In this lecture, I’m going to discuss
congenital infections of the infant.
So we often call these TORCH infections.
TORCH, the letters stand
for the diseases.
T is toxoplasmosis.
O is unfortunately other, which includes
syphilis, parvovirus, HIV, varicella.
R is rubella.
C is cytomegalovirus or CMV.
And H is herpes simplex virus or HSV.
I want to go through these
infections one at a time.
So let’s start with toxoplasmosis.
Toxoplasmosis is caused by a parasite,
Toxoplasma gondii, that’s found in animals.
In particular, you can find
it in cat litter of cats,
especially cat litter that’s
been out for more than 24 hours.
And you may find raw or
undercooked meat especially beef.
It’s mom’s first infection
that confers risk.
So it should be her first
infection during pregnancy.
Sometimes, patients will be tested for toxo
in that they’ll be checked to see if they
have antibodies already formed against toxo
and if they do, they’re at lower
risk conferring this to a child.
It’s the women who are not immune to toxo
who get it first during pregnancy
that can confer a risk to their infant.
Also, in immunocompromised parents,
they may have a reactivation
of their latent toxo infection
and that can also confer a risk.
So, it’s the first
infection during pregnancy
or a reactivation in an immunocompromised
mother that confers risk of toxo.
Toxo can present with a variety of
symptoms including hydrocephalus,
This is one of the few congenital
infections that causes microcephaly.
So keep that one in mind and the
calcifications we see commonly.
So if we suspect toxoplasmosis,
we generally would diagnose it by
getting serology, serologic testing.
And we would treat it in the
infant with medications
similar to what we treat
in older people with toxo,
which is pyrimethamine,
sulfadiazine, and leucovorin.
Sadly, the drug company that
was making pyrimethamine
was bought out by
another drug company.
And so now, the cost of pyrimethamine
went from what is 2 cents in say Brazil
to $750 per pill.
This was purely a profit move.
So now, the cost of management
of toxoplasmosis and treatment,
which is a long term cost, is
as much a $75,000 a month.
So toxoplasmosis prevention is what’s key.
Pregnant women should be tested if there’s
a concern for risk of toxoplasmosis.
And pregnant women should
avoid uncooked meat.
So steak tartare is
forbidden during pregnancy.
Additionally, we recommend that
pregnant women should change their
cat litter at least daily
or have someone else do it.
It takes a day for the
form of the toxoplasmosis
to become effective while
outside of the cat’s body.
So rapid or frequent changing
of kitty litter should be okay.
Let’s move on to syphilis.
Syphilis is caused by the
spirochete, Treponema pallidum.
In the United States, we are having
currently a rising epidemic of syphilis.
The highest transmission to the fetus is
if the mother has secondary syphilis.
Primary syphilis is less likely
to transfer, but it still can.
So if a mother has secondary
syphilis, we worry about that baby.
The baby can present with
a variety of symptoms.
They may be asymptomatic or they
may be dead on presentations.
So stillbirth is possible,
but also, more than 60% will be
completed asymptomatic at birth.
But watch out, they may later present with a
second or a third staged disease syphilis.
So a child may be
asymptomatic at birth,
and then at few years of age,
develops secondary syphilis.
So early findings in syphilis
lymphadenopathy, rash, a
rhinitis or syphilitic snuffles,
or they may have metaphyseal
lucencies on radiography.
That can be a classic x-ray finding.
Later findings include Hutchinson
teeth, which are notched teeth.
Hearing loss, a saddle
or Saber shins, which are sharpened
shins in the front from hematopoiesis.
Or they may also get