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TORCH is an acronym for TOxoplasmosis, Rubella, Cytomegalovirus, and Herpes simplex.

Toxoplasmosis

Definition:
A common infection with the protozoan intracellular parasite Toxoplasma gondii.

Causes, incidence, and risk factors:
Toxoplasmosis is found in humans worldwide and in many species of animals and birds. The cat is the definitive host of the parasite. Human infection results from ingestion of contaminated soil, careless handling of cat litter, ingestion of raw or undercooked meat, or transmission from a mother to a fetus through the placenta (congenital infection). Over 80% of primary infections produce no symptoms, but the incubation period for symptoms is 1 to 2 weeks.

Symptoms:
In the normal host:

mild febrile illness resembling mononucleosis

enlarged lymph nodes in the head and neck

headache

sore throat

muscle pain

Rubella

Definition:
A contagious viral infection with mild symptoms associated with a rash.


Causes, incidence, and risk factors:
The disease is caused by a virus that is spread through the air or by close contact. It can also be transmitted to a fetus by a mother with an active infection. The disease is usually mild and may even go unnoticed. Children may have few symptoms, but adults may experience a prodrome (warning symptom) of a fever, headache, malaise, runny nose, and inflamed eyes that lasts from 1 to 5 days before the rash appears. A person can transmit the disease from 1 week before the onset of the rash until 1 week after the rash disappears. The disease is not as contagious as rubeola (measles), therefore many people are not infected during childhood. Lifelong immunity to the disease follows infection. Epidemics may occur at about 6- to 9-year intervals. The risk factors are the unimmunized individuals. Only 1,400 cases were reported in the U.S. in 1991.

Symptoms:

low-grade fever (102 F or lower)

headache

general discomfort or uneasiness (malaise)

runny nose

inflammation of the eyes (bloodshot eyes)

rash with skin redness or inflammation

cloudy cornea

Note: There may be no symptoms

Cytomegalovirus

Definition:
An acute viral infection causing high temperature, sore throat, and swollen lymph glands, especially in the neck (when caused by the cytomegalovirus).


Causes, incidence, and risk factors:
The infection is caused by two viruses, the Epstein-Barr virus (EB) or cytomegalovirus (CMV pneumonia), both members of the herpes virus family. Infection with CMV occurs less commonly than Epstein-Barr. The infection is probably transmitted by saliva, sexual contact, respiratory droplets, and blood transfusions. Sore throat is less common in CMV infectious mononucleosis than in Epstein-Barr. While the peak incidence occurs in 15- to 17-year-old adolescents, the infection may occur at any age, usually between 10 and 35 years old. Abnormal lymphocytes (white blood cells) are seen in the peripheral blood and may persist for 2 to 8 weeks. Abnormalities of liver function are also characteristic. Risk factors other than age are not known. The incidence is 8 out of 100,000 people.


Symptoms:

fever

sore throat

enlarged lymph nodes, especially in the neck (CMV)

malaise (vague ill feeling)

frequent tiredness or fatigue

loss of appetite

muscular aches or stiffness

enlarged spleen

rash

Less frequently occurring symptoms include:

jaundice (yellow cast to skin)

headache

neck stiffness

sensitivity to light

cough

shortness of breath

chest pain

rapid heart rate

irregular heart rate

hives

Herpes simplex.

Definition:
An infection caused by the herpes virus; it is characterized by an eruption of small and usually painful blisters on the skin.

Causes, incidence, and risk factors:
There are two strains of herpes viruses. Herpes simplex virus type 1 (HSV-1) is usually associated with infections of the lips, mouth, and face. It is common in children between 1 and 3 years old and may cause lesions inside the mouth and inflamed gums. It causes cold sores or fever blisters and is transmitted by oral and respiratory secretions (for example, sneezing or coughing can transmit the virus). Herpes simplex virus 2 (HSV-2) is usually associated with genital lesions and is transmitted by sexual contact. Cross-infection of type 1 and 2 viruses may occur from oral-genital sex. Both viruses are contagious and the first symptoms usually appear 1 or 2 weeks after contact with an infected person.

The virus spreads to nerve cells within the body, and then to other mucosal skin surfaces. The virus remains dormant in the body after an active infection and recurrences of the symptoms can take place at a later time. Recurrences may be precipitated by overexposure to sunlight, fever, stress, or certain foods and drugs.

Symptoms:

skin rash or lesion with itching

skin rash or lesion with a burning or tingling sensation before other symptoms develop

mouth sores

genital lesions (male)

genital lesions (female)

blisters anywhere on the skin, most frequent on the mouth, lips, conjunctiva and cornea of the eye, and the genitalia

smaller blisters merge to form a larger blister

yellow crusts form on blisters at the beginning of healing (7 to 10 days)

fever blisters

mild fever

enlargement of lymph nodes in the neck or groin

Additional symptoms that may be associated with this disease:

vaginal discharge

throat, sore

memory loss