TORCH panel

TORCH panel

TORCH antibody panel Pediatrics A serologic screen for diagnosing prenatal infection; the finding of ↑ IgM in the neonate implies in utero infection by one of the TORCH agents–toxoplasma, rubella, CMV, herpes simplex, which is then characterized by measuring specific IgM levels.

TORCH agents  

Toxoplasmosis may cause periventricular microglial nodules, thrombosis and necrosis; obstruction of cerebral foramina causes hydrocephalus; with prolonged survival, there is intracranial calcification, hepatocellular, adrenal, pulmonary, cardiac necrosis and extramedullary hematopoiesis

Rubella may cause LBW, hepatosplenomegaly, petechiae and purpura, congenital heart disease, cataracts, microophthalmia and microcephaly; CNS symptoms include lethargy, irritability, dystonia, bulging fontanelles and seizures. Cf Congenital rubella syndrome.

Cytomegalovirus may cause hepatosplenomegaly, hyperbilirubinemia, neonatal thrombocytopenia, microcephaly and a mortality of 20-30%; later manifestations include mental retardation, deafness, psychomotor delays, dysodontogenesis, chorioretinitis, learning disabilities; ± 33 000 congenital cases/year–US, of which 10% are symptomatic

Herpes simplex may cause prematurity, and becomes symptomatic after the first week of life; CNS symptoms include irritability, seizures, chorioretinitis, hydrocephalus, flaccid or spastic paralysis, opisthotonos, decerebrate rigidity and coma; in neonatal HSV infection, no deaths occur in those with localized disease, 15% die if encephalitis is present and 57% die if HSV is disseminated, potentially evoking DIC NEJM 1991; 324:450

Syphilis–an optional 'TORCH' Congenital syphilis has ↑ to epidemic rates in the urban US since the mid-1980s; the clinical findings are nonspecific and include fever, lethargy, failure to thrive, and irritability