TORCH
The acronym “TORCH” stands for Toxoplasma gondii (Toxo), Rubella, Cytomegalovirus (CMV), and Herpes Simplex-1 and -2. It was first coined to simplify the diagnostic process for these pathogens, which can cause congential, perinatal, or neonatal infection. These pathogens may cause:
- Mild symptoms in a healthy individual
- Severe damage and even death in the developing fetus or newborn child
- Serious complications in the immunocompromised, such as HIV or transplant patients
- CMV is the most common viral infection in transplant patients, affecting 20-60% of all recipients1
- HSV infections remain an important risk for transplant recipients2
To accurately assess infection and qualify risk, screening of IgG and IgM antibodies to TORCH pathogens is widely recommended for pregnant women, neonates, and individuals with a compromised immune system.
The presence of IgM antibodies or seroconversion to IgG indicates primary, acute infection, while that of IgG indicates recent or chronic infection in the case of Toxo and HSV-1 and 2, and past infection in the case of Rubella and CMV.
Due to the complexity of the immune system, many factors may impede the detection of IgM antibodies, making IgG detection important for the consideration of any necessary medical action.
Combining the results of IgG and IgM antibody detection can suggest:
| Pathogen | IgG and IgM Negative | IgM Positive | IgG+IgM Positive | IgG Positive |
| Toxo | No infection; Avoid vector contact (i.e. cat feces) | Current infection | Recent infection | Chronic infection |
| CMV | No infection; Susceptible to infection,Vaccine eligible | Current infection | Recent infection | Past infection or vaccination |
| Rubella | No infection; Susceptible to infection,Vaccine eligible | Current infection | Recent infection | Past infection or vaccination |
| HSV-1 | No infection; Avoid contact with infected personnel | Current infection | Recent infection | Chronic infection |
| HSV-2 | No infection; Avoid contact with infected personnel | Current infection | Recent infection | Chronic infection |
Once a diagnosis is confirmed, available treatment options and ways to minimize risk of transmission include:
- Proper treatment with suitable antibiotics or antiviral medication
- Fetal monitoring during pregnancy in order to assess any necessary medical attention
- Precautions to prevent transmission of infectious agents to the immunocompromised
If neither IgG nor IgM antibodies are detected, avoiding risky behavior and pathogen vector contact will help to minimize the risk of acquiring an acute infection. In the case of a negative Rubella result, vaccination may be an important preventative action.
For more information about each of these pathogens, please click on the respective disease page.
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