TORCH | Overview
TORCH is an acronym for a group of diseases that cause congenital (present at birth) conditions if a fetus is exposed to them in the uterus. TORCH stands for:
- other (such as syphilis, varicella, mumps, parvovirus, and HIV)
- herpes simplex
The “other” diseases described in this article include:
- varicella-zoster virus (chickenpox)
- fifth disease (Parvovirus B19)
- HIV (human immunodeficiency virus)
Frequently asked questions
What causes these in utero TORCH infections?
A baby contracts a TORCH infection in the uterus when the mother catches the infectious disease and carries it through her bloodstream to the baby.
The developing fetus is especially vulnerable to illness because its immune system is not yet strong enough to permanently fight off infection.
Since a baby in utero cannot completely get rid of an infection, the disease remains in the body and can prevent the child's vulnerable organs from developing correctly.
Syphilis is a sexually transmitted disease caused by the bacteria treponema pallidum that can result in serious congenital conditions if contracted during prenatal development.
There are three main stages of syphilis, which progressively become more serious:
- primary stage: isolated physical symptoms, most noticeably a syphilitic chancre (hard, red sore) and inflamed lymph nodes
- secondary stage: syphilis circulates throughout the blood stream, producing a rash on the hands and feet several weeks after the chancre heals
- tertiary stage: comes after a latency period, during which there are no symptoms of the disease. This final stage of syphilis involves the neurological, cardiovascular, and musculoskeletal systems.
Newborns with syphilis are considered to be in the secondary stage of the disease, but move to the final, and most serious period, of the disease by their second birthday.
Syphilis is most likely passed from a mother to her child if she is in the first or second stage of the disease, rather than the latent phase. If the mother is not treated, syphilis infects the baby more than 75 percent of the time.
Almost half of children infected before birth do not make it to term or die soon afterwards. The majority of children born with syphilis do not show any physical symptoms of the disease until weeks or months after birth. If left untreated, syphilis becomes a severe and chronic illness that affects the neurological and cardiovascular systems.
Symptoms of congenital syphilis differ between newborns and older infants because the disease progresses from its secondary stage to its final phase.
- failure to thrive
- watery nasal discharge (“sniffles”)
- rash and lesions
- early rash: small blisters on palms and soles of feet
- late rash: copper-colored on palms, soles, and face
- rash around mouth, genitalia, anus
- severe pneumonia
In older infants:
- tooth abnormalities (notched and peg-shaped teeth)
- bone pain and abnormalities in lower leg
- neurological problems
Symptoms of congenital syphilis may resemble other skin conditions or medical problems. Always consult your child's physician for a diagnosis.
A single dose of antibiotics usually gets rid of congenital syphilis and prevents recurrent infections.
If the mother is treated early in the pregnancy, the infant is at minimal risk for infection.
If the baby is born with syphilis, he can be treated with antibiotics, as well, to get rid of the infection. Other effects of the baby’s syphilis may be treated separately.
By screening women early in their pregnancy, syphilis can be detected before it harms the mother or child.
Regular screenings during pregnancy can help ensure the baby's health.
Congenital varicella syndrome is caused by the same virus (varicella) as chickenpox, a common childhood disease.
When a fetus contracts varicella, the disease is known as congenital varicella syndrome, and the resulting health conditions may be severe.
A woman who gets varicella for the first time (chickenpox) during her pregnancy can pass it on to her unborn child, causing the syndrome.
Varicella is highly contagious — there is a 90 percent chance that an infected person will spread the disease to a household member who has not had chickenpox before.
For adults and children, varicella is spread through direct skin contact with the chickenpox rash or through the droplets in the air.
The risk of a mom passing the varicella virus onto her baby is extremely low. Only a primary varicella infection can cause the condition, and most adults and children have already had chickenpox or have been vaccinated against it.
Even if a mother does contract chickenpox while pregnant, there is only a 2 percent chance that the baby will develop congenital varicella syndrome.
Babies born with congenital varicella syndrome may have birth defects that affect the following parts of their bodies:
- skin (mostly on arms and legs)
- thickened, overgrown scar tissue
- hardened, red, and inflamed skin
- limb atrophy: limb deficiencies, malformations, and underdevelopment
- autonomic nervous system: controls involuntary functions
- ventriculomegaly: enlarged ventricles of the brain
- cortical atrophy: degeneration of outer portion of brain
- low birth weight
- microcephaly: abnormally small head
- cataracts: clouding over the lens of the eye
- abnormally small eye(s)
- rapid, involuntary eye movement
- chorioretinitis: inflammation of the choroids layer behind the retina
- psychomotor skills: motor movements caused by mental process
- learning disabilities
- mental retardation
If you contract chickenpox during your pregnancy, fetal ultrasounds can monitor your baby to determine if varicella affects its development.
Varicella-zoster immune globin (VZIG) can be administered to newborns infected immediately after birth, in order to lessen the severity of the varicella disease.
For pregnant women who are exposed to the varicella virus and are at risk for developing chickenpox, VZIG can help prevent infection.
Pregnant women who contract varicella during pregnancy often have a more severe case of the disease than women who are not pregnant. Severe varicella may be treated with an antiviral medication given through an IV.
For babies born with congenital varicella syndrome, specific symptoms of the disease can be treated accordingly.
It is not a concern if the mother has already contracted chickenpox.
However, if you are pregnant and have not had chickenpox before, the following steps can help prevent congenital varicella syndrome:
- Avoid contact with anybody who has chickenpox.
- Susceptible people who are living with a pregnant woman should get the varicella vaccine.
- If you are already pregnant, DO NOT get the varicella vaccine, as it contains a live version of the virus. Get vaccinated at least a month before your pregnancy or after giving birth.
Congenital fifth disease (Parvovirus B19)
Fifth disease is a mild illness, caused by parvovirus B19, and is spread through droplets in the air.
- It is often referred to as "slapped cheek disease" because of its characteristic rash on the face.
- Fifth disease got its name when it was ranked fifth on a list of the top causes of childhood rashes and fevers.
- Although the symptoms are usually mild in adults, fifth disease may cause complications in a pregnancy.
Several factors influence the likelihood of congenital fifth disease, including:
- Whether the mother is immune. About half the adult population has been exposed to fifth disease and is therefore unaffected by contact with parvovirus B19.
- How early in the pregnancy the mother is infected. A baby is more likely to be affected by fifth disease if the mother contracts the virus during the first half of the pregnancy.
- Whether or not the mother is in contact with young children. Fifth disease is a childhood illness, so women who have frequent contact with children are likely to be exposed to the disease. Fortunately, these women are also the most likely to be immune to parvovirus B19.
Overall, fewer than 5 percent of pregnant women infected with parvovirus B19 transmit fifth disease to their baby.
Fifth disease is usually diagnosed based on a medical history and physical examination. The rash and progression of fifth disease is unique and can easily be diagnosed.
A blood test can determine if the mother:
- is immune to fifth disease
- has been recently infected
To determine if the baby has been infected with fifth disease, your physician can test for parvovirus B19 in amniotic fluid or fetal blood.
Since fifth disease is caused by a virus, medications cannot treat it. Your physician may closely monitor your baby’s development through fetal ultrasounds and blood tests.
In rare cases when the fetus has severe anemia, your doctor may suggest an intrauterine blood transfusion.
Frequent hand washing is the most common way to prevent the spread of viruses. Since fifth disease is contagious before the symptoms develop, avoiding people with the disease will not prevent infection.
HIV (human immunodeficiency virus)
HIV is the virus that is responsible for causing acquired immune deficiency syndrome (AIDS).
- The virus destroys or impairs cells of the immune system and progressively destroys the body's ability to fight infections and certain cancers.
- In children under the age of 13 in the United States, nearly all HIV infections are passed to the child when they are in their mother's womb or as they pass through the birth canal.
- However, not every child born to an HIV-infected mother will acquire the virus.
Between 1992 and 1997, the number of infants who became HIV positive when born to an infected mother decreased by 50 percent. This reduction reflects the use of new anti-retroviral medications that are given to the mother before her baby is born. Because transmission often occurs during delivery, your doctor may recommend a cesarean section if you are infected with HIV.
The virus has also been detected in breast milk.
At birth, infants born to an HIV-infected mother may test negative for the virus and have no symptoms. This does not mean that the infant does not have the virus. Blood tests will be done at various stages after birth up to and past 6 months of age to determine an infant's HIV status.
Symptoms may include the following:
- failure to thrive: delayed physical and developmental growth as evidenced by poor weight gain and bone growth
- swollen abdomen (due to swelling of the liver and spleen)
- swollen lymph nodes
- intermittent diarrhea
- oral thrush: a fungal infection in the mouth that is characterized by white patches on the cheeks and tongue. These lesions may be painful to the infant.
If your in infant is born to an HIV-infected mother, he may not test positive at birth and it may be necessary for him to undergo multiple blood tests at different intervals during his first 6 months of life.
As with many other conditions, early detection offers more options for treatment. Today, there are medical treatments that can slow down the rate at which HIV weakens the immune system, but, currently, there is no cure for the disease.
However, there are other treatments that can prevent or cure the conditions associated with HIV.
- Anti-retroviral drug therapy may be given to a pregnant woman, which has proven to greatly reduce the chance of an infant developing HIV.
- A cesarean section may be recommended to reduce infant transmission from the birth canal.
- If other feeding options are available, an infected mother should not breastfeed her infant.
Leading the way in fetal care
Through the joint work of researchers, genetic specialists, surgeons and other care providers, Boston Children's Hospital's Maternal Fetal Care Center is breaking ground in understanding and successfully treating a wide variety of fetal health concerns.