The original TORCH complex described clinically similar congenital
infections caused by Toxoplasma gondii, rubella virus, cytomegalovirus, and herpes simplex virus, types 1 and 2. Cutaneous manifestations, including
petechiae,
purpura,
jaundice, and dermal erythropoiesis, are commonly seen in
toxoplasmosis,
rubella, and
cytomegalovirus infections. In herpes simplex virus
infections, 80% of symptomatic infants show single or grouped cutaneous vesicles,
oral ulcers, or
conjunctivitis. Extracutaneous signs and symptoms are variable and can be severe. Significant clinical signs in
congenital toxoplasmosis include diffuse intracerebral calcification,
chorioretinitis, and
microcephaly; congenital
rubella can result in
deafness,
congenital heart disease, retinopathy, and brain calcification.
Cytomegalic inclusion disease can include
hepatomegaly,
splenomegaly, paraventricular calcification, and
intrauterine growth retardation. Localized or disseminated congenital herpes
virus infection often involves the central nervous system and the eye. Diagnosis is confirmed by culture and identification of species-specific
immunoglobulin M within the first 2 weeks of life. Histological examination contributes to the diagnosis in
herpes simplex virus infection. Treatment for
toxoplasmosis includes
pyrimethamine with
sulfadiazine or
trisulfapyrimidine; congenital
herpes simplex virus infection is treated with
acyclovir. No specific
therapy for congenital
rubella or
cytomegalovirus infections has been established, and so treatment is primarily supportive.