active herpes lesions at the time of delivery are often advised to have a caesarean section.

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