Epps R E, Pittelkow M R, Su W P
Department of Dermatology, Mayo Clinic, Rochester, MN 55905, USA.
Semin Dermatol. 1995 Jun;14(2):179-86. doi: 10.1016/s1085-5629(05)80016-1.
The original TORCH complex described clinically similar congenital infections caused by Toxoplasma gondii, rubella virus, cytomegalovirus, and herpes simplex virus, types 1 and 2. Cutaneous manifestations, including petechiae, purpura, jaundice, and dermal erythropoiesis, are commonly seen in toxoplasmosis, rubella, and cytomegalovirus infections. In herpes simplex virus infections, 80% of symptomatic infants show single or grouped cutaneous vesicles, oral ulcers, or conjunctivitis. Extracutaneous signs and symptoms are variable and can be severe. Significant clinical signs in congenital toxoplasmosis include diffuse intracerebral calcification, chorioretinitis, and microcephaly; congenital rubella can result in deafness, congenital heart disease, retinopathy, and brain calcification. Cytomegalic inclusion disease can include hepatomegaly, splenomegaly, paraventricular calcification, and intrauterine growth retardation. Localized or disseminated congenital herpes virus infection often involves the central nervous system and the eye. Diagnosis is confirmed by culture and identification of species-specific immunoglobulin M within the first 2 weeks of life. Histological examination contributes to the diagnosis in herpes simplex virus infection. Treatment for toxoplasmosis includes pyrimethamine with sulfadiazine or trisulfapyrimidine; congenital herpes simplex virus infection is treated with acyclovir. No specific therapy for congenital rubella or cytomegalovirus infections has been established, and so treatment is primarily supportive.
最初描述的TORCH综合征包括由弓形虫、风疹病毒、巨细胞病毒以及1型和2型单纯疱疹病毒引起的临床上相似的先天性感染。皮肤表现，包括瘀点、紫癜、黄疸和皮肤造血，在弓形虫病、风疹和巨细胞病毒感染中很常见。在单纯疱疹病毒感染中，80%有症状的婴儿表现为单个或成簇的皮肤水疱、口腔溃疡或结膜炎。皮肤外的体征和症状各不相同，可能很严重。先天性弓形虫病的重要临床体征包括弥漫性脑内钙化、脉络膜视网膜炎和小头畸形；先天性风疹可导致耳聋、先天性心脏病、视网膜病变和脑钙化。巨细胞包涵体病可包括肝肿大、脾肿大、脑室周围钙化和宫内生长迟缓。局部或播散性先天性疱疹病毒感染常累及中枢神经系统和眼睛。在出生后2周内通过培养和鉴定种特异性免疫球蛋白M来确诊。组织学检查有助于单纯疱疹病毒感染的诊断。弓形虫病的治疗包括乙胺嘧啶联合磺胺嘧啶或三磺胺嘧啶；先天性单纯疱疹病毒感染用阿昔洛韦治疗。对于先天性风疹或巨细胞病毒感染，尚未确立特异性治疗方法，因此治疗主要是支持性的。
