Abnormal Development - TORCH Infections

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Educational Use Only - Embryology is an educational resource for learning concepts in embryological development, no clinical information is provided and content should not be used for any other purpose.

Introduction

Toxoplasmosis lifecycle

Infections, collectively grouped under the acronym TORCH for Toxoplasmosis, Other organisms (parvovirus, HIV, Epstein-Barr, herpes 6 and 8, varicella, syphilis, enterovirus) , Rubella, Cytomegalovirus and Hepatitis. (some of these infections have additional pages and also see related pages on maternal hyperthermia and bacterial infections}.


Materal effects should really be called environmental (in contrast to genetic) removing the association of mother with the deleterious agent. Accepting this caveat, there are several maternal effects from lifestyle, environment and nutrition that can be prevented or decreased by change which is not an option for genetic effects.


Finally, when studying this topic remember the concept of "critical periods" of development that will affect the overall impact of the above listed factors. This can be extended to the potential differences between prenatal and postnatal effects, for example with infections and outcomes.


Environmental Links: Introduction | Low Folic Acid | Iodine Deficiency | Nutrition | Drugs | Australian Drug Categories | USA Drug Categories | thalidomide | herbal drugs | Illegal Drugs | smoking | Fetal Alcohol Syndrome | TORCH | viral infection | bacterial infection | Zoonotic Infection | Toxoplasmosis | Malaria | Maternal Diabetes | Maternal Hypertension | maternal hyperthermia | Maternal Inflammation | Maternal Obesity | Hypoxia | Biological Toxins | Chemicals | heavy metals | radiation | Prenatal Diagnosis | Neonatal Diagnosis | International Classification of Diseases | Fetal Origins Hypothesis


Viral Links: viral infection | TORCH | cytomegalovirus | Hepatitis Virus | HIV | Parvovirus | Polio Virus | rubella virus | Chickenpox | Lymphocytic Choriomeningitis Virus | Zika Virus | rotavirus | vaccination | Environmental
Historic Embryology - Viral 
1941 Rubella Cataracts | 1944 Rubella Defects


Abnormality Links: abnormal development | abnormal genetic | abnormal environmental | Unknown | teratogens | ectopic pregnancy | cardiovascular abnormalities | Coelomic Cavity | endocrine abnormalities | gastrointestinal abnormalities | genital abnormalities | head abnormalities | integumentary abnormalities | musculoskeletal abnormalities | limb abnormalities | neural abnormalities | neural crest abnormalities | renal abnormalities] | respiratory abnormalities | placenta abnormalities | hearing abnormalities | vision abnormalities | twinning | Developmental Origins of Health and Disease | ICD-10
Historic Embryology  
1915 Congenital Cardiac Disease | 1917 Frequency of Anomalies in Human Embryos | 1920 Hydatiform Degeneration Tubal Pregnancy | 1921 Anencephalic Embryo | 1921 Rat and Man | 1966 Congenital Malformations

Some Recent Findings

  • Seroprevalence of TORCH infections in women of childbearing age in Croatia.[1] "During 2005-2009, a seroepidemiological study was carried out in Croatia to define the population susceptible to common TORCH agents among pregnant and non-pregnant women of childbearing age. The IgG seroprevalence was 29.1% forT. gondii, 94.6% for rubella, 75.3% for cytomegalovirus (CMV), 78.7% for herpes simplex virus type 1 (HSV-1), and 6.8% for HSV-2. Acute toxoplasmosis and CMV infection (positive IgM antibodies with low IgG avidity) were documented in 0.25% and 0.09% women, respectively. IgM prevalence was 1.2% for both HSV-1 and HSV-2. None of the participants showed acute rubella infection. Seropositivity to T. gondii and HSV-2 varied significantly between age groups (p = 0.001 and p = 0.036, respectively). Women residing in rural regions showed a significantly higher seroprevalence rate for T. gondii, CMV, and HSV-1 than urban women (T. gondii: 44.0% vs. 25.4%, p < 0.001; CMV: 85.0% vs. 73.1%, p = 0.018; HSV-1: 86.0% vs. 76.4%, p = 0.041)."
  • Routine TORCH screening is not warranted in neonates with subependymal cysts.[2] "Congenital infections are associated with a wide variety of clinical symptoms, including subependymal cysts (SEC). ...The co-occurrence of TORCH congenital infections in infants with SEC is rare. Routine TORCH screening in neonates with SEC does not seem warranted."
More recent papers
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This table shows an automated computer PubMed search using the listed sub-heading term.

  • Therefore the list of references do not reflect any editorial selection of material based on content or relevance.
  • References appear in this list based upon the date of the actual page viewing.

References listed on the rest of the content page and the associated discussion page (listed under the publication year sub-headings) do include some editorial selection based upon both relevance and availability.

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Search term: TORCH Infections

Zheng Ying-Yan, Xie Ting-Jun, Wang Man, Fang Yue-Yi, Luo Le ##Title## Zhongguo Xue Xi Chong Bing Fang Zhi Za Zhi: 2018, 30(2);219-221 PubMed 29770671

Camila Gálvez V, Isidro Huete, Marta Hernández Congenital Hydrocephalus: Gómez-López-Hernández syndrome. An underdiagnosed Syndrome. A clinical case. [Hidrocefalia Congénita: Síndrome de Gómez-López-Hernández, un síndrome subdiagnosticado. Caso clínico.] Rev Chil Pediatr: 2018, 89(1);92-97 PubMed 29664509

Maiken Worsøe Rosenstierne, Frederik Schaltz-Buchholzer, Fernanda Bruzadelli, Asson Có, Placido Cardoso, Charlotte Sværke Jørgensen, Johan Michiels, Leo Heyndrickx, Kevin K Ariën, Thea Kølsen Fischer, Anders Fomsgaard Zika Virus IgG in Infants with Microcephaly, Guinea-Bissau, 2016. Emerging Infect. Dis.: 2018, 24(5);948-950 PubMed 29664391

Jane Learmount, Mike J Glover, Mike A Taylor Resistance delaying strategies on UK sheep farms: A cost benefit analysis. Vet. Parasitol.: 2018, 254;64-71 PubMed 29657014

Lisa M Daum, Lindsay R Sklar, Darius R Mehregan Blueberry muffin rash secondary to hereditary spherocytosis. Cutis: 2018, 101(2);111-114 PubMed 29554165

Toxoplasmosis

The causal agent of Toxoplasmosis is the protist Toxoplasma gondii. This unicellular eukaryote is a member of the phylum Apicomplexa which includes other parasites responsible for a variety of diseases (malaria, cryptosporidiosis). The diagnosis and timing of an infection are diagnostically based on serological tests.

Toxoplasmosis lifecycle Toxoplasma tachyzoites
Toxoplasmosis lifecycle Toxoplasma tachyzoites

Recent findings suggest that pre-pregnancy immunization against toxoplasmosis may not protect against reinfection by atypical strains.


Links: Toxoplasmosis

Other Organisms

A general term covering a ranges of viruses: parvovirus, HIV, Epstein-Barr, herpes 6 and 8, varicella, syphilis, enterovirus.

Human immunodeficiency virus

[3]

Links: Abnormal Development - Viral Infection

Rubella

Rubella virus (Latin, rubella = little red) is also known as "German Measles" due to early citation in German medical literature. Infection during pregnancy can cause congenital rubella syndrome (CRS) with serious malformations of the developing fetus. This association between infection and abnormal development was first identified in 1941.[4] The type and degree of abnormality relates to the time of maternal infection.

Infant rubella virus.jpg Rubella virus.jpg
Infant rubella virus Rubella virus (electron micrograph


Links: Rubella Virus

Cytomegalovirus

Cytomegalovirus.jpg

Human cytomegalovirus (HCMV, Greek, cyto = "cell", megalo = "large") or Human Herpesvirus 5 (HHV-5) is a member of the herpes virus family. A viral infection that causes systemic infection and extensive brain damage and cell death by necrosis. HCMV infection is ranked as one of the most common infections in adults, with the seropositive rates ranging from 60–99% globally. In Western countries, adults with advanced AIDS prior to the introduction of highly active antiretroviral therapy (HAART) this virus also a cause of blindness (CMV retinitis) and death in patients.

Estimated annual number of United States children with long-term sequelae caused by various disease conditions.[5]

Congenital cytomegalovirus data are from a literature review, with varying collection periods spanning multiple years.

Assumes 4 million live births per year and 20 million children less than 5 years of age. Where applicable, numbers represent means of published estimates. All estimates should be considered useful for rough comparisons only since surveillance methodology, time periods, and diagnostic accuracy varied by study.

CDC Congenital abnormality graph.jpg


Links: Cytomegalovirus | Torch Infections | Trisomy 21 | Fetal Alcohol Syndrome

Hepatitis

Hepatitis B virus.jpg Hepatitis (inflammation of the liver) is caused in humans by one of 7 viruses (A, B, C, D, E) with the 2 additional F has not been confirmed as a distinct genotype; and G is a newly described flavivirus.

"All of these viruses can cause an acute disease with symptoms lasting several weeks including yellowing of the skin and eyes (jaundice); dark urine; extreme fatigue; nausea; vomiting and abdominal pain. It can take several months to a year to feel fit again." (CDC text).

Virus particles measure 42nm in overall diameter and contain a 27nm diameter DNA-based core.

Hepatitis Transmission Risk to the Fetus

  • Hepatitis A - Fetal transmission of virus occurs with extreme rarity.
  • Hepatitis B - Can occur as a consequence of intrapartum exposure, transplacental transmission, and breastfeeding.

20%–30% of HBsAg-positive/HbeAg-negative women will transmit virus to their infants. 90% of HBsAg- and HBeAg-positive women will transmit virus to their infants. Immunoprophylaxis at birth with both HBIG and Hepatitis B vaccine within 12 hours of birth decreases the risk of transmission. Passive (HBIG) and active immunization is 85%–95% effective in preventing neonatal HBV infection.

  • Hepatitis C - The overall risk of transmission is approximately 5%–10% with unknown maternal viral titers.

All pregnant women with HCV should have viral titers performed.

Data: Hepatitis and reproduction[6]


Links: Hepatitis Virus

References

  1. Vilibic-Cavlek T, Ljubin-Sternak S, Ban M, Kolaric B, Sviben M & Mlinaric-Galinovic G. (2011). Seroprevalence of TORCH infections in women of childbearing age in Croatia. J. Matern. Fetal. Neonatal. Med. , 24, 280-3. PMID: 20476874 DOI.
  2. van der Weiden S, Steggerda SJ, Te Pas AB, Vossen AC, Walther FJ & Lopriore E. (2010). Routine TORCH screening is not warranted in neonates with subependymal cysts. Early Hum. Dev. , 86, 203-7. PMID: 20227842 DOI.
  3. Brogly SB, Abzug MJ, Watts DH, Cunningham CK, Williams PL, Oleske J, Conway D, Sperling RS, Spiegel H & Van Dyke RB. (2010). Birth defects among children born to human immunodeficiency virus-infected women: pediatric AIDS clinical trials protocols 219 and 219C. Pediatr. Infect. Dis. J. , 29, 721-7. PMID: 20539252 DOI.
  4. Gregg NM. (1991). Congenital cataract following German measles in the mother. 1941. Epidemiol. Infect. , 107, iii-xiv; discussion xiii-xiv. PMID: 1879476
  5. Centers for Disease Control and Prevention, Congenital CMV Infection Trends and Statistics http://www.cdc.gov/cmv/trends-stats.html, viewed 6 November 2012 (EST).
  6. Practice Committee of American Society for Reproductive Medicine. (2008). Hepatitis and reproduction. Fertil. Steril. , 90, S226-35. PMID: 19007636 DOI.

Reviews

Nickerson JP, Richner B, Santy K, Lequin MH, Poretti A, Filippi CG & Huisman TA. (2012). Neuroimaging of pediatric intracranial infection--part 2: TORCH, viral, fungal, and parasitic infections. J Neuroimaging , 22, e52-63. PMID: 22309611 DOI.

Ishaque S, Yakoob MY, Imdad A, Goldenberg RL, Eisele TP & Bhutta ZA. (2011). Effectiveness of interventions to screen and manage infections during pregnancy on reducing stillbirths: a review. BMC Public Health , 11 Suppl 3, S3. PMID: 21501448 DOI.

Stegmann BJ & Carey JC. (2002). TORCH Infections. Toxoplasmosis, Other (syphilis, varicella-zoster, parvovirus B19), Rubella, Cytomegalovirus (CMV), and Herpes infections. Curr Womens Health Rep , 2, 253-8. PMID: 12150751

Helfgott A. (1999). TORCH testing in HIV-infected women. Clin Obstet Gynecol , 42, 149-62; quiz 174-5. PMID: 10073308

Newton ER. (1999). Diagnosis of perinatal TORCH infections. Clin Obstet Gynecol , 42, 59-70; quiz 174-5. PMID: 10073301

Greenough A. (1994). The TORCH screen and intrauterine infections. Arch. Dis. Child. Fetal Neonatal Ed. , 70, F163-5. PMID: 8198407

. (1990). TORCH syndrome and TORCH screening. Lancet , 335, 1559-61. PMID: 1972489

Articles

Vilibic-Cavlek T, Ljubin-Sternak S, Ban M, Kolaric B, Sviben M & Mlinaric-Galinovic G. (2011). Seroprevalence of TORCH infections in women of childbearing age in Croatia. J. Matern. Fetal. Neonatal. Med. , 24, 280-3. PMID: 20476874 DOI.

Abu-Madi MA, Behnke JM & Dabritz HA. (2010). Toxoplasma gondii seropositivity and co-infection with TORCH pathogens in high-risk patients from Qatar. Am. J. Trop. Med. Hyg. , 82, 626-33. PMID: 20348511 DOI.

Kriebs JM. (2008). Breaking the cycle of infection: TORCH and other infections in women's health. J Midwifery Womens Health , 53, 173-4. PMID: 18455090 DOI.

Singh S. (2002). Prevalence of torch infections in Indian pregnant women. Indian J Med Microbiol , 20, 57-8. PMID: 17657031

Abdel-Fattah SA, Bhat A, Illanes S, Bartha JL & Carrington D. (2005). TORCH test for fetal medicine indications: only CMV is necessary in the United Kingdom. Prenat. Diagn. , 25, 1028-31. PMID: 16231309 DOI.

Search Pubmed

June 2010 "TORCH Infections" All (183) Review (37) Free Full Text (18)

Search Pubmed: TORCH Infections | maternal infections | teratogens


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Cite this page: Hill, M.A. (2018, May 22) Embryology Abnormal Development - TORCH Infections. Retrieved from https://embryology.med.unsw.edu.au/embryology/index.php/Abnormal_Development_-_TORCH_Infections

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© Dr Mark Hill 2018, UNSW Embryology ISBN: 978 0 7334 2609 4 - UNSW CRICOS Provider Code No. 00098G