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TORCH Infections, Overview
Surjith Vattoth, MD, FRCR; Gary L. Hedlund, DO
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Synonyms

                • TORCH(S), (S)TORCH
              • Definitions

                • TORCH infection characteristics
                  • Vertical transmission from infected mother to fetus
                    • Transplacental mainly or via birth vaginal canal in few
                  • Mostly only mild maternal illness
                  • May cause severe fetal anomalies
                  • Treating maternal infection does not significantly affect fetal prognosis
                • Toxoplasmosis (toxo): Toxoplasma gondii; other agents: Varicella zoster, syphilis, parvovirus B19; rubella: Rubella virus; cytomegalovirus (CMV): Most common TORCH infection; herpes: HSV type 2 (HSV-2)
                • Acronym TORCH 1st suggested in 1971 by Nahmias et al to denote toxoplasmosis, rubella, CMV, & HSV 1/2, not easily distinguishable clinically
                • Researchers later used "O" to denote "other infections"
                • Recent opinions to include Zika virus in TORCH infections

              IMAGING

              • General Features

                • CT Findings

                  • MR Findings

                    • Ultrasonographic Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Gross Pathologic & Surgical Features

                              • Microscopic Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      • Treatment

                                        DIAGNOSTIC CHECKLIST

                                        • Consider

                                          • Image Interpretation Pearls

                                            Selected References

                                            1. Kumar G et al: Microcephaly and intracranial calcifications: not always TORCH infection! J Paediatr Child Health. 55(8):1000-1, 2019
                                            2. Lockrow J et al: Epileptic spasms as the presenting seizure type in a patient with a new "O" of TORCH, congenital Zika virus infection. Epilepsy Behav Case Rep. 11:1-3, 2019
                                            3. Wang Y et al: The association of ToRCH infection and congenital malformations: a prospective study in China. Eur J Obstet Gynecol Reprod Biol. 240:336-40, 2019
                                            4. Coyne CB et al: Zika virus - reigniting the TORCH. Nat Rev Microbiol. 14(11):707-15, 2016
                                            5. Bajaj M et al: Clinical and neuroimaging findings in neonatal herpes simplex virus infection. J Pediatr. 165(2):404-7.e1, 2014
                                            6. Bale JF Jr: Congenital cytomegalovirus infection. Handb Clin Neurol. 123:319-26, 2014
                                            7. Wilson MR et al: Diseases of the central nervous system caused by lymphocytic choriomeningitis virus and other arenaviruses. Handb Clin Neurol. 123:671-81, 2014
                                            8. Anderson JL et al: Congenital lymphocytic choriomeningitis virus: when to consider the diagnosis. J Child Neurol. 29(6):837-42, 2013
                                            9. Nickerson JP et al: Neuroimaging of pediatric intracranial infection--part 2: TORCH, viral, fungal, and parasitic infections. J Neuroimaging. 22(2):e52-63, 2012
                                            10. Parmar H et al: Pediatric intracranial infections. Neuroimaging Clin N Am. 22(4):707-25, 2012
                                            11. Kulkarni AM et al: Fetal intracranial calcification: pseudo-TORCH phenotype and discussion of related phenotypes. Am J Med Genet A. 152A(4):930-7, 2010
                                            12. Briggs TA et al: Band-like intracranial calcification with simplified gyration and polymicrogyria: a distinct "pseudo-TORCH" phenotype. Am J Med Genet A. 146A(24):3173-80, 2008
                                            13. Sanchis A et al: Genetic syndromes mimic congenital infections. J Pediatr. 146(5):701-5, 2005
                                            14. de Vries LS et al: The spectrum of cranial ultrasound and magnetic resonance imaging abnormalities in congenital cytomegalovirus infection. Neuropediatrics. 35(2):113-9, 2004
                                            15. Jones J et al: Congenital toxoplasmosis. Am Fam Physician. 67(10):2131-8, 2003
                                            16. Bale JF Jr: Congenital infections. Neurol Clin. 20(4):1039-60, vii, 2002
                                            Related Anatomy
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                                            Related Differential Diagnoses
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                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Terminology

                                              • Imaging

                                                • Top Differential Diagnoses

                                                  • Pathology

                                                    • Clinical Issues

                                                      • Diagnostic Checklist

                                                        TERMINOLOGY

                                                        • Synonyms

                                                          • TORCH(S), (S)TORCH
                                                        • Definitions

                                                          • TORCH infection characteristics
                                                            • Vertical transmission from infected mother to fetus
                                                              • Transplacental mainly or via birth vaginal canal in few
                                                            • Mostly only mild maternal illness
                                                            • May cause severe fetal anomalies
                                                            • Treating maternal infection does not significantly affect fetal prognosis
                                                          • Toxoplasmosis (toxo): Toxoplasma gondii; other agents: Varicella zoster, syphilis, parvovirus B19; rubella: Rubella virus; cytomegalovirus (CMV): Most common TORCH infection; herpes: HSV type 2 (HSV-2)
                                                          • Acronym TORCH 1st suggested in 1971 by Nahmias et al to denote toxoplasmosis, rubella, CMV, & HSV 1/2, not easily distinguishable clinically
                                                          • Researchers later used "O" to denote "other infections"
                                                          • Recent opinions to include Zika virus in TORCH infections

                                                        IMAGING

                                                        • General Features

                                                          • CT Findings

                                                            • MR Findings

                                                              • Ultrasonographic Findings

                                                                • Imaging Recommendations

                                                                  DIFFERENTIAL DIAGNOSIS

                                                                    PATHOLOGY

                                                                    • General Features

                                                                      • Gross Pathologic & Surgical Features

                                                                        • Microscopic Features

                                                                          CLINICAL ISSUES

                                                                          • Presentation

                                                                            • Demographics

                                                                              • Natural History & Prognosis

                                                                                • Treatment

                                                                                  DIAGNOSTIC CHECKLIST

                                                                                  • Consider

                                                                                    • Image Interpretation Pearls

                                                                                      Selected References

                                                                                      1. Kumar G et al: Microcephaly and intracranial calcifications: not always TORCH infection! J Paediatr Child Health. 55(8):1000-1, 2019
                                                                                      2. Lockrow J et al: Epileptic spasms as the presenting seizure type in a patient with a new "O" of TORCH, congenital Zika virus infection. Epilepsy Behav Case Rep. 11:1-3, 2019
                                                                                      3. Wang Y et al: The association of ToRCH infection and congenital malformations: a prospective study in China. Eur J Obstet Gynecol Reprod Biol. 240:336-40, 2019
                                                                                      4. Coyne CB et al: Zika virus - reigniting the TORCH. Nat Rev Microbiol. 14(11):707-15, 2016
                                                                                      5. Bajaj M et al: Clinical and neuroimaging findings in neonatal herpes simplex virus infection. J Pediatr. 165(2):404-7.e1, 2014
                                                                                      6. Bale JF Jr: Congenital cytomegalovirus infection. Handb Clin Neurol. 123:319-26, 2014
                                                                                      7. Wilson MR et al: Diseases of the central nervous system caused by lymphocytic choriomeningitis virus and other arenaviruses. Handb Clin Neurol. 123:671-81, 2014
                                                                                      8. Anderson JL et al: Congenital lymphocytic choriomeningitis virus: when to consider the diagnosis. J Child Neurol. 29(6):837-42, 2013
                                                                                      9. Nickerson JP et al: Neuroimaging of pediatric intracranial infection--part 2: TORCH, viral, fungal, and parasitic infections. J Neuroimaging. 22(2):e52-63, 2012
                                                                                      10. Parmar H et al: Pediatric intracranial infections. Neuroimaging Clin N Am. 22(4):707-25, 2012
                                                                                      11. Kulkarni AM et al: Fetal intracranial calcification: pseudo-TORCH phenotype and discussion of related phenotypes. Am J Med Genet A. 152A(4):930-7, 2010
                                                                                      12. Briggs TA et al: Band-like intracranial calcification with simplified gyration and polymicrogyria: a distinct "pseudo-TORCH" phenotype. Am J Med Genet A. 146A(24):3173-80, 2008
                                                                                      13. Sanchis A et al: Genetic syndromes mimic congenital infections. J Pediatr. 146(5):701-5, 2005
                                                                                      14. de Vries LS et al: The spectrum of cranial ultrasound and magnetic resonance imaging abnormalities in congenital cytomegalovirus infection. Neuropediatrics. 35(2):113-9, 2004
                                                                                      15. Jones J et al: Congenital toxoplasmosis. Am Fam Physician. 67(10):2131-8, 2003
                                                                                      16. Bale JF Jr: Congenital infections. Neurol Clin. 20(4):1039-60, vii, 2002