Department of Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, London, UK
Department of Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, London, UK.
Arch Dis Child. 2021 Feb;106(2):117-124. doi: 10.1136/archdischild-2020-318841. Epub 2020 Jun 25.
The epidemiology of congenital infections is ever changing, with a recent resurgence in syphilis infection rates seen in the UK. Identification of congenital infection is often delayed; early recognition and management of congenital infections is important. Testing modalities and investigations are often limited, leading to missed diagnostic opportunities.
The SCORTCH (syphilis, cytomegalovirus (CMV), 'other', rubella, toxoplasmosis, chickenpox, herpes simplex virus (HSV) and blood-borne viruses) acronym increases the awareness of clinicians to the increased risk of congenital syphilis, while considering other infectious aetiologies including: zika, malaria, chagas disease, parvovirus, enterovirus, HIV, hepatitis B and C, and human T-lymphotropic virus 1, in addition to the classic congenital infections recognised in the 'TORCH screen' (toxoplasmosis, 'other', rubella, CMV, HSV). The SCORTCH diagnostic approach describes common signs present in infants with congenital infection, details serological testing for mother and infant and important direct diagnostics of the infant. Direct diagnostic investigations include: radiology, ophthalmology, audiology, microbiological and PCR testing for both the infant and placental tissue, the latter also warrants histopathology.
The traditional 'TORCH screen' focuses on serology-specific investigations, often omits important direct diagnostic testing of the infant, and fails to consider emerging and re-emerging congenital infections. In recognition of syphilis as a re-emerging pathogen and the overlapping clinical presentations of various infectious aetiologies, we advocate for a broader outlook using the SCORTCH diagnostic approach.
先天性感染的流行病学一直在变化，最近在英国，梅毒感染率出现了反弹。先天性感染的诊断往往被延误；早期识别和管理先天性感染很重要。检测方式和检查往往受到限制，导致错失诊断机会。
SCORTCH（梅毒、巨细胞病毒（CMV）、“其他”、风疹、弓形体病、水痘、单纯疱疹病毒（HSV）和血源性病原体）首字母缩略词提高了临床医生对先天性梅毒风险增加的认识，同时考虑了其他感染性病因，包括：寨卡病毒、疟疾、恰加斯病、细小病毒、肠病毒、HIV、乙型肝炎和丙型肝炎以及人 T 淋巴细胞病毒 1，除了经典的先天性感染在“TORCH 筛查”（弓形体病、“其他”、风疹、CMV、HSV）中被识别。SCORTCH 诊断方法描述了患有先天性感染的婴儿常见的体征，详细介绍了母婴血清学检测以及婴儿重要的直接诊断方法。直接诊断检查包括：放射学、眼科学、听力学、婴儿和胎盘组织的微生物学和 PCR 检测，后者还需要组织病理学检查。
传统的“TORCH 筛查”侧重于血清学特异性检查，往往忽略了婴儿重要的直接诊断检查，也没有考虑到新出现和再次出现的先天性感染。鉴于梅毒是一种再次出现的病原体，以及各种感染性病因的重叠临床表现，我们提倡使用 SCORTCH 诊断方法来扩大视野。
