The Indian Journal of Pediatrics

, Volume 78, Issue 1, pp 88–95 | Cite as

Congenital and Perinatal Infections: Throwing New Light with an Old TORCH

  • Anita Shet
Symposium on Infections Old and New


Infections acquired in utero or in the immediate post-natal period play a prominent role in perinatal and childhood morbidity. The TORCH constellation continues to be popular among perinatologists and paediatricians, although its limitations are increasingly known. A host of new organisms are now considered to be perpetrators of congenital and perinatal infections, and a diverse range of diagnostic tests are now available for confirming infection in the infant. In general, the collective TORCH serological panel has low diagnostic yield; instead individual tests ordered according to clinical presentation can contribute better towards appropriate diagnosis. This review captures the essence of established congenital infections such as cytomegalovirus, rubella, toxoplasmosis, syphilis and herpes simplex virus, as well as more recent entrants such as HIV and hepatitis B infection, varicella and tuberculosis. Selective screening of the mother and newborn, encouraging good personal hygiene and universal immunization are some measures that can contribute towards decreasing the incidence and morbidity of congenital and perinatal infections.


Congenital infections Perinatal TORCH Infants 


Conflict of Interest


Role of Funding Source



  1. 1.
    Nahmias A, Walls K, Stewart J, Hermann K, Flynt W. The ToRCH complex-perinatal infections associated with toxoplasma and rubella, cytomegol-and herpes simplex viruses. Ped Research. 1971;5(8):405.Google Scholar
  2. 2.
    Epps RE, Pittelkow MR, Su WP. TORCH syndrome. Semin Dermatol. 1995;14(2):179–86.CrossRefPubMedGoogle Scholar
  3. 3.
    Greenough A. The TORCH screen and intrauterine infections. Arch Dis Child Fetal Neonatal Ed. 1994;70(3):F163–5.CrossRefPubMedGoogle Scholar
  4. 4.
    Stagno S, Pass RF, Dworsky ME, et al. Congenital cytomegalovirus infection: the relative importance of primary and recurrent maternal infection. N Engl J Med. 1982;306(16):945–9.CrossRefPubMedGoogle Scholar
  5. 5.
    Boppana SB, Pass RF, Britt WJ. Virus-specific antibody responses in mothers and their newborn infants with asymptomatic congenital cytomegalovirus infections. J Infect Dis. 1993;167(1):72–7.PubMedGoogle Scholar
  6. 6.
    Deorari AK, Broor S, Maitreyi RS, et al. Incidence, clinical spectrum, and outcome of intrauterine infections in neonates. J Trop Pediatr. 2000;46(3):155–9.CrossRefPubMedGoogle Scholar
  7. 7.
    Dar L, Pati SK, Patro AR, et al. Congenital cytomegalovirus infection in a highly seropositive semi-urban population in India. Pediatr Infect Dis J. 2008;27(9):841–3.CrossRefPubMedGoogle Scholar
  8. 8.
    Kylat RI, Kelly EN, Ford-Jones EL. Clinical findings and adverse outcome in neonates with symptomatic congenital cytomegalovirus (SCCMV) infection. Eur J Pediatr. 2006;165(11):773–8.CrossRefPubMedGoogle Scholar
  9. 9.
    Vauloup-Fellous C, Ducroux A, Couloigner V, et al. Evaluation of cytomegalovirus (CMV) DNA quantification in dried blood spots: retrospective study of CMV congenital infection. J Clin Microbiol. 2007;45(11):3804–6.CrossRefPubMedGoogle Scholar
  10. 10.
    Kimberlin DW, Lin CY, Sanchez PJ, et al. Effect of ganciclovir therapy on hearing in symptomatic congenital cytomegalovirus disease involving the central nervous system: a randomized, controlled trial. J Pediatr. 2003;143(1):16–25.CrossRefPubMedGoogle Scholar
  11. 11.
    Pass RF, Zhang C, Evans A, et al. Vaccine prevention of maternal cytomegalovirus infection. N Engl J Med. 2009;360(12):1191–9.CrossRefPubMedGoogle Scholar
  12. 12.
    Gregg M. Congenital cataract following German measles in mother. Trans Ophthalmol Soc Aust. 1941;3:35–46.Google Scholar
  13. 13.
    Cutts FT, Robertson SE, Diaz-Ortega JL, Samuel R. Control of rubella and congenital rubella syndrome (CRS) in developing countries, Part 1: burden of disease from CRS. Bull World Health Organ. 1997;75(1):55–68.PubMedGoogle Scholar
  14. 14.
    Broor S, Kapil A, Kishore J, Seth P. Prevalence of rubella virus and cytomegalovirus infections in suspected cases of congenital infections. Indian J Pediatr. 1991;58(1):75–8.CrossRefPubMedGoogle Scholar
  15. 15.
    Peckham CS. Clinical and laboratory study of children exposed in utero to maternal rubella. Arch Dis Child. 1972;47(254):571–7.CrossRefPubMedGoogle Scholar
  16. 16.
    Banatvala JE, Brown DW. Rubella. Lancet. 2004;363(9415):1127–37.CrossRefPubMedGoogle Scholar
  17. 17.
    Progress toward elimination of rubella and congenital rubella syndrome—the Americas, 2003–2008. MMWR Morb Mortal Wkly Rep 2008;57(43):1176–9.Google Scholar
  18. 18.
    Lappalainen M, Koskiniemi M, Hiilesmaa V, et al. Outcome of children after maternal primary Toxoplasma infection during pregnancy with emphasis on avidity of specific IgG. The Study Group. Pediatr Infect Dis J. 1995;14(5):354–61.CrossRefPubMedGoogle Scholar
  19. 19.
    Singh S, Pandit AJ. Incidence and prevalence of toxoplasmosis in Indian pregnant women: a prospective study. Am J Reprod Immunol. 2004;52(4):276–83.CrossRefPubMedGoogle Scholar
  20. 20.
    Mittal V, Bhatia R, Singh VK, Sengal S. Low incidence of congenital toxoplasmosis in Indian children. J Trop Pediatr. 1995;41(1):62–3.PubMedGoogle Scholar
  21. 21.
    Wilson CB, Remington JS, Stagno S, Reynolds DW. Development of adverse sequelae in children born with subclinical congenital toxoplasma infection. Pediatrics. 1980;66(5):767–74.PubMedGoogle Scholar
  22. 22.
    Chaudhary M, Kashyap B, Bhalla P. Congenital syphilis, still a reality in 21st century: a case report. J Med Case Reports. 2007;1:90.CrossRefPubMedGoogle Scholar
  23. 23.
    Woods CR. Syphilis in children: congenital and acquired. Semin Pediatr Infect Dis. 2005;16(4):245–57.CrossRefPubMedGoogle Scholar
  24. 24.
    Workowski KA, Berman SM. Sexually transmitted diseases treatment guidelines, 2006. MMWR Recomm Rep. 2006;55(RR-11):1–94.PubMedGoogle Scholar
  25. 25.
    Kropp RY, Wong T, Cormier L, et al. Neonatal herpes simplex virus infections in Canada: results of a 3-year national prospective study. Pediatrics. 2006;117(6):1955–62.CrossRefPubMedGoogle Scholar
  26. 26.
    Cowan FM, French RS, Mayaud P, et al. Seroepidemiological study of herpes simplex virus types 1 and 2 in Brazil, Estonia, India, Morocco, and Sri Lanka. Sex Transm Infect. 2003;79(4):286–90.CrossRefPubMedGoogle Scholar
  27. 27.
    Malm G, Forsgren M. Neonatal herpes simplex virus infections: HSV DNA in cerebrospinal fluid and serum. Arch Dis Child Fetal Neonatal Ed. 1999;81(1):F24–9.CrossRefPubMedGoogle Scholar
  28. 28.
    Stone KM, Brooks CA, Guinan ME, Alexander ER. National surveillance for neonatal herpes simplex virus infections. Sex Transm Dis. 1989;16(3):152–6.CrossRefPubMedGoogle Scholar
  29. 29.
    Cantwell MF, Shehab ZM, Costello AM, et al. Brief report: congenital tuberculosis. N Engl J Med. 1994;330(15):1051–4.CrossRefPubMedGoogle Scholar
  30. 30.
    Pal P, Ghosh A. Congenital tuberculosis: late manifestation of the maternal infection. Indian J Pediatr. 2008;75(5):516–8.CrossRefPubMedGoogle Scholar
  31. 31.
    Vallejo JG, Ong LT, Starke JR. Clinical features, diagnosis, and treatment of tuberculosis in infants. Pediatrics. 1994;94(1):1–7.PubMedGoogle Scholar
  32. 32.
    Connell T, Bar-Zeev N, Curtis N. Early detection of perinatal tuberculosis using a whole blood interferon-gamma release assay. Clin Infect Dis. 2006;42(11):e82–5.CrossRefPubMedGoogle Scholar
  33. 33.
    Guidance for national tuberculosis programmes on the management of tuberculosis in children, 2006. World Health Organization, Geneva. Available at:, 2006.
  34. 34.
    Dworsky M, Whitley R, Alford C. Herpes zoster in early infancy. Am J Dis Child. 1980;134(6):618–9.PubMedGoogle Scholar
  35. 35.
    Smith CK, Arvin AM. Varicella in the fetus and newborn. Semin Fetal Neonatal Med. 2009;14(4):209–17.CrossRefPubMedGoogle Scholar
  36. 36.
    Nguyen HQ, Jumaan AO, Seward JF. Decline in mortality due to varicella after implementation of varicella vaccination in the United States. N Engl J Med. 2005;352(5):450–8.CrossRefPubMedGoogle Scholar
  37. 37.
    Chang MH. Hepatitis B virus infection. Semin Fetal Neonatal Med. 2007;12(3):160–7.CrossRefPubMedGoogle Scholar
  38. 38.
    Mortality Country Fact Sheet, India 2006. World Health Organization, Geneva. Available at 2006.
  39. 39.
    WHO Guidelines. Antiretroviral drugs for treating pregnant women and preventing HIV infection in infants in resource-limited settings. Towards universal access: recommendations for a public health approach. 2006.Google Scholar

Copyright information

© Dr. K C Chaudhuri Foundation 2010

Authors and Affiliations

  1. 1.Department of PediatricsSt. John’s National Academy of Health SciencesBangaloreIndia

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