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My Child Has:
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Other In Utero TORCH Infections
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TORCH is an acronym for a group of diseases that cause congenital (present at birth) conditions if a fetus is exposed to them when in the uterus (when a mother is pregnant).
TORCH stands for:
Toxoplasmosis
Other (such as syphilis, varicella, mumps, parvovirus, and HIV)
Rubella
Cytomegalovirus
Herpes simplex
The "other" diseases -- described in this article -- include:
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Syphilis is a sexually transmitted disease caused by the bacteria Treponema pallidum that can result in serious congenital (present at birth) conditions if contracted during pre-natal development.
There are three main stages of syphilis, which progressively become more serious:
- Primary stage -- isolated physical symptoms, most noticeably a syphilitic chancre (hard, red, insensitive sore) and inflamed lymph nodes
- Secondary stage -- syphilis circulates throughout the blood stream, producing a rash on the hands and feet several weeks after the chancre heals
- Tertiary stage -- comes after a latency period, during which there are no symptoms of the disease. This final stage of syphilis involves the neurological, cardiovascular and musculoskeletal systems.
Newborns with syphilis are considered to be in the secondary stage of the disease, but transition to the final, and most serious period, of the disease by their second birthday.
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Syphilis is most likely passed from mother to child if she is in the first or second stage of the disease, rather than the latent phase. If the mother is not treated, syphilis infects the baby more than 75 percent of the time.
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Almost half of children infected before birth do not make it to term or die soon afterwards. The majority of children born with syphilis do not show any physical symptoms of the disease until weeks or months after birth. If left untreated, syphilis becomes a severe and chronic illness that affects the neurological and cardiovascular systems.
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Symptoms of congenital syphilis differ between newborns and older infants because the disease progresses from its secondary stage to its final phase:
Newborns
- Failure to thrive
- Irritability
- Watery nasal discharge ("sniffles")
- Rash and lesions
- Early rash -- small blisters on palms and soles of feet
- Late rash -- copper-colored on palms, soles, and face
- Rash around mouth, genitalia, anus
- Severe pneumonia
Older infants
- Tooth abnormalities (notched and peg-shaped, called "Hutchison teeth")
- Bone pain and abnormalities in lower leg ("Saber shins")
- Neurological problems
- Blindness
- Deafness
Symptoms of congenital syphilis may resemble other skin conditions or medical problems. Always consult your child's physician for a diagnosis.
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A simple blood test can determine if a mother or child has syphilis. For older infants, in which the disease has progressed, an eye exam, bone X-ray, or lumbar puncture (spinal tap) can detect the presence of syphilis in the eyes, bones, or brain and central nervous system, respectively.
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By screening women early in their pregnancy, syphilis can be detected before it harms the mother or child. However, any woman who suspects she may have a sexually transmitted disease, including syphilis, should get tested, regardless of whether or not she is pregnant. Regular screenings during pregnancy can help ensure the baby's health.
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A single dose of antibiotics (like penicillin) usually gets rid of congenital syphilis and prevents recurrent infections. If the mother is treated early in the pregnancy, the infant is at minimal risk for infection. If the baby is born with syphilis, he or she can be treated with antibiotics, as well, to get rid of the infection. Other effects of the baby's syphilis may be treated separately.
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Congenital Varicella Syndrome is caused by the same virus as the chicken pox, a common childhood disease. Congenital (present at birth) Varicella Syndrome is an illness caused by the varicella-zoster virus that children can get from their mother during pre-natal development.
When children and adults are infected for the first time (primary infection), it causes chicken pox. Later in life, the virus can reassert itself in the form of herpes zoster (shingles).
When a fetus contracts varicella, the disease is known as Congenital Varicella Syndrome, and the resulting health conditions may be severe.
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A woman who gets varicella for the first time (chicken pox) during her pregnancy can pass it on to her unborn child, causing Congenital Varicella Syndrome.
For adults and children, varicella is spread through direct skin contact with the chicken pox rash or through the droplets in the air. Varicella is highly contagious -- there is a 90 percent chance that an infected person will spread the disease to a household member who has not had chicken pox before.
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The risk of a mom passing the varicella virus onto her baby is extremely low. Only a primary varicella infection can cause the condition, and most adults and children have already had chicken pox or have been vaccinated against it. Even if a mother does contract chicken pox while pregnant, there is only a 2 percent chance that the baby will develop Congenital Varicella Syndrome.
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Babies born with Congenital Varicella Syndrome may have birth defects affecting:
- Skin (mostly on arms and legs)
- Thickened, overgrown scar tissue
- Hardened, red and inflamed skin
- Limbs
- Limb atrophy -- limb deficiencies, malformations and underdevelopment LINK
- Autonomic nervous system -- controls involuntary functions
- Brain
- Ventriculomegaly -- enlarged ventricles of the brain LINK
- Cortical Atrophy -- degeneration of outer portion of brain
- Growth
- Eyes
- Cataracts -- clouding over the lens of the eye
- Abnormally small eye(s)
- Rapid, involuntary eye movement
- Chorioretinitis -- inflammation of the choroids layer behind the retina
- Psychomotor skills -- motor movements caused by mental process
- Learning disabilities
- Mental retardation
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If a woman contracts chicken pox during her pregnancy, fetal ultrasounds can monitor the baby to determine if varicella affects its development.
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Varicella-zoster immune globin (VZIG) can be administered to newborns infected immediately after birth, in order to lessen the severity of the varicella disease. For pregnant women who are exposed to the varicella virus and are at risk for developing chicken pox, VZIG can help prevent infection.
Pregnant women who contract varicella during pregnancy often have a more severe case of the disease than women who are not pregnant. Severe varicella may be treated with acyclovir, an antiviral medication given intravenously (through an IV).
For babies born with Congenital Varicella Syndrome, specific symptoms of the disease can be treated accordingly.
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Congenital Varicella Syndrome is not a concern if the mother has already contracted chicken pox. However, if you are pregnant and have not had chicken pox before, the following steps can help prevent Congenital Varicella Syndrome:
- Avoid contact with anybody who has chicken pox
- Susceptible people who are living with a pregnant woman should get the varicella vaccine
- If you are already pregnant, DO NOT get the varicella vaccine, as it contains a live version of the virus. Get vaccinated at least a month before your pregnancy or after giving birth.
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Fifth disease is a mild illness, caused by parvovirus B19, and is spread through droplets in the air. It is often referred to as "slapped cheek disease" because of its characteristic rash on the face.
Fifth disease got its name when it was ranked fifth on a list of the top causes of childhood rashes and fevers. Although the symptoms are usually mild in adults, fifth disease may cause complications in a pregnancy.
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Complications can occur during pregnancy if a fetus is exposed to fifth disease. The disease affects the baby's ability to produce red blood cells and can lead to:
- Severe anemia
- Heart failure
- Fetal death
Fifth disease has not been cited as a cause for other birth defects.
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Several factors influence the likelihood of congenital (present at birth) fifth disease, including:
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Fifth disease is usually diagnosed based on a medical history and physical examination. The rash and progression of fifth disease is unique, and can easily be diagnosied.
A blood test can determine if the mother:
- Is immune to fifth disease
- Has been recently infected.
To determine if the baby has been infected with fifth disease, your physician can test for parvovirus B19 in amniotic fluid or fetal blood.
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Since fifth disease is caused by a virus, medications cannot treat it. Your physician may closely monitor the baby's development through fetal ultrasounds and blood tests. In rare cases when the fetus has severe anemia, an intrauterine blood transfusion may be suggested.
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Frequent hand washing is the most common way to prevent the spread of viruses. Since fifth disease is contagious before the symptoms develop, avoiding people with the disease will not prevent infection.
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Human immunodeficiency virus (HIV) is the virus that is responsible for causing acquired immune deficiency syndrome (AIDS). The virus destroys or impairs cells of the immune system and progressively destroys the body's ability to fight infections and certain cancers.
In children under the age of 13 in the United States, nearly all HIV infections are from vertical transmission, which means the virus is passed to the child when they are in their mother's womb or as they pass through the birth canal. However, not every child born to an HIV-infected mother will acquire the virus.
The virus has also been detected in breast milk. Before 1985, a small group of children were infected with the virus by contaminated blood products, but routine screening of blood products for HIV began in 1985.
Between 1992 and 1997 the number of infants who became HIV positive when born to an infected mother decreased by 50 percent. This reduction reflects the use of new anti-retroviral medications that are given to the mother before her baby is born. Because transmission often occurs during delivery, cesarean section may be indicated for some women.
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At birth, infants born to an HIV-infected mother may test negative for the virus and have no symptoms. This does not mean that the infant does not have the virus.
Blood tests will be done at various stages after birth up to and past 6 months of age to determine an infant's HIV status.
Symptoms may include the following:
- failure to thrive - delayed physical and developmental growth as evidenced by poor weight gain and bone growth.
- swollen abdomen (due to swelling of the liver and spleen)
- swollen lymph nodes
- intermittent diarrhea (diarrhea that may come and go) pneumonia
- oral thrush - a fungal infection in the mouth that is characterized by white patches on the cheeks and tongue. These lesions may be painful to the infant.
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An infant born to an HIV-infected mother may not test positive at birth and it may be necessary for the infant to undergo multiple blood tests at different intervals during his/her first 6 months of life.
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As with many other conditions, early detection offers more options for treatment. Today, there are medical treatments that can slow down the rate at which HIV weakens the immune system, but, currently, there is no cure for the disease. However, there are other treatments that can prevent or cure the conditions associated with HIV.
Anti-retroviral drug therapy may be given to a pregnant woman, which has proven to greatly reduce the chance of an infant developing HIV. A cesarean section may be recommended to reduce infant transmission from the birth canal.
In the US, where other feeding options are available, an infected mother should be discouraged from breastfeeding her infant.
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