Current use of the TORCH screen in the diagnosis of congenital infection

Utility of routine urine CMV PCR and total serum IgM testing of small for gestational age infants: a single center review

BACKGROUND

Due to the extremely low incidence of TORCH (toxoplasmosis, rubella, CMV, herpes simplex virus) infections, diagnostic testing of all small for gestational age (SGA) infants aimed at TORCH etiologies may incur unnecessary tests and cost.

OBJECTIVE

To determine the frequency of urine CMV PCR and total IgM testing among infants with birth weight <10% and the rate of test positivity. To evaluate the frequency of alternative etiologies of SGA in tested infants.

METHODS

Retrospective chart review of SGA infants admitted to the neonatal intensive care unit (NICU) at NYU Langone Medical Center between 2007 and 2012. Subjects were classified as being SGA with or without intrauterine growth restriction (IUGR). The IUGR subjects were then further categorized as having either symmetric or asymmetric IUGR utilizing the Fenton growth chart at birth. Initial testing for TORCH infections, which included serum total IgM, CMV PCR and head ultrasound, were reviewed and analyzed.

RESULTS

Three hundred and eighty-six (13%) infants from a total of 2953 NICU admissions had a birth weight ≤10th percentile. Of these, 44% were IUGR; 34% being symmetric IUGR and 10% asymmetric. A total of 32% of SGA infants had urine CMV PCR and total IgM tested with no positive results. As expected, significantly higher percentage of symmetric IUGR infants were tested compared to asymmetric IUGR and non-IUGR SGA infants, (64% vs. 47% vs. 19%) P≤0.01. However, 63% of infants with a known cause for IUGR had same testing done aimed at TORCH infections. We calculated additional charges of $64,065 that were incurred by such testing.

CONCLUSIONS

The majority of infants in our study who received testing for urine CMV PCR and total IgM aimed at TORCH infections had one or more other known non-infectious etiologies for IUGR. Because the overall yield of such testing is extremely low, we suggest tests for possible TORCH infections may be limited to symmetric IUGR infants without other known etiologies. Improved guidelines testing for TORCH infections can result in reducing hospital charges and unnecessary studies.

Is routine TORCH screening and urine CMV culture warranted in small for gestational age neonates?

BACKGROUND

congenital infections are associated with a wide variety of clinical symptoms, including small for gestational age (SGA).

AIMS

to determine the co-occurrence of SGA and congenital TORCH infections, as diagnosed by TORCH serologic tests and/or cytomegalovirus (CMV) urine culture.

STUDY DESIGN

we performed a retrospective study of all neonates admitted to our neonatal intensive care unit from January 2004 to February 2010 in whom SGA was diagnosed and TORCH serologic tests and/or CMV urine cultures were performed.

RESULTS

TORCH serologic tests (in neonatal or maternal serum) and/or a CMV urine culture were performed in 112 neonates with SGA. None of the neonates tested positive for Toxoplasma gondii, Rubella, and Herpes simplex virus. Positive CMV urine culture was detected in 2% (2/112) of neonates, but their CMV IgM titers were negative.

CONCLUSIONS

the co-occurrence of TORCH congenital infection in infants with SGA is rare. Routine TORCH screening in neonates with isolated SGA does not seem warranted and should be limited to CMV urine cultures.

Routine TORCH screening is not warranted in neonates with subependymal cysts

BACKGROUND

Congenital infections are associated with a wide variety of clinical symptoms, including subependymal cysts (SEC).

OBJECTIVE

To determine the co-occurrence of SEC and congenital infections, as diagnosed by TORCH serologic tests and/or cytomegalovirus (CMV) urine culture.

METHODS

We performed a retrospective study of all neonates admitted to our neonatal intensive care unit from 1998 to 2009 in whom SEC were detected on cranial ultrasound and TORCH serologic tests and/or CMV urine cultures were performed.

RESULTS

Fifty-nine neonates fulfilled the inclusion criteria. TORCH serologic tests were performed in 69% (41/59) of cases. Urine CMV culture was performed in 68% (40/59) of cases. None of the neonates tested positive for IgM Toxoplasma gondii, Rubella and Herpes simplex virus. Positive CMV IgM titers and/or a positive urine CMV culture were detected in 2% (1/59) of neonates.

CONCLUSION

The co-occurrence of TORCH congenital infections in infants with SEC is rare. Routine TORCH screening in neonates with SEC does not seem warranted.

Intrauterine infections: a literature review

During gestation, many microorganisms can infect the fetus, causing severe birth defects. Such organisms and the resulting clinical syndromes have been categorized as TORCH infections, a useful acronym referring to Toxoplasma gondii, other microorganisms (like syphilis), rubella virus, cytomegalovirus, and herpesviruses. Since dental patients typically report pregnancy or previous infections as part of their health history, and TORCH infections can manifest oral symptoms, the dentist is in a position to act as an educator and screener for these infections. This article reviews TORCH agents for dentists to help the clinician in educating pregnant patients about the risks these infections pose to the fetus. The authors also note oral symptoms related to these infections.

Viral infections in neonates with seizures

The aim of this study was to determine the incidence of viral infections in the central nervous system (CNS) of neonates with seizures of unknown origin. Serum and cerebrospinal fluid (CSF) samples of 50 neonates were studied for antibodies to 13 different microbes by enzyme immunoassay, and CSF samples were investigated for four specific nucleic acids by polymerase chain reaction. For viral cultures throat, stool and CSF samples were obtained. CNS viral infection was suggested in 13 of the 50 neonates (26%). Antibodies to varicella, herpes simplex 1, influenza A or B, parainfluenza 1, adeno or enteroviruses were detected in the CSF of nine children; and herpes simplex 2 specific DNA was found in one child. Cytomegalovirus was cultured from the urine of two children. In one child unspecified, but evident pleocytosis in the CSF was observed. The incidence of CNS viral infections in association with neonatal seizures may be much higher than previously reported.