T O R C HT O R C H

S.M.F Obgin RSUDS.M.F Obgin RSUD

PekanbaruPekanbaru

Infeksi TORCHInfeksi TORCH

Definisi :Definisi :

TORCH adalah singkatan dari spesial TORCH adalah singkatan dari spesial

grup infeksi. grup infeksi. Yang apabila mengenai wanita hamil Yang apabila mengenai wanita hamil

dapat mempunyai dampak pada dapat mempunyai dampak pada janin dalam kandunganjanin dalam kandungan

T O R C HT O R C H

TToxoplasma infection , disebut oxoplasma infection , disebut ToxoplasmosisToxoplasmosis..

OOther infections seperti ther infections seperti Hepatitis B, Hepatitis B, Syphilis, Herpes Zoster, Varicella.Syphilis, Herpes Zoster, Varicella.

RRubella virus penyebab ubella virus penyebab campak campak JermanJerman

CCytomegalovirus, atau CMVytomegalovirus, atau CMVHHerpes Simplex virus, penyebab erpes Simplex virus, penyebab

herpes genitalisherpes genitalis

T O R C HT O R C H

Infeksi dapat terjadi pada semua orang, Infeksi dapat terjadi pada semua orang, semua golongan umur dan kelamin.semua golongan umur dan kelamin.

Istilah TORCH hanya khusus diberikan Istilah TORCH hanya khusus diberikan bila terkena pada wanita hamil atau bila terkena pada wanita hamil atau janin dalam kandungan dan janin yang janin dalam kandungan dan janin yang baru dilahirkan. baru dilahirkan.

Beberapa menyebabkan kelainan dan Beberapa menyebabkan kelainan dan kematian janin dalam kandungan.kematian janin dalam kandungan.

T O R C HT O R C H

Gejala pada wanita hamil ringan saja.Gejala pada wanita hamil ringan saja.Tapi menimbulkan kelainan yang Tapi menimbulkan kelainan yang

serius pada janin bila ibunya terkena serius pada janin bila ibunya terkena dalam kehamilan.dalam kehamilan.

Kelainan yang berat terjadi bila ibunya Kelainan yang berat terjadi bila ibunya kena pada trimester pertama kena pada trimester pertama kehamilan.kehamilan.

Dimana organ janin pada saat itu Dimana organ janin pada saat itu mulai tumbuh.mulai tumbuh.

T O R C HT O R C H

Gejala infeksi:Gejala infeksi:

Pada ibu : Pada ibu : Gejalanya mungkin ringan saja hanya Gejalanya mungkin ringan saja hanya

sedikit keluhan seperti layaknya sedikit keluhan seperti layaknya terkena penyakit virus yang lain.terkena penyakit virus yang lain.

Berdampak buruk pada janin dalam Berdampak buruk pada janin dalam kandungankandungan

T O R C H pada janin :T O R C H pada janin :

Mental retardationMental retardationGangguan belajar, sikap dan emosiGangguan belajar, sikap dan emosiMicrocephaly, ukuran kepala dan Microcephaly, ukuran kepala dan

otak lebih kecil dari normalotak lebih kecil dari normal Icterus, anemia, BBLRIcterus, anemia, BBLRButa, catarak, TuliButa, catarak, Tuli Jantung bawaanJantung bawaanGangguan kulit, rash, parut.Gangguan kulit, rash, parut.

KucingKucing

Kucing satu2nya hewan yang Kucing satu2nya hewan yang fesesnya dapat menularkan infeksi fesesnya dapat menularkan infeksi pd manusia. pd manusia.

Semua binatang dapat terkena Semua binatang dapat terkena infeksi toxoplasma bila makan infeksi toxoplasma bila makan daging terinfek si. daging terinfek si.

Kucing terinfeksi bila makan bajing, Kucing terinfeksi bila makan bajing, daging mentah, kecoa, lalat, atau daging mentah, kecoa, lalat, atau bila tertular kucing lain , kotoran bila tertular kucing lain , kotoran kucing, atau makanan yang kucing, atau makanan yang terinfeksi. terinfeksi.

Before pregnancyBefore pregnancy

testing for Toxoplasma antibodies when a testing for Toxoplasma antibodies when a woman is pregnant can be woman is pregnant can be complicatedcomplicated and and worrisomeworrisome

Because testing for toxoplasmosis infection Because testing for toxoplasmosis infection can be can be difficult to interpretdifficult to interpret, the test may , the test may need to be sent to a need to be sent to a special laboratoryspecial laboratory

Women planning to become pregnant Women planning to become pregnant should discuss with their doctors whether should discuss with their doctors whether they should have this they should have this blood test before blood test before pregnancy pregnancy

Prevention of ToxoplasmosisPrevention of Toxoplasmosis Previous exposure Previous exposure prevents congenitalprevents congenital

Toxo transmission - buy a cat ! Toxo transmission - buy a cat ! education education avoiding exposure to the parasite, mostly by avoiding exposure to the parasite, mostly by

simple hygienic measures. simple hygienic measures. avoid exposure to oocytesavoid exposure to oocytes

no cats or cat feces !no cats or cat feces ! no raw meat for you or your kitty !no raw meat for you or your kitty ! keep house cats inside - avoid stray cats !keep house cats inside - avoid stray cats ! let anyone empty the cat box !let anyone empty the cat box ! cover the kid’s sand box !cover the kid’s sand box ! wear gloves in the garden, wash your hands!wear gloves in the garden, wash your hands! wash all fruits and vegetables,wash all fruits and vegetables, wash hands carefully after handling raw meat, fruit, wash hands carefully after handling raw meat, fruit,

vegetables, and soilvegetables, and soil pregnant women should pregnant women should cookcook their meat until it is no longer pink their meat until it is no longer pink

and the juices run clearand the juices run clear

DrugsDrugsSpiromycin(rovamycin)Spiromycin(rovamycin) Daily for rest of pregnancyDaily for rest of pregnancy OR 3weeks ttt then 1 week rest then repeat for rest OR 3weeks ttt then 1 week rest then repeat for rest

of pregnancyof pregnancy OR 1 week ttt then 1 week rest then repeat for rest OR 1 week ttt then 1 week rest then repeat for rest

of pregnancyof pregnancy OR 3 weeks tttOR 3 weeks ttt

Treatment:Treatment:NO TTT in Asymptomatic Because it NO TTT in Asymptomatic Because it

is self limiting disease Exept in is self limiting disease Exept in children to prevent retinal children to prevent retinal inflammationinflammation

In healthy people, infection with In healthy people, infection with Toxoplasma gondiiToxoplasma gondii, leads to the production , leads to the production of sarcocysts in various tissues and of sarcocysts in various tissues and immunity to additional infections. Thus, an immunity to additional infections. Thus, an infected but asymptomatic person in good infected but asymptomatic person in good health generally does not need treatment. health generally does not need treatment.

TTT of pregnant women is TTT of pregnant women is controversy because of toxicity of controversy because of toxicity of medication but TTT is still advocatedmedication but TTT is still advocated

Congenital infectionsCongenital infections Conditions of transmissionConditions of transmission

[nfection during parasitemia – in unexposed mother with an [nfection during parasitemia – in unexposed mother with an active primary infection during pregnancy or previously active primary infection during pregnancy or previously exposeexposed d mother before pregnancy with immune compromise mother before pregnancy with immune compromise eg : (AIDS ) very rareeg : (AIDS ) very rare

tachyzoites cross placental barriertachyzoites cross placental barrier fetus becomes infected only about 40% of timefetus becomes infected only about 40% of time

the risk of the baby's infectionthe risk of the baby's infection depend partly upon the depend partly upon the timing of the mother's infection. timing of the mother's infection.

when mothers are infected in the when mothers are infected in the first trimesterfirst trimester, 15 percent , 15 percent of fetuses become infected,of fetuses become infected,

as compared to 30 percent in the as compared to 30 percent in the second trimestersecond trimester and 65 percent in the and 65 percent in the third trimester.third trimester.

severity of the baby's infectionseverity of the baby's infection the earlier in pregnancy the infection occurs, the more the earlier in pregnancy the infection occurs, the more

severe the fetal infection. severe the fetal infection. When the mother is infected between 10 to 24 weeks When the mother is infected between 10 to 24 weeks

gestation, the risk for severe problems in the newborn is gestation, the risk for severe problems in the newborn is about 5 to 6 percent. When the mother is infected late in a about 5 to 6 percent. When the mother is infected late in a pregnancy, the chance that the baby will have problems is pregnancy, the chance that the baby will have problems is very smallvery small..

Prenatal Management of Prenatal Management of Congenital ToxoplasmosisCongenital Toxoplasmosis

Identified acute maternal Toxo infectionIdentified acute maternal Toxo infection tested fetal blood for Toxo (culture/serology)tested fetal blood for Toxo (culture/serology)confirmed fetal CNS involvement (ultrasound)confirmed fetal CNS involvement (ultrasound)

spiromycin for acutely Toxo in affected motherspiromycin for acutely Toxo in affected motheradded pyrimethamine /sulfadiazine if fetus is added pyrimethamine /sulfadiazine if fetus is

affectedaffected TTT reduced congenital symptoms by 70%TTT reduced congenital symptoms by 70%

2 of 15 children infected 2 of 15 children infected in uteroin utero had chorioretinitis had chorioretinitis

(While these results are encouraging, the safety, (While these results are encouraging, the safety, effectiveness and feasibility of prenatal effectiveness and feasibility of prenatal toxoplasmosis screening, diagnosis and treatment toxoplasmosis screening, diagnosis and treatment are not yet established. For these reasons, in the are not yet established. For these reasons, in the United States, most pregnant women are not United States, most pregnant women are not screened for toxoplasmosis. )screened for toxoplasmosis. )

Congenital ToxoplasmosisCongenital Toxoplasmosis Two types:Two types:

Asymptomatic (inapparent) Congenital ToxoAsymptomatic (inapparent) Congenital Toxo 60% of infected60% of infected may suffer from Long Term Sequella may suffer from Long Term Sequella up to 90 percent of infected babies appear normal at birth, 80 up to 90 percent of infected babies appear normal at birth, 80

to 90 percent will develop sight-threatening eye infections to 90 percent will develop sight-threatening eye infections months to years after birth. About 10 percent will develop months to years after birth. About 10 percent will develop hearing loss and/or learning disabilitieshearing loss and/or learning disabilities

Symptomatic Congenital ToxoSymptomatic Congenital Toxo 40% of infected--About one in 10 infected babies has a severe 40% of infected--About one in 10 infected babies has a severe

Toxoplasma infection that is evident at birth. These newborns Toxoplasma infection that is evident at birth. These newborns often have severe eye infections, an enlarged liver and spleen, often have severe eye infections, an enlarged liver and spleen, jaundice (yellowing of the skin and eyes), pneumonia and other jaundice (yellowing of the skin and eyes), pneumonia and other problems. Some die within a few days of birth. Those who problems. Some die within a few days of birth. Those who survive sometimes suffer from mental retardation, severely survive sometimes suffer from mental retardation, severely impaired eyesight, cerebral palsy, seizures and other impaired eyesight, cerebral palsy, seizures and other problems. problems.

more likely if mother infected in 1st/2nd Trimestermore likely if mother infected in 1st/2nd Trimester Severe damage to fetus = stillbirth or abortionSevere damage to fetus = stillbirth or abortion

Treatment of Infected NewbornsTreatment of Infected Newborns Infected babies should be treated as Infected babies should be treated as

soon as possible after birth with soon as possible after birth with pyrimethamine and sulfadiazine pyrimethamine and sulfadiazine which, as mentioned earlier, can help which, as mentioned earlier, can help prevent or reduce the disabilities prevent or reduce the disabilities associated with toxoplasmosis. associated with toxoplasmosis.