Chapter 11: TORCH infections

Question 1

TORCH Infections

Answer 1

a group of maternal infectious diseases that cause harm to the embryo-fetus
-stands for:
>Toxoplasmosis
>Rubella
>Cytomegalovirus (CMV)
>Herpes Simplex virus type 2 (HSV-2)
(exposure during the first 12 weeks of gestation is associated with fetal developmental anomalies)

Question 2

Toxoplasmosis

Answer 2

toxoplasma gondii
-transmitted transplacentally
-Detection: antibody testing IgM-specific, antibody IGG seroconversion from negative to positive; active infection indicated by a rise in IgG titer in 2 appropriately spaced tests; after 20 weeks gestation fetal blood samples can be tested for presence of specific IgM
-Maternal Effects: asymptomatic, but may cause fatigue, muscle pains, penumonitis, myocarditis, and lymphadenopathy
-Neonatal Effects: varies with gestational age; the earlier the fetus is the more severe the disease; congenital infection if acute toxoplasmosis occurs during third trimester; spontaneous abortion, low birth weight, hepatosplenomegaly, icterus, anemia, neurological disease, and chorioretinitis
>Management: treated with spiramycin if women acquire toxoplasmosis; if fetal infection established, combination of pyrimethamine, sulfadiazine, and folinic acid, alternating with spiramycin to eradicate parasites in the placenta and fetus
>Nursing: avoid consuming raw or poorly cooked meat (pork, lamb, or venison); do not touch hands or mouth after handling undercooked meat; avoid contact with cat feces; peel or thoroughly wash fruits and vegetables; does not need routine screening unless have HIV

Question 3

Rubella (German Measles)

Answer 3

caused by rubella virus
-transmitted via nasopharyngeal secretions; placentally
>Detection: Rubella specific IgM antibodies; Rubella antibody titer of 1:8 or more indicates immune status
>Maternal Effects: erythematous maculopapular rash on face, neck, arms, and legs lasting 3 days; lymph node enlargement, slight fever, malaise, headache, and arthralgia
>Neonatal Effects: congenital rubella syndrome; congenital spectrum anomalies: deafness, eye defects, CNS anomalies, cardiac malformation
>Management: women require no special therapy other than mild analgesics and rest; infants born with congenital rubella may shed virus for many months and thus be a threat to other infants and susceptible adults
>Nursing: vaccine contraindicated during pregnancy, if nonimmune be vaccinated immediately postpartum, use contraception at least 1 month after vaccination

Question 4

Cytomegalovirus (CMV)

Answer 4

DNA virus of the herpes group
-transmitted by droplet and contact with infected secretions (saliva, urine, breast milk, cervical mucus, semen); transplacentally
>Detection: Serology of CMV-specific IgM antibody
>Maternal Effects: asymptomatic but when present include mononucleosis-like syndrome (i.e. fever, pharyngitis, lymphadenopathy, polyarthritis)
>Neonatal Effects: low birth weight, Intrauterine growth restriction, microcephaly, CNS abnormalities, mental and motor retardation, intracranial calcifications, sensorineural deafness, blindness with chorioretinitis, intellectual and developmental disabilities, jaundice, hepatosplenomegaly
>Management: Mother: treat symptoms, Infant: isolate infant, no satisfactory treatment available; Ganciclovir may prevent hearing loss and developmental outcomes but it has serious side effects
>Nursing: counsel patients to practice safe handling techniques such as rigorous hand-washing and use of latex gloves, avoid high risk behaviors, use condoms, maintain hygiene throughout pregnancy; vaccine is available but needs more research, maternal immunity does not eliminate the possibility of fetal infection, routine screening not recommended

Question 5

Herpes Simplex Virus (HSV)

Answer 5

transmitted via viral exposure at time of birth ad ascending infection; transplacentally
>Detection: tissue culture (swab specimen from vesicles); immunofluorescent staining of the cell can differentiate from HSV-1 and HSV-2
>Maternal Effects: painful genital vesicle lesions (on cervix, vagina, or external genitalia), commonly associated with burning, itching, pain, fever, malaise and myalgia, numbness, and tingling; also have lymphadenopathy and urinary retention
>Neonatal Effects: neurological morbidity associated with chorioretinitis, microcephaly, intellectual and developmental disabilities, seizures, and apnea
>Management: maternal prophylactic treatments with oral acyclovir, valacyclovir, or famciclovir for frequent recurrent infections; with active recurrent genital herpes should be offered suppressive viral therapy at or beyond 36 weeks gestation; intrapartally avoid invasive monitoring
>Nursing: use condoms to decrease exposure, with active HSV and ruptured membranes at or near term recommendations are for cesarean delivery, breastfeeding not contraindicated but practice hand washing when handling infant, HSV cultures in asymptomatic patients with recurrent disease not recommended, routine HSV screening of pregnant women not recommended