Síndrome de TORCH: enfoque racional del diagnóstico y tratamiento pre y post natal. Recomendaciones del Comité Consultivo de Infecciones Neonatales Sociedad Chilena de Infectología, 2016 / TORCH syndrome: Rational approach of pre and post natal diagnosis and treatment. Recommendations of the Advisory Committee on Neonatal Infections Sociedad Chilena de Infectología, 2016

There is a lot of bacterial, viral or parasite infections who are able to be transmitted vertically from the mother to the fetus or newborn which implicates an enormous risk for it. The TORCH acronym is used universally to refer to a fetus or newborn which presents clinical features compatible with a vertically acquired infection and allows a rational diagnostic and therapeutic approach. The traditional "TORCH test" is nowadays considered not appropriate and it has been replaced for specific test for specific pathogens under well defined circumstances. The present document reviews the general characteristics, epidemiology, pathogenesis, diagnostic and therapeutic options for the most frequently involved pathogens in the fetus or newborn with TORCH suspicion.

Existen numerosas infecciones bacterianas, virales y parasitarias que pueden transmitirse desde la madre al feto o recién nacido (RN) y que significan un riesgo para él. El acrónimo TORCH se utiliza en forma universal para caracterizar a aquel feto o RN que presenta un cuadro clínico compatible con una infección congénita y que permite un enfrentamiento racional, tanto diagnóstico como terapéutico. El concepto tradicional de realizar un "test de TORCH" sin consideraciones específicas a cada paciente, hoy en día se considera no adecuado y ha sido reemplazado por exámenes específicos para patógenos específicos bajo circunstancias bien definidas. El presente documento revisa las características generales, epidemiológicas, patogénicas, diagnósticas y terapéuticas de los patógenos más frecuentemente involucrados en el estudio de pacientes con sospecha de TORCH.

Toxoplasmic encephalitis in an HIV infected pregnant woman: successful outcome for both mother and child

This report describes a case of Toxoplasma encephalitis during pregnancy of an HIV infected woman who was severely immunosuppressed (CD(4): 17 cells/mm3), had a high viral load (RNA PCR:230,000 copies/ml), was treated with sulfadiazine, pyrimethamine and folinic acid for toxoplasmosis and was being treated with highly potent antiretroviral drugs (AZT, 3TC and nelfinavir) for HIV infection. The newborn was born through an elective C-section, received six weeks of AZT according to the 076 protocol and was clinically normal at birth. Subsequently he had two RNA PCR negatives for HIV, seroreverted and had no clinical or laboratory evidence of congenital toxoplasmosis. Despite the concerns of the use of these combined therapies on the foetus during pregnancy, their efficacy illustrates that keeping the mother alive and in good health is an important strategy to protect the unborn child from acquiring these two infections.

Hepatitis B and C between mother and newborn

Maternal infection during pregnancy with hepatitis [B] virus [HBV] and hepatitis [C] virus [HBV] is increasingly recognized as a threat to the fetus or the neonate. Blood samples were collected from 69 mothers in delivery once admitted to Mattaria Teaching Hospital, Cairo, Egypt and their newborns during the period from May to October 1994. The apparentely healthy mothers were randomly selected. Blood samples were collected from the cord blood using angiocathers. Sera was separated and stored at -70 degrees untill tested. Sera were tested by enzyme linked immunosorbent assay [ELISA] by Abbott for hepatitis [B] surface antigen [HBsAg] and anti-hepatitis [C] antibody [anti-RCV] using second generation ELISA by Abbott. Out of the 69 mothers 15 [21.6%] had HBsAg, 10 [28.8%] had anti-HCV and 7 [10%] had both markers. In the newborns 7 [10%] had HBsAg, 12[17.4%] had anti-HCV and 5[7.2%] had both markers. This study shows that vertical transmission could be a reality and screening mothers especially those at high risk of infection is important. This gives us a chance to vaccinate their newborns with hepatitis 1B vaccine on the day of delivery and with hepatitis [C] vaccine once it becomes available. Extent of vertical transmission needs further studies. Follow up of babies who have reactive sera or of carrier mothers is recommended

Role of cytomegalovirus in inducing congenital anomalies

Sixty eight infants and newborns were included in the present study being consisted of 55 cases with congenital anomalies and 13 cases of apparently healthy infants acting as controls. Three types of congenital anomaly cases were studied; 17 cases of microcephaly, 17 cases of cerebral palsy and 21 cases with jaundice. All serum samples were tested for cytomegalovirus 1gM antibodies [CMV IgM] by microassay ELISA technique to explore the role of CMV infection in inducing congenital anomalies. Six out of the 68 serum samples were found to be positive for CMV IgM. Four of them were detected among the congenital cases [5 out of 55; 7.3%], while 2 cases were among the controls [2 out of 13; 15.4%]. The microcephalic group showed 5.9% positivity [one out of 17]. The jaundiced infants showed 14.3% positivity [3 out of 21], while all the cerebral palsy cases were negative for CMV IgM. Such a high percentage of CMV IgM in the control group may be attributed to asymptomatic infection, with liability for long term sequelae, particularly hearing loss or ocular abnormalities by 2 years of age. So, continuous follow-up of such asymptomatic cases is essential to control any possible congenital abnormality as early as possible

Detection of cytomegalovirus and herpes virus infection in high risk newborns

ELISA was used to detect specific viral antibodies [IgG and IgM] for both cytomegalovirus [CMV] and herpes simplex virus II [HSV-2]. The study included 77 newborns, classified as 33 preterms, 32 infants of diabetic mothers [DMs] and 12 controls. The mean of CMV IgG and IgM were higher in preterm newborns than in IDMs and both were higher than in the control. As regards HSV-2, the mean of IgG was equal in both preterm newborns and IDMs, but higher than in controls. For IgM the mean in IDMs was higher than in preterm newborns, and both were higher than the controls. 33% of preterm newborns were CMV IgG positive and 21.2% were CMV IgM positive. As regards HSV-2, 24.2% of preterm newborns were IgG positive and 9.1% were IgM positive. Both results are statistically highly significant. With maternal infection during pregnancy, the risk for the baby to acquire congenital CMV infection is 63.71%, while it is 37.6% in cases of HSV-2 infection