ABSTRACT
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.
Subject(s)
Humans , Male , Female , Pregnancy , Infant, Newborn , Infant, Newborn, Diseases/microbiology , Infant, Newborn, Diseases/parasitology , Infant, Newborn, Diseases/virology , Pregnancy Complications, Infectious/microbiology , Pregnancy Complications, Infectious/parasitology , Pregnancy Complications, Infectious/virology , Prenatal Diagnosis , Rubella/congenital , Rubella/diagnosis , Rubella/therapy , Syndrome , Toxoplasmosis, Congenital/diagnosis , Toxoplasmosis, Congenital/therapy , Risk Factors , Chagas Disease/congenital , Chagas Disease/diagnosis , Chagas Disease/therapy , Practice Guidelines as Topic , Cytomegalovirus Infections/congenital , Cytomegalovirus Infections/diagnosis , Cytomegalovirus Infections/therapy , Fetus , Herpes Simplex/congenital , Herpes Simplex/diagnosis , Herpes Simplex/therapyABSTRACT
Primary TORCH [Toxoplasmosis, rubella, cytomegalovirus, herpes simplex virus] and Treponema palidum infections in the mothers can lead to severe fetal anomalies. This study was done to explore the prevalance of TORCH antibodies in newborns with congenital malformations and their mothers in Gorgan-Iran. This descriptive, cross-sectional study was done on newborns with major congential malformations, during 20 months [2003-04] in Dezyani hospital- a referal gynecology center in Gorgan, in north of Iran. The blood sample of 64 newborns with congenital malformations and their mothers collected. Serologic testes were done on newborns and mothers' sera to determine IgM and IgG levels against rubella, toxoplasma gondeie, Cytomegalo virus, Herpes simplex type II with ELISA test. For Terponema palidum PRP test was used. Four of 64 infants [6%] had positive IgM antibody titers for Toxoplasma, Rubella, and Cytomegalovirus. Nine of mothers with affected newborns [14%] had positive IgM antibody titers for Toxoplasma, Rubella, and Cytomegalovirus. This study showed that the prevalance of TORCH antibodies are observed in 6% of birth defects, in this region
Subject(s)
Humans , Congenital Abnormalities/immunology , Prevalence , Toxoplasmosis, Congenital/epidemiology , Syphilis, Congenital/epidemiology , Rubella/congenital , Cytomegalovirus Infections/congenital , Immunoglobulin G/blood , Immunoglobulin M/blood , Mothers , Enzyme-Linked Immunosorbent AssayABSTRACT
BACKGROUND & OBJECTIVE: Rubella virus (RV) is one of the leading causes of childhood blindness in India. In this study we applied an optimized nested reverse transcription polymerase chain reaction (nRT-PCR) to detect RV in clinical specimens. METHODS: nRT-PCR was optimized using total RNA extracted from standard strain of RV using nested sets of primers specific for E1 open reading frame. nRT-PCR was applied onto 30 lens aspirates and corresponding peripheral blood leucocytes of 30 infants with congenital (29)/ developmental (01) cataract. Serology for anti-RV IgG and IgM antibodies was done. RV isolation was attempted using Vero and SIRC cell cultures. RESULTS: Optimized nRT-PCR was specific for RV and sensitive to detect 10 fg of RV RNA. Among 30 patients, nRT-PCR detected presence of RV in lens aspirates of 6 (20%) and 4 corresponding leucocytes. RV was isolated from 3 (10%) lens aspirates (nRT-PCR positive) of the 30 patients. Sera of these 6 patients showed presence of anti-RV IgG and IgM in one, only anti-RV IgG in 3 others and none in the other two. Of the remaining 24 patients, anti-RV IgG was detected in 3 and no anti-RV IgM antibodies in others. INTERPRETATION & CONCLUSION: Findings of our study showed that the nRT-PCR was a more sensitive and rapid technique to detect RV from lens aspirates compared to conventional methods of virus isolation and serology.
Subject(s)
Animals , Cataract/congenital , Chlorocebus aethiops , Humans , Infant , Infant, Newborn , Polymerase Chain Reaction/methods , RNA, Viral/analysis , Reverse Transcriptase Polymerase Chain Reaction/methods , Rubella/congenital , Rubella virus/genetics , Vero CellsABSTRACT
Este trabalho aborda as possíveis alterações na dentição decídua de pacientes portadores de rubéola congênita com o relato de um caso clínico. O feto pode ser infectado pelo vírus da rubéola em qualquer estágio gestacional . Porém, as conseqüên-cias desta infecção fetal estão relacionadas ao período de gestação onde as oito primeiras semanas são as que mais ocasionam alterações de ordem geral e local, no caso, os dentes em formação...
Subject(s)
Mouth Diseases , Rubella virus , Rubella/congenital , Rubella/prevention & control , Tooth, DeciduousABSTRACT
OBJECTIVE: To determine the susceptibility to rubella infection in early pregnancy and the incidence of seropositivity of cord blood for rubella specific IgM among the newborn babies at Colombo South Teaching Hospital. METHODS: 1000 cord blood samples and 500 maternal blood samples from pregnant women before the 16th week of gestation were taken from the labour room and the antenatal clinic of the University Unit, Colombo South Teaching Hospital during the period of February 1999 to February 2001. These samples were tested for rubella specific IgM and IgG antibodies by ELISA. A detailed questionnaire was filled during the time of sampling. RESULTS: Of the 500 antenatal blood samples 82% were positive for rubella specific IgG. 373(75%) women gave a history of vaccination against rubella before their present pregnancy. Among the vaccinated 2(0.5%) were negative for IgG antibodies by ELISA. Out of 127 unvaccinated women 12(9%) gave a history of past infection with rubella and of this 3(25%) were seronegative for rubella specific IgG. 18% of pregnant women at 16 weeks of gestation were at risk of giving birth to a baby with congenital rubella syndrome. Among the tested 1000 cord blood samples three were seropositive (0.3%) for rubella specific IgM. CONCLUSIONS: A significant proportion of pregnant women were susceptible to rubella infection in the studied population. The present strategy of selective rubella vaccination should be reconsidered if we are to get closer to eliminating rubella syndrome in Sri Lanka.
Subject(s)
Adult , Disease Susceptibility , Female , Hospitals, Teaching , Humans , Immunoglobulin M/analysis , Infant, Newborn , Pregnancy , Pregnancy Complications, Infectious/epidemiology , Rubella/congenital , Seroepidemiologic Studies , Sri Lanka/epidemiologySubject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Malocclusion/congenital , Malocclusion/etiology , Malocclusion/genetics , Birth Injuries , Cerebral Palsy , Cleft Lip , Cleft Palate , Cleidocranial Dysplasia , Congenital Hypothyroidism , Macroglossia , Rubella/congenital , Rubella/etiology , Syphilis/classification , Syphilis/etiology , Syphilis/genetics , Down Syndrome/etiology , Down Syndrome/genetics , Torticollis , Temporomandibular Joint Disorders/etiology , Temporomandibular Joint Disorders/geneticsABSTRACT
Relatamos um caso de diagnostico pre-natal de rubeola congenita. Apos o nascimento, alem da confirmacao feita atraves do exame fisico e sorologico do recem-nascido, o virus tambem pode ser demonstrado no primeiro fluido aspirado da orofaringe do recem-nascido, utilizando-se a reacao em cadeia da polimerase (PCR). Sugerimos que este fluido (colhido rotineiramente no momento da reanimacao neonatal) possa ser utilizado na pesquisa de outros agentes infecciosos, que nao sao facilmente identificados por outros metodos
Subject(s)
Humans , Female , Pregnancy , Adult , Infant, Newborn , Polymerase Chain Reaction , Rubella/congenital , Prenatal Diagnosis , SuctionABSTRACT
Most of the theories attribute congenital cataract to hereditary, idiopathic metabolic and systemic diseases. In a trial to clarify the situation, 40 children presenting with cataract were studied. This work was designed to explain various etiological factors and to identify the common risk factors for its occurrence. Complete medical and ophthalmic evaluation in addition to laboratory investigation [rubella and toxoplasma IgG and IgM titer, aminogram, reducing substances in urine] were done. 80% of the cases had bilateral congenital cataract, while 20% had unilateral cataract. History of exposure to maternal infection was present in 30% of cases. 50% of cases had associated neurological abnormalities in the form of spastic diplegia, spastic paraplegia, cranial nerve affection and mental retardation. The study showed that the two commonest causative factors were familial cataract and congenital infection, especially rubella eye disease in the cases. Other metabolic diseases and perinatal risk factors, especially prematurity and anoxia, were of less importance. Most of these congenital cataracts were potentially remediable. Genetic cause through genetic counseling, congenital rubella infection through investigation of susceptible mothers and better care of preterm infants as well as good communication between ophthalmologist and the pediatrician is the appropriate way to reduce the number of cases
Subject(s)
Humans , Male , Female , Cataract/congenital , Rubella/congenital , Toxoplasmosis/pathology , Infant, Newborn, Diseases , Genetic Diseases, Inborn/complications , Blindness/etiology , Immunoglobulin G/urine , Immunoglobulin M/urine , Risk Factors , Toxoplasmosis, Congenital/pathologyABSTRACT
As doenças infecciosas sao a causa primária das alteraçöes auditivas. Dentre os agentes infecciosos de origem conhecida a rubéola se enquadra dentro das principais causas de surdez. Em mulheres com rubéola confirmada sorologicamente se a infecçäo fetal ocorrer no primeiro trimestre da gravidez os riscos de defeitos congênitos é de 85 por cento, sendo que mais de 50 por cento das crianças nascidas säo surdas. Nossos resultados säo semelhantes aos da literatura. A síndrome da rubéola congênita se caracteriza por apresentar surdez, anomalias congênitas do coraçäo e alteraçöes oculares. O diagnóstico da rubéola congênita foi realizado através de exames clínicos e sorológicos. A avaliaçäo audiológica se fez através de teste de screening, audiometria condicionada, impedanciometria e audiometria do tronco cerebral. Os autores salientam a importância de um programa de prevençäo da infecçäo uterina pela rubéola através da vacinaçäo.
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Hearing Loss/etiology , Rubella/congenital , Cataract/etiology , Speech Disorders/etiology , Cardiovascular Diseases/etiology , Gestational Age , Infant, Low Birth Weight , Rubella/complications , Strabismus/etiologyABSTRACT
Analisaram-se 1300 exames de Potencial Evocado, Auditivo. Classificaram-se os pacientes segundo faixa de idade, apresentaçäo clínica, relato de fatores de risco que levam a deficiência auditiva e limiar auditivo determinado pelo exame. Distribuíram-se os resultados em 5 faixas de limiar auditivo: audiçäo normal (até 25 dBHL); perda auditiva moderada (25-50 dBHL); perda acentuada (50-70 dBHL); perda severa (70-90 d BHL); e sem resposta ao estímulo auditivo. Estudaram-se os fatores de risco relativos a gestaçäo, parto e período neonatal, história familiar de deficiência auditiva, malformaçöes do aparelho auditivo de doenças infecciosas e uso de determinadas drogas. Investigaram-se também os itens Retardo do Desenvolvimento Neuropsicomotor, Paralisia Cerebral e os casos sem antecedentes conhecidos. Entre as conclusöes destacam-se" 82,8 por cento dos pacientes eram portadores de alguma forma de deficiência auditiva; o encaminhamento é tardio, evidenciado pelo fato de 54, 1 por cento dos pacientes situarem-se entre 1 e 3 anos de idade; 54,0 por cento da totalidade dos casos apresentaram -se sem linguagem; o fator de risco "Rubéola Congênita" possui incidência de 14,8 por cento, e este percentual distribuído nas faixas de limiar auditivo revelou um crescimento exponencial, demonstrando inequívoca e acentuada correlaçäo da moléstia com deficiência auditiva
Subject(s)
Humans , Infant, Newborn , Infant , Child, Preschool , Child , Auditory Threshold , Evoked Potentials, Auditory, Brain Stem , Hearing Loss, Sensorineural/diagnosis , Audiometry, Evoked Response , Hearing Loss, Sensorineural/etiology , Language Development , Risk Factors , Rubella/congenitalABSTRACT
Quarenta e uma crianças deficientes auditivas de 5 a 12 anos de idade, sendo que 21 delas foram acometidas por meningite do tipo bacteriano e 20 delas acometidas por rubéola materna, foram submetidas à avaliaçäo da funçäo vestibular. Na avaliaçäo vecto-electronistagmográfica, as crianças acometidas por meningite bacteriana apresentaram, com freqüência, ausência de respostas à prova rotatória decrescente e à prova calórica e as crianças acometidas por rubéola materna apresentaram reposta dentro dos padröes de normalidade em todas as provas
Subject(s)
Humans , Child, Preschool , Child , Electronystagmography , Meningitis, Bacterial/complications , Rubella/complications , Hearing Disorders/etiology , Rubella/congenitalABSTRACT
Two hundred and twenty five school going girls belonging to three districts of Hazara Division, Pakistan were sampled for rubella antibodies. Age range selected was 5 to 15 years. IgG was positive in 78.22% of cases and IgM in 24.44% of cases. The antibodies pattern and prevalence was the same in all the three districts. A clear increase of IgG was.seen up to the age of 11 years but between 12 and 15 years of age the increase of IgG was not very significant. This study reveals high prevalence of IgG [78.22%] up to the age of 15 years but still a very high figure of about 21.74% of girls remained susceptible to rubella at a critical period of child-bearing age [i.e. 15 years]. This is in contrast to the susceptible subjects of 1.1-4.2%in developed countries
Subject(s)
Humans , Female , Rubella Syndrome, Congenital/immunology , Rubella Vaccine/immunology , Rubella/congenitalABSTRACT
Las primeras vacunas utilizadas para uso generalizado fueron las elaboradas con las cepas HPV77 y la Cendehill en 1969. A partir de entonces diversas vacunas han estado disponibles en el mercado, pero la de uso más generalizado es la preparada con la cepa RA27/3 cultivada en células diploides humanas que es más inmunogénica y estimula tanto la producción de anticuerpos humorales como secretorios, todo ello sin que se presente un incremento de los efectos colaterales indeseables. La vacuna antirrubéolica existe en tres presentaciones: sola o asociada con otras, la viral doble (rubéola-sarampión) y la viral triple (rubéola-sarampión-parotiditis). En las tres formas la dosis es de 0.5 mL, se prepara en forma liofilizada y debe guardarse en refrigeración (entre 2§C y 8§C) antes de su reconstrucción. Una vez reconstruida debe aplicarse antes de ocho horas. En relación con la vacunación antirrubéolica, existen varias posibles estrategias. Las más importantes son: 1.No incluir a la vacuna contra la rubéola en los programas nacionales de vacunación. 2.Vacunar a todos los suceptibles mayores de un año de edad con énfasis en niños, adolescentes y mujeres adultas. 3.Vacunar a todas las niñas de 11 a 14 años de edad. Y 4.vacunar a grupos específicos: mujeres adultas rubéola-seronegativas, mujeres en el post-parto y personal médico y paramédico principalmente
Subject(s)
Rubella/complications , Rubella/congenital , Rubella/diagnosis , Rubella/epidemiology , Rubella/etiology , Rubella/history , Rubella/immunology , Rubella/pathology , Rubella/prevention & control , Rubella/transmission , Rubella Vaccine/administration & dosage , Rubella Vaccine/isolation & purification , Rubella Vaccine/analysis , Rubella Vaccine/classification , Rubella Vaccine/pharmacology , Rubella Vaccine/historyABSTRACT
Although rubella virus and cytomegalovirus (CMV) are important causes of congenital infections, information on their prevalence in our country is scarce. We studied a total of 249 infants suspected of having congenital infections from January 1988 to September 1989. Serum samples of these infants were tested for rubella and cytomegalovirus specific IgM antibodies by mucapture ELISA. Thirty (12%) infants were positive for rubella IgM antibody, and 50 (20%) had CMV specific IgM antibody. In the group presenting with hepatosplenomegaly (n = 56) rubella and CMV specific IgM antibodies were detected in 1 (1.7%) and 25 (44.6%) infants respectively. In the group presenting with congenital malformations (n = 90), 23 (25.5%) were positive for rubella, and only 9 (10%) had CMV IgM antibodies. Of the infants presenting with mental retardation (n = 39), only CMV infection was detected in 3 (7.7%) infants, whereas amongst the group showing intrauterine growth retardation (n = 16), 5 (31.25%) had CMV specific IgM antibodies and 2 (12.5%) had rubella specific IgM antibodies. In the miscellaneous group (n = 48), 4 (8.3%) and 8 (16.6%) infants had rubella and CMV IgM antibodies respectively. CMV infection was prevalent in a significantly higher number of children with hepatosplenomegaly than rubella while in infants with congenital malformations a significantly higher number had rubella infection. It is concluded that rubella and CMV infections are commonly seen in children with intrauterine infections in our population.
Subject(s)
Antibodies, Viral/analysis , Cytomegalovirus/immunology , Cytomegalovirus Infections/congenital , Humans , India/epidemiology , Infant , Infant, Newborn , Prevalence , Rubella/congenital , Rubella virus/immunologyABSTRACT
Rubeola es una enfermedad viral autolimitada. Su más temida sequela es el síndrome de Rubeola Congenito. La llegada de la vacuna de rubeola la ha hecho posible la erradicación del Síndrome de Rubeola Congénito. Son necesarios los siguientes datos para determinar la amenaza de nuevos casos del Síndrome de Rubeola Congénito; la incidencia de rubeola, la incidencia del Síndrome de Rubeola Congénito y el porciento de la población inmune a rubeola. Estas estadísticas no estan disponibles en Puerto Rico. Este estudio fue diseñado para determinar el porciento de mujeres susceptibles a rubeola de dos clínicas de cuidado prenatal. Se hizo una correlación contra el historial dado por las pacientes y los resultados de las pruebas serológicas hechas para determinar la inmundad a rubeola. El porciento de mujeres suscetibles a rubeola en este aestudio es más alto que en estudios similares hechos en los Estados Unidos. La correlación entre los resultados de las pruebas serológicas y el historial dado por las pacientes fue muy pobre. Esto indica que todos los médicos primarios deben evaluar el status de inmunidad a rubeola de sus pacientes femeninas y/o vacunadas contra rubeola
Subject(s)
Prenatal Care , Rubella/immunology , Age Factors , Antibodies, Viral/blood , Disease Susceptibility/epidemiology , Disease Susceptibility/immunology , Prevalence , Puerto Rico/epidemiology , Rubella/congenital , Rubella/prevention & control , Rubella virus/immunologyABSTRACT
26 temporal bones from patients with neonatal infections [viraemia osepticaemia] were examined. In cases with viraemia, a primary affection of the Stria Vascularis from settlement of the virus was found, Consequent alteration in the endolymph with affection of the organ of Corti and ganglion cells occurred. In cases with septicaemia there was a primary affection in the spiral ganglion cells with normal organ of Corti proving a spread from a CNS affection via the internal auditory meatus and cochlear duct
Subject(s)
Humans , Infant, Newborn , Hearing Loss/etiology , Rubella/congenitalABSTRACT
Se evaluaron epidemiológica y clínicamente 25 casos de Embriopatía Rubeóla (E.R.) y sus respectivas madres que consultaron en el período comprendido entre octubre de 1980 y diciembre del 1985, encontrándose que 44% de las embarazadas no presentaron síntomas de la enfermedad, por lo que no tienen opción del aborto terapéutico, justificándose una vez más la prevención por vacunación como la mejor alternativa. El período de infección epidémica fue notorio en los años 1980-1981, no presentándose ningún caso en el 1982 y 1983, para reaparecer en los años 1984-1985, lo que implica que hubo un receso de la epidemia. La mayor frecuencia de los casos se presentó durante los meses de primavera a verano. Las manifestaciones fenotípicas como cara alargada, aletas nasales hipoplásicas, labios finos, estuvieron presentes en la mayoría de los pacientes, por lo que son de utilidad en el diagnóstico, además de la triada clásicamente descrita de cataratas, cardiopatía y deficiencia auditiva