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.

Clinical presentation of neonatal malaria

To study the prevalence, clinical presentation and laboratory findings in neonates suffering from malaria. Paediatrics Unit-I Bahawal Victoria Hospital, Bahawalpur from April 2006 to March 2008. Neonates with negative blood culture but positive slides for malarial parasites were included. The prevalence rate of neonatal malaria was 3.06%. 54% cases were due to plasmodium falciparum and 40% were due to plasmodium vivax while in 6% cases species could not be identified. The male to female ratio was 1.5:1. 46% cases presented within 7 days of birth. 80% cases were born by spontaneous vaginal delivery, 16% by spontaneous vaginal delivery with episiotomy while 4% by Cesarean section. Fever was present in 100%, hypothermia on examination in 4%, splenomegaly in 24%, hepatomegaly in 28%, jaundice in 30%, irritability in 52%, reluctant to feed in 8%, vomiting in 48%, cough in 8%, diarrhea in 50%, abdominal distension in 8%, seizures in 8%, apnoea in 4%, lethargy in 24%, respiratory distress in 28%, bloody stool in 4%, leucopenia in 6%, anemia in 40%, thrombocytopenia in 6% and hypoglycemia in 10% cases. There was no statistically significant difference in the clinical features or laboratory findings of malaria due to both the species. Neonatal malaria is, although, uncommon but resembles to that of neonatal sepsis and clinical presentation of malaria due to falciparum or vivax is same

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.