TORCH

T
O
R
C
H

oksoplasma
ther: Syphilis, Strepto Gr-B, Listeriosis
ubella
ytomegalovirus, Chlamydia
erpes, HIV, HPV, H.Parvovirus B19, HBV,
HCV

SOURCE OF TORCH IN THE BODY: Live in nucleated cell only

Rubella (Respiratory)
Toxoplasma (Muscle)

CMV (Mucosa)
HSV1 (Nerve)

HSV2 (Nerve)

CLINICAL STAGES OF TORCH INFECTION

SOURCE CASE:
Agent:
Population
Transmission
Generation

EXPOSURE TO CONTACT:
Intensity and duration

CONTACT:
Inborn defenses
Immune defenses

NO INFECTION

INFECTION:
Cell mediated immunity
Humoral mediated
Latency, tolerance

NO DISEASE

DISEASE:
Early
Late

MORFOLOGI TORCH (SKEMA)

surface and trans
membrane Antigen

Conoid
Pole-ring

HSV1/2

Micronemen
Rhoptrien

CMV

Nucleus
Mitochondria
T. Gondii

Nucleocapsid and
ssRNA genome
Rubella

VZV
Herpesviridae

EBV

THE ANTIBACTERIAL ROLE & EFFECT OF ANTIBODY

Antibody to

Antibody block/neutralize

Lipotheic
Fimbriae
Capsules

Lipid bilayer

Attachment

Effect Antibody & Complement

Survival of 100 bacteria (%)

Bacterial
proliferation

Bacterial metabolic
transportand receptor

100
10

M protein
Capsule

Phagocyte
avoidance

Antibody neutralize antigen

1
0.1

Host damage

0.01
1

Toxin

Toxic
Invasive

Antibody neutralize spreading

factors, hyaluronidase

2 hour

Non Ab, non C3b

(+) Ab, non C3b
(+) Ab, (+) C3b

IMMUNE SYSTEM IN ACUTE INFLAMMATION

5

Inflammatory mediators

Ts

Tumor, Rubor, Calor, Dolor, Punctio lesie

2B4

Mast cell

C3a/C5a

Hageman.F

2B
2

Th

2A2

Histamine

Tc

IgM/G

2B3

Bradikinin
Fibrinogen

Injury

IgE

2B
1

1B

1A

Antigen: Viral, Bacteria, Parasite, Fungal, Tumor

REAKTIFASI TORCH & PENYAKIT PENYERTA

LAIN PADA BERBAGAI KADAR CD4 PENDERITA
DEFISIENSI IMMUNE
IM. NORMAL (CD4>750/UL)
M.nucleosis : 4L+Mioatralgia
DEF. DINI (CD4>500/UL, LOWRISK, OPPORTUNITY):
Autoimun.D: Ruam kulit, ITP,
S.Sjogren, Guillain-Bare, Polio,
Demielinisasi syaraf perifer,
M.Ensefalitis, Low Re-activation
TB/TORCH
DEF.MENENGAH (CD4=200500/UL, MIDLE OPPORTUN)

Diare, BBturun, Lnnpatia,

fever Infeksi ringanKeganasan:
395/ul = TBC;
275/ul = HZV,HSV, K.oral,
HL 240/ul = NHL
224/ul = Kaposi.S
DEF. LANJUT
(CD4<200/UL, AIDSOPPORTUNISTIK) : 122/ul
= P.Karinii
98/ul = Kompleks M.Avium
93/ul = Eis Toksoplasma
73/ul = Mis Kriptokokus
29/ul = Retinitis CMV

TRANSMITTY OF TORCH

TOXOPLASMA
(Fecal-oral)

RUBELLA
Aerosal

CMV
(In-/direct contact,
Trans-fuse/plantation)

HSV1/2
(Intimate.C)

Salad (oocyst)
Raw meat (cyst)

Droplet

Sexual intercourse

Sexual.I

Mother-baby

+, labor, lactation

+ labor

SEROPREVALENCE OF IgG/M ANTI-TORCH

IN THE MOTHER LIVE IN INDONESIA
CITY

TOKSO (%)
IgG
IgM

RUBELLA
IgG IgM

CMV (%)
IgG
IgM

HSV2 (%)
IgG IgM

Jakarta
Bandung
Semarang
Yogyakarta
Surabaya
Denpasar

61,6
74,5
44,0
55,4
55,5
23,0

16,4
11,3
18,0
16,3
18,8
5,0

67,1
74,5
78,0
79,4
77,2
78,0

1,4
1,0
3,0

93,2
94,3
99,0
98,9
99,0
98,0

2,7
-

42,5
55,7
48,0
44,6
39,6
56,0

12,3
16,0
20,0
28,3
16,8
21,0

National

52,1

14,2

76,1

0,9

97,2

0,4

48,1

19,2

SEROPREVALENCE OF IgG ANTI TOKSOPLASMA

IN MAMALIA IN INDONESIA

Kalimantan
Lampung
Sumut
Tuban
Gresik
Jakarta
Jabar
Irian
Yogya

Goat
(%)
61,0
47,5
23,5
20,6
20,0
50

Cat
(%)
9,0
3,3
72,7
-

Dog
(%)
75,6
-

Fog
(%)
51,0
50,0
40,0

National

20-61

3-73

40-50

CMV: Viral excretion from assymptomayic persons

Urine
Oral secrete
Cement
Cervical secrete
Milk

Neonatus
(%)

Child
(%)

Adult
(%)

0,5-2,5
0,5-2,5
-

10-29
10-29
-

0-2
0-2
5-10
10-28
13-27

MODE OF TORCH INFECTION IN THE FETUS AND NEWBORN

Fetus
Toksoplasma
Rubella
Cytomegalo
Herpes

Transplacental
++
++
+
+

Newborn
During birth
++
++

Shortly after birth

++/Milk
+

MOST FREQUENT PHYSICAL SIGNS OF SEVERE

CONGENITAL TORCH INFECTION
DEFECT
Apparent at birth
Microcephaly
Intracranial calcification
Pneumonitis
Hepatosplenomegaly, Icteric
Trombocytopenia, Petechial,
Purpura, Haemorraghes
Choroidoretinitis
Cataracts
Glaucoma
Patent ductus arteriosus/PDA
Bone defect
Skin vesicles
Apparaent months/years after birth
Sensorineural deafness, Mental.R
Diabetes Mellitus

TOK

RUB

CMV

HSV2

+
+
+
+
+

+
+
+
+

+
+
+
+
+

+
+
+
+

+
+
+
-

+
+
+
+

+
-

+
-

+
+

+
-

FREQUENCY ORGAN YANG TERLIBAT

BBL Rendah
Abnormal lipat palmar
Pneumonia

60%
45%
15%

Kardiovaskuler
(MI,Septal,Stenosis,PDA) 70%
Mata
Katarak bilateral
Retinopatia
Mikroptalmia
Opasitas kornea
Glaukoma

77%
30%
25%
10%
7%
5%

Hepatomegali
Splenomegali
Ikterik
Anemia hemolitik

65%
60%
15%
13%

Trombositopenia

50%

Tuli
50%
Retardasi
40%
Protein liquor >
5%
Mikrosefal
2%
Radioluscent femur,tibia 35%

RELATIONSHIP BETWEEN SEVERITY CONGENITAL

TOXOPLASMOSE and TIME OF INFECTION IN THE GRAVID
Infection risk in fetus

Severity of congenital defect in fetus

A. Increase of trimester in the gravid , increase the risk of fetus to infected

B. More early infection in the fetus, more severe congenital defect in the fetus
TIME OF INFECTION

Infected Fetus
(%)

1st Trimester
2nd Trimester
3th Trimester

25
54
65

TOKSOPLASMOSE
Severe (%)
Mild/Nonsymptom (%)
60
30
0

40
70
100

SEVERITY OF CONGENITAL DEFECT IN THE FETUS

BY TIME OF RUBELA INFECTION IN THE GRAVID
Umur
Kehamilan

% Janin
terinfeksi

% Janin
Cacat

<11W
11-12W
13-14W
15-16W
17-18W
19-22W
23-26W
27-28W
7 Bulan
8 Bulan
9 Bulan

90
67
67
47
39
34
25
12
35
60
100

90
33
11
24
Fetal.D
and
Sequele
-

CLINICAL MANIFESTATION OF CMV INFECTION

TISSUE

CHLIDREN/ADULT

AIDS

Eyes
Lung
GIT
Nervous system
Lymphoid system
Major organ
Diseases

Polineuromyelitis
MI
Carditis
Subclinic

Chorioretinitis
Pneumonia
Esophagocolitis
Meningoencephalis
Lpenia, limfositosis
Hepatitis
Severe, generalized

Re-/1st INFECTION
Transfusion
Contact

REACTIVATION
Old age
Hydraemia
AIDS/Transplantation
Chronic diseases

METHODS FOR TORCH DETECTION

HA inhibition/HAI, Passive HA
Latex agglutination
Neutralization test
Fluorescent immuno assay/FIA
Anticomplement IFA

Toxo
-

Rub
+
+
+
+
+

CMV
-

HSV1/2
-

Sabin-feldman dye test

Indirect HA assay/IHA
Complemen fixation/CF

+
+
+

+
+

Indirect fluorescent assay/IFA

RIA, EIA
EIA capture, ISAGA

+
+
+

+
+

+
-

+
-

BASIC TO TORCH DETECTION BY SENSITIVITY

2n PCR gene

PCR1/ml

1 Particle MO
Detection

4 Antigen
Detection

Culture 104/ml

4 IgM anti MO
Detection

Microscope105/ml

4x5=20 IgG anti

MO Detection

4x5x4=80 IgG EIA

anti MO Detection

1,2,3,4 Serologic 10,4,3,2,1/ml

KINETICK OF SEROLOGIC MARKER IN TORCH

INFECTION
1st Infection
IgG

IgG high avidity

IgM
IgA
IgG low avidity

IgE anti-TORCH
.0

.3

.6

.12

.24 Months

PREVALENCE OF TOXOPLASMA AMONG PREGNANT

WOMEN FROM DIFFERENT PARTS OF THE WORLD

TORCH PRENATAL/MARITAL CARE PLUS

G/M
Tox
G/M
Rub
G/M
cmv
G/M
Hsv
G/M
Aca
Ket

Jan

Feb

Mar

Apr

Mei

Jun
S

Jul

Agt
S

Sep

Okt
S

Nov Des
S

Ket