Late congenital Syphilis (symptoms after 2 years of age) Maculopapular rash, “snuffles,” maculopapular rash, lymphadenopathy, hepatomegaly, thrombocytopenia, anemia, meningitis, chorioretinitis, osteochondritis Glucocorticoids (Prednisone 0.5 mg twice per day) are added if CSF protein is > 1 g/dL or when active chorioretinitis threatens vision.Ĭausative Organism – Treponema pallidum TransmissionĮarly Congenital Syphilis (symptoms at 1-2 months of age) Infants should be weighed weekly and dosages adjusted accordingly. Leucovorin 10 mg three times per week during and once a week after pyrimethamine therapy.
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Sulfadiazine 100 mg/kg per day divided in two doses every day for one year, plus Pyrimethamine 2 mg/kg (maximum 50 mg/dose) once daily for two days then 1 mg/kg (maximum 25 mg/dose) once daily for six months then 1 mg/kg (maximum 25 mg/dose) every other day to complete one year of therapy, plus Symptoms may also include fever, IUGR, microcephaly, seizure, hearing loss, maculopapular rash, jaundice, hepatosplenomegaly, anemia, and lymphadenopathyĭefinitive – Isolating organism from placenta, serum, or CSFĪlso available – PCR & IgM titer (IgG will be elevated if mother is infected regardless of transmission) Third Trimester – often asymptomatic at birth Severity of fetal infection decreases with gestational age Risk of fetal infection increases with gestational age As more infections that cause similar sequelae became recognized the “O” in the acronym came to stand for “other.”įound in undercooked meat, contaminated water/soil, and unpasteurized goat milk Only a year later Roger Brumback proposed the acronym TORCHES ( TOxoplasmosis, Rubella, Cytomegalovirus, HErpes, Syphilis) because it would be better recognized by pediatricians already familiar with the old acronym. The new acronym he proposed was STORCH, German for “ stork,” which he thought was a particularly suitable name given its association with the perinatal period. In 1975 Harold Fuerst proposed that one “particularly disturbing” omission be added to the acronym: syphilis. In 1971 Andres Nahmias proposed the acronym ToRCH to denote 4 congenital infections that are sometimes difficult to distinguish: TOxoplasmosis, Rubella, Cytomegalovirus, and Herpes Simplex Virus. Nonetheless, a “TORCH panel” is used by many institutions. There is significant controversy regarding the benefits and cost-effectiveness of universal screening for these diseases and universal antenatal screening is not currently recommended in the United States. It is important to consider TORCH infections whenever a neonate presents with intrauterine growth restriction (IUGR), microcephaly, intracranial calcifications, conjunctivitis, hearing loss, rash, hepatosplenomegaly, or thrombocytopenia.Īlthough the five classic infections are discussed here, the “ other” category now also includes HIV, VZV, parvovirus B19, enteroviruses, and others. While each infection is distinct, there are many similarities in how these infections present. These infections are acquired by the mother and passed either transplacentally or during the birth process. TORCH infections are a group of congenitally acquired infections that cause significant morbidity and mortality in neonates.