TORCH is: refers to pathogens that can cause congenital intrauterine infections and perinatal infections resulting in perinatal malformations, it is the abbreviation of the English name of a group of pathogenic microorganisms, of which T(Toxopasma) is Toxoplasma gondii, R(Rubella.Virus) is rubella virus, C(Cytomegalo.Virus) is cytomegalo, H(Herpes. Virus) is herpes simplex type I/II.
1. Basic introduction
This group of microbial infections share common features, i.e., they can cause mother-infant infections. Pregnant women are prone to primary infections due to endocrine changes and decreased immunity, and potential viruses in previously infected pregnant women are also prone to recurrent infections due to activation. When viraemia occurs in pregnant women, the virus can spread through the placenta or birth canal and infect the fetus, causing premature birth, miscarriage, stillbirth or malformation, as well as causing damage to multiple systems and organs in the newborn, resulting in various degrees of mental retardation and other symptoms. Especially in the first trimester of pregnancy, when the embryo is in the organogenesis stage, infection by virus can destroy cells or inhibit cell division and proliferation. TORCH infection affects the quality of the population and has an important relationship with eugenics.
2.Infection of TORCH
Toxoplasma gondii (TOX):
Fetal malformations caused by Toxoplasma gondii infection in early pregnancy mainly include: hydrocephalus, microcephaly, chorioretinitis and cerebral calcification. Bloodstream infection can cause fetal multi-organ necrotic damage, such as hepatosplenomegaly, myocarditis and thrombocytopenia.
Rubella virus (RV).
RV is mainly transmitted through the respiratory tract and can cause fetal teratogenicity in pregnant women. The virus infects the fetus through the placenta to form a congenital infection called congenital rubella syndrome (CRS), mainly congenital cataracts, congenital heart disease and neurological deafness, with little effect in those infected after 20 weeks. The earlier the rubella infection occurs in pregnancy, the more severe the teratogenicity of the fetus.
Cytomegalovirus (CMV):
Infection can cause intrauterine fetal growth retardation, microcephaly, encephalitis, retinal chorioretinitis, jaundice, hepatosplenomegaly, hemolytic anemia, etc. The neonatal mortality rate is high, and the CMV infection rate due to perinatal breast milk detoxification is 63%.
Herpes simplex virus (HSVI, type II).
HSV is usually latent in the ganglia. Physiological changes in the mother during pregnancy activate HSV, and infection in early pregnancy can destroy the germinal surface leading to miscarriage, and in mid- and late pregnancy can cause fetal and neonatal morbidity, although few malformations occur.
3, TORCH test significance
Patients with TORCH syndrome cause miscarriage and stillbirth in pregnant women, and after birth, they have serious intellectual disabilities and cannot take care of themselves, causing great mental and economic burdens. There are about 26,000 children born with TORCH in China every year, an average of 3 people per hour, posing a great threat to eugenics and population quality, so its infection diagnosis and treatment work has attracted widespread attention.
TORCH infection is one of the most important factors that seriously endanger the health of newborns. It can lead to multi-organ damage and a series of serious sequelae taunt. Therefore, in order to reduce the birth rate of sick and disabled children and
To improve the quality of the birth population, clinical workers should further strengthen the publicity and education for pregnant women and actively do serological screening for TORCH infection in order to detect adverse pregnancies early and deal with them in a timely manner. Newborns should also be routinely tested for
Serological screening for TORCH infection is of great practical importance for eugenics, and should be routinely performed in clinical settings.
TORCH testing should be carried out routinely in clinical practice.
4.Methods of TORCH detection
At present, the most convenient and commonly used early screening method in China is to use ELISA enzyme immunoassay diagnostic technique. ELISA enzyme immunoassay test method is to detect specific IgM and IgG antibodies in human serum, because IgM is an early infection indicator and has great impact on the fetus, so the detection of IgM is of great concern. ELISA reagents are widely used in general laboratories because of their stability, high sensitivity, specificity and low cost, but they are generally used for qualitative and not quantitative purposes.
Currently, the quantitative assay is performed by chemiluminescence. The methodological evaluation shows that the chemiluminescence CLIA assay has high sensitivity, low intra- and inter-batch variability, and good anti-interference ability, which can remove the possible interference of viral IgG antibodies as well as rheumatoid factor in the specimen and is suitable for routine clinical work.
Understanding the TORCH serology report card
After TORCH infection, patient-specific antibodies IgM and IgG can rise rapidly, with IgM appearing early and lasting 6-12 weeks, and IgG appearing late but lasting a lifetime. Therefore, we often regard IgG positivity as a previous infection, while IgM positivity is used as a diagnostic indicator for the first infection.
1. IgG-positive IgM-negative
If the baby has been infected with this virus before or has been vaccinated and has developed immunity, it is very unlikely that the baby will be infected.
2.IgG-negative IgM-negative
indicates that the pregnant woman is a susceptible person. It is best to repeat the IgG test during pregnancy to observe whether there is a positive turn.
3.IgG-positive IgM-positive
It indicates that the pregnant woman may be primary infected or reinfected. It can be identified by IgG affinity test.
4.IgG-negative IgM-positive
Recent infection or acute infection; may also be false positive IgM caused by other interfering factors. Need to recheck after 2 weeks, such as IgG positive turn, for acute infection, otherwise judged as false positive.
5, the processing of various TORCH test results
1.Herpes simplex virus infection
Hazards: Infection in early pregnancy can cause miscarriage or fetal malformation. Its teratogenic effect is weaker than cytomegalovirus infection. Common malformations include eye malformations (such as small eyes, one-eyed, cataracts and optic papillary atrophy), neurological defects (such as cortical atrophy and dementia) and bone and skin damage.
Treatment: If the serum herpes simplex virus is IgM antibody-positive, clearing and detoxifying herbs (e.g. Panax notoginseng) can be used to inhibit the proliferation of the virus and control the infection. Since the chance of the fetus being affected is small, it is usually not necessary to terminate the pregnancy. In principle, cesarean delivery is performed during delivery; even if the lesion has been cured, cesarean delivery is still preferable if the first infection has occurred for less than one month.
2.Rubella infection
Hazards: Rubella virus infection in early pregnancy can infect the fetus through the placenta, causing miscarriage, intrauterine growth retardation and congenital rubella syndrome (CRS).
Congenital rubella syndrome is a syndrome of fetal malformations caused by rubella virus infection. It mainly includes eye malformations (such as congenital cataract, microphthalmia, strabismus), small head size, congenital heart disease, deafness, cleft palate, short and parallel fingers, hypospadias and hemolytic anemia. The earlier a pregnant woman is infected with rubella, the higher the incidence of fetal malformations and the more severe the malformations.
Treatment: Rubella infection (positive serum IgM antibody) in early pregnancy has a high probability of leading to malformed development of the fetus, and the pregnant mother should terminate the pregnancy. If the infection occurs in the middle and late stages of pregnancy, prenatal diagnosis should be conducted to exclude the fetal baby from infection before continuing the pregnancy.
3.Toxoplasma gondii infection
Hazards: Fetal malformations caused by Toxoplasma gondii infection in early pregnancy mainly include hydrocephalus, microcephaly, chorioretinitis and cerebral calcification. Bloodstream infection can cause fetal multi-organ necrotic damage, such as hepatosplenomegaly, myocarditis and thrombocytopenia. Asymptomatic infections can cause intrauterine growth retardation and preterm delivery. Infection in late pregnancy usually does not cause fetal developmental abnormalities.
Treatment: Early pregnancy should be actively tested for Toxoplasma gondii antibodies, and acute infection should be treated with anthelmintic therapy as soon as possible according to medical advice. For early and mid-term pregnancies (within 24 weeks) with positive IgM antibodies to Toxoplasma gondii, abortion or medication should be given to reduce the occurrence of intrauterine fetal infection.
4. Cytomegalovirus infection
Hazards: Infection in early pregnancy can cause miscarriage and fetal death; infection in middle and late pregnancy section causes fetal jaundice, hepatosplenomegaly, cerebellar malformation, hydrocephalus, cerebral softening, cataract, cytomegalovirus pneumonia, congenital heart disease, cleft lip and palate.
Treatment: [1] Cytomegalovirus, such as positive serum antibody IgM or IgG, all indicate that the pregnant woman has been infected. Generally, those infected in early pregnancy can terminate the pregnancy immediately or wait until 16-20 weeks of gestation to draw amniotic fluid (or umbilical cord blood) IgM for prenatal diagnosis to find out whether the baby is congenitally infected. If the infection is confirmed, the pregnancy should be terminated at the appropriate time.
The majority of cytomegalovirus infections in pregnant women are subclinical and generally do not require special treatment. Even if intrauterine cytomegalovirus infection is detected by prenatal diagnosis, drug treatment is not recommended because it does not change the condition of the baby. Antiviral therapy (which only works to treat the pregnant mother) is only considered if she is immunocompromised and shows symptoms of cytomegalovirus overt infection. The drug currently considered more effective is ganciclovir. If it is already late in pregnancy and cytomegalovirus is isolated from the cervical canal, special treatment is usually not necessary and vaginal delivery may be allowed, as the fetal baby may already be infected in utero. As cytomegalovirus may be present in the newborn’s urine, used diapers should be disinfected or disposable diapers should be used.
6.TORCH and jaundice
TORCH infection is one of the important etiologies of neonatal hyperbilirubinemia. In neonatal hyperbilirubinemia cases, children with TORCH infection have no obvious clinical symptoms at birth and first show jaundice, and the duration of jaundice in the TORCH-infected group is significantly longer than that in the non-TORCH-infected group. TORCH infection has a certain incidence in neonatal hyperbilirubinemia and is one of the important causes of neonatal hyperbilirubinemia.
In order to improve eugenics, it is the effort of physicians to accurately diagnose the presence and extent of TORCH infection before the birth of a newborn, therefore, attention should be paid to prenatal screening for TORCH infection, while routine screening should be performed in neonatal jaundice.
7. Prevention and treatment measures need to be improved
So far, various preventive measures for intrauterine infections are not very well developed. For cytomegalovirus infection, high-valent immunoglobulin and inactivated vaccines are ineffective, and there are still difficulties in the application of live attenuated vaccines; for herpes simplex virus and toxoplasma infection, these two vaccines are under development; for rubella virus infection only, live attenuated rubella vaccine is available and can be given once to girls aged 15 months to 12 years, but cannot be used in pregnant women.
Therefore, the prevention of TORCH infection should focus on personal hygiene and protection of pregnant women.
protection. For example, pregnant women should avoid contact with TORCH patients and animals during pregnancy; do not consume undercooked meat, and do not eat raw meat; wear gloves when touching raw meat and handling cat or dog feces.
At least wash your hands carefully and repeatedly afterwards; feed cooked food to domestic cats and dogs. In addition, it is important to screen pregnant women for prenatal TORCH infection. If the infection is found in early pregnancy, termination of pregnancy may be considered; pregnant women with syphilis and toxoplasmosis should be treated; pregnant women with cytomegalovirus and herpes simplex virus infection in the reproductive tract should be delivered by cesarean section.
Regarding the treatment of intrauterine infection, in addition to general supportive treatment and enhanced care for the child, herpes simplex virus infection can be treated with acyclic guanosine, propoxyphene or adenosine, but there are certain toxic side effects; for congenital melioidosis, penicillin can be used for treatment, and if penicillin allergy can be changed to vincristine; for toxoplasmosis, sulfadiazine, ethidiazine or spiramycin can be used for treatment; all the above diseases should be treated under the All these diseases should be treated under the guidance of an experienced physician.
It is important to note that even uninfected infants in utero can be infected through the hands, droplets, utensils, clothing, or even the mother’s milk or blood transfusion. Therefore, health care workers should be better managed and transferred out of their positions as soon as they are found to be carriers of the virus. Blood transfusion workers should be screened for TORCH infection to eliminate blood-borne infections. Lactating mothers whose milk is found to contain the virus should stop breastfeeding.
8.Social significance of TORCH
From the perspective of eugenics, it is necessary to conduct TORCH-specific antibody screening for pre-pregnant women and regular monitoring of IgM-positive women, especially those with a history of pet keeping or contact or other exposure should undergo TORCH-specific antibody screening 3-5 months before planned pregnancy, and RV-IgG-negative patients should be vaccinated in time to obtain immunity, and TORCH- IgM-positive patients should delay the planned gestation period to avoid possible acute infection stage. If available, the appropriate TORCH-specific antibody test should be repeated between the first and third month of pregnancy.