TORCH
Congenital Infections (Vertical Transmission)
The classic vertical-infection screen for neonatal red flags.
Clinicians lean on this acronym when a newborn presents with hepatosplenomegaly, microcephaly, rash, or hearing loss and the differential is congenital infection. TORCH — Toxoplasmosis, Other (syphilis, varicella, parvovirus B19, HIV, Zika), Rubella, Cytomegalovirus, Herpes simplex — captures the classic vertical transmissions that lead to neonatal disease. CMV is the most common congenital infection in the US; congenital syphilis is rising and the AANP exam reflects current prevalence. Test maternal serologies in pregnancy and newborn studies when red flags appear. Boards questions test the prenatal clue (rubella exposure, untreated syphilis) paired with the neonatal finding (cataracts, snuffles, blueberry muffin rash).
- TToxoplasmosisCat feces, undercooked meat. Counsel pregnant patients on avoidance.
- OOtherSyphilis (screened on every prenatal panel), VZV, parvovirus B19, HIV, listeria, Zika.
- RRubellaMMR is live-attenuated — do NOT vaccinate during pregnancy.
- CCMVMost common congenital infection in the US; often asymptomatic in mom, causes sensorineural hearing loss in infant.
- HHerpes simplexVertical transmission at delivery — C-section if active genital lesions at labor onset.
Clinical Context
Consider TORCH in a neonate with microcephaly, hepatosplenomegaly, chorioretinitis, hearing loss, rash ("blueberry muffin"), or IUGR. The overlap in presentation is broad — confirmatory serologies or PCR pin down the specific cause.
CMV is the sneaky one: often no maternal symptoms, but the leading infectious cause of congenital hearing loss. Syphilis screening on every prenatal panel is non-negotiable — untreated congenital syphilis is devastating. For HSV, a positive history or active lesion at delivery changes the delivery plan to C-section.
Related Mnemonics
- qSOFA — Quick Sepsis Bedside Screen
Sources
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