How to test for Torch infections. Testing for TORCH infections during pregnancy

The abbreviation TORCH stands for as follows:

T - toxoplasmosis

O - other infections (others)

R - rubella (rubella)

C - cytomegalovirus infection (cytomegalovirus)

H - herpes (herpes simplex virus)

Toxoplasmosis

The pathogen was first isolated by Sh. Nicole and A. Manso in Tunisia from Gondi rodents ( Ctenodactylus gundi ) and A. Splendora in Brazil in rabbits (1908). The pathogenic importance of microorganisms for humans was proven by A. Castellani (1914), A.I. Fedorovich (1916). Fundamental research on toxoplasmosis in the USA was carried out by A. Sabin and his colleagues (1937-1955). The features of the inside of the cell have been studied

Etiology

The asexual development cycle of Toxoplasma occurs in the human body or various mammals.

Epidemiology

Reservoir and source of invasion - domestic cats and some representatives of the cat family (lynx, puma, ocelot, Bengal cat, jaguar, etc.), in whose body the pathogen goes through a full development cycle (tissue and intestinal) and is excreted in the form of oocysts with feces. In the soil, invasive stages - sporozoites - develop in them within 1-5 days. Cats shed the pathogen within an average of 3 weeks from the moment of infection. During this time, up to 1.5 billion toxoplasma enters the environment. About 1% of domestic cats excrete oocysts in their feces. Toxoplasma or traces of its presence have been found in more than 200 species of mammals and 100 species of birds. Mouse-like rodents and hares are especially often infected, among which toxoplasmosis takes on the character of an epizootic. By becoming prey for cats, rodents support the life cycle of Toxoplasma. Infection of animals occurs as a result of ingestion of mature oocysts containing sporozoites. Intermediate hosts of toxoplasma (dogs, farm animals), including humans, do not release the pathogen into the external environment and do not pose an epidemiological danger to others.

Transmission mechanism - fecal-oral, main transmission routes - food, water and household. It is possible to implement a contact path through microtraumas of the outer integument. The main transmission factor is raw or insufficiently heat-treated meat (minced meat) with toxoplasma cysts contained in it. Most often (from 10 to 25%) toxoplasma cysts contain lamb and pork. Additional transmission factors include poorly washed greens, vegetables, fruits (from the ground), and dirty hands. Less commonly, Toxoplasma infection occurs transplacentally (no more than 1% of diseases), through blood transfusions and organ transplants.

When the mother is infected in the first trimester of pregnancy, severe congenital toxoplasmosis develops in 15-20% of children. In a similar situation in the third semester of pregnancy, 65% of newborns are infected, but the invasion, as a rule, is asymptomatic. If a woman becomes infected before pregnancy (6 months or more), intrauterine infection does not occur. If infection occurs shortly before pregnancy, the risk of developing congenital toxoplasmosis is very small.

Natural sensitivity of people high, but clinical manifestations of invasion are noted in weakened individuals, as well as in individuals with acquired or congenital immunodeficiency. Toxoplasmosis is often an opportunistic infection in AIDS.

Due to the difficulties of recognizing a clinically pronounced, and even more so subclinically occurring infection, the true incidence of toxoplasmosis remains unknown. The prevalence or infection rate of the population of Russia with Toxoplasma is on average about 20%. The incidence is higher in regions with hot climates. Persons of certain professions (meat processing plants and fur farms workers, livestock breeders, veterinarians, etc.) are more often infected. The infestation rate in women is usually 2-3 times higher than in men, which explains the widespread habit of tasting raw minced meat.

Pathogenesis

Immunity for toxoplasmosis is non-sterile; the state of hyperthyroidism plays a significant role in its development. When immunity is formed in an infected person, cysts are formed that can persist in the body for decades or for life in calcified areas of tissue. Sensitization and hypersensitization reactions are of great importance in the pathogenesis of the disease.

These processes in most cases do not lead to the development of clinical manifestations of the disease (compensated primary latent form of toxoplasmosis). Sluggish chronic recurrent forms of toxoplasmosis, and even more so its acute severe course, are observed in no more than 0.5-1% of cases.

However, toxoplasmosis poses a particular danger to pregnant women. With intrauterine infection of the fetus in the early stages of pregnancy (1st trimester), miscarriages, stillbirths, or the development of developmental defects are possible in 40% of cases. When infested in late pregnancy, the child is born with a clinical picture of generalized toxoplasmosis.

Clinical picture

Acquired toxoplasmosis. In the clinical course, inapparent, chronic and acute forms are distinguished.

Inapparate form. The most common, but extremely difficult to diagnose

nostable. It is impossible to determine the length of the incubation period; for a long time the disease occurs without any clinical manifestations. Toxoplasmosis can be suspected only when its residual effects are detected - calcifications in various organs, sclerotic lymph nodes, decreased vision due to the formation of scar changes in the retina. The diagnosis is confirmed by serological tests.

Chronic form develops gradually; the disease becomes sluggish. Elevated, often subfebrile body temperature constantly persists for a long time or alternates with periods of apyrexia. Against this background, signs of chronic intoxication appear. Patients present numerous and varied complaints of progressive weakness, headache, poor appetite, irritability, memory loss, sleep disturbances, palpitations and heart pain, nausea, abdominal pain, etc. Characterized by muscle pain, sometimes restricting the patient's movements (specific myositis). Arthralgia is also possible.

Examination often reveals generalized lymphadenopathy with damage to various groups of lymph nodes, including mesenteric ones. In the dynamics of the disease, the lymph nodes are subject to sclerosis: gradually they become small, dense, their pain on palpation disappears or decreases. During palpation, painful compactions - calcifications - can sometimes be detected in the thickness of the muscles, which is confirmed by x-ray examination.

The development of pathological signs from the respiratory system is atypical. From the outside of cardio-vascular system tachycardia, arterial hypotension, and, in some cases, signs of myocarditis (displacement of the borders of the heart to the left, muffled tones, signs of heart failure) are detected.

More than half of the patients have hepatomegaly; liver functions are slightly impaired. An enlarged spleen is less common. Intestinal motility decreases (flatulence, constipation, abdominal pain on palpation).

Frequent involvement of the central nervous system in the process is accompanied by neurotic symptoms - emotional lability, irritability, suspiciousness, decreased ability to work, sometimes neurasthenic attacks and severe neuroses.

Eye lesions include chorioretinitis, uveitis, and progressive myopia.

Women experience menstrual irregularities, and men develop impotence.

Possible adrenal and thyroid insufficiency.

Acute form. Rarely encountered; it is distinguished by diverse manifestations. In some cases, polymorphic exanthema occurs without any other symptoms or in combination with the development of encephalitis and meningoencephalitis. A typhoid-like variant of the course of toxoplasmosis is also isolated, reminiscent of typhoid-paratyphoid diseases in its clinical manifestations.

A rare generalized acute toxoplasmosis with high fever and other signs of intoxication, the development of hepatolienal syndrome, myocarditis, encephalitis and meningoencephalitis is very difficult. The prognosis for the condition is unfavorable.

Congenital toxoplasmosis. It can occur in inapparent, acute and chronic forms.

Inapparate form. Clinically similar to a similar form of acquired

nogo toxoplasmosis.

Acute form. Relatively rare; manifests itself in the form of generalized

bathroom, severe disease. High fever and other signs of severe intoxication are noted. Upon examination, one can detect exanthema of a maculopapular nature, enlarged lymph nodes, the presence of hepatolienal syndrome, and often jaundice. Severe damage to the central nervous system in the form of encephalitis and meningoencephalitis is possible. In the dynamics of the disease, children with congenital toxoplasmosis develop characteristic clinical manifestations: chorioretinitis, calcifications in the brain, determined by X-ray examination, hydrocephalus, decreased intelligence, convulsive epileptiform syndrome.

Chronic form. It is often asymptomatic and may only appear

a few years later in the form of oligophrenia, chorioretinitis, episyndrome.

Differential diagnosis

Complex due to the variety of clinical variants of the disease. Signs of the disease such as prolonged, often low-grade, fever, persistent manifestations of intoxication, lymphadenopathy, liver enlargement, changes in the myocardium, calcifications in the muscles and brain, and foci of chorioretinitis are of greatest diagnostic importance. If the clinical and laboratory picture of any infectious disease is unclear, it is necessary to conduct tests for the presence of toxoplasma. In addition to clinical dynamic observation of the patient, studies should include the entire range of necessary laboratory and instrumental diagnostic methods (ECG, radiography of the skull and muscles, fundus examination, etc.).

Laboratory diagnostics

In the hemogram, especially in chronic toxoplasmosis, leukopenia, neutropenia, relative lymphomonocytosis and normal ESR values ​​can be noted.

To determine specific AT, RSK is performed with toxoplasma Ag, RNIF and ELISA. Positive laboratory test results can confirm the diagnosis of acute or chronic toxoplasmosis only in combination with clinical manifestations. In the inapparent form of the disease, the determination of specific IgM and IgG over time is of particular importance. Negative results rule out toxoplasmosis.

The most evidence-based, but rarely used in practice, is the detection of toxoplasma in preparations prepared from biological fluids and body fluids: blood, cerebrospinal fluid, punctate lymph nodes and tonsils, amniotic fluid, placenta, etc. A positive test result is absolute confirmation of invasion.

The most accessible diagnostic method is a skin test with toxoplasmin. The test is positive starting from the 4th week of the disease and persists for many years. A positive result is not evidence of illness, but only indicates a past infection and the need for a more thorough examination.

Treatment

In acute toxoplasmosis, the basis of therapy is the use of etiotropic drugs - chloridine (Daraprim) 25 mg 3 times a day for 5-7 days in combination with sulfadimezine (2-4 g/day for 7-10 days). For children, chloridine is prescribed at a rate of 0.5-1 mg/kg. 2-3 courses of treatment are carried out at intervals of 10-15 days. The most effective is considered to be a continuous course of chloridine (100 mg on the first day of treatment and 25 mg/day on subsequent days) and sulfadimezine (4 g/day) for 3-4 weeks.

For congenital toxoplasmosis, children are prescribed chloridine 1 mg/kg/day in the first 3 days, then 0.5 mg/kg/day, sulfadimezine 100 mg/kg/day.

In case of toxoplasmosis, other drugs also exhibit an etiotropic effect - de-lagil (Chingamine, Chloroquine), metronidazole (Trichopol, Klion), sulfapyridazine and sulfadimethoxine, co-trimoxazole, tetracyclines, lincomycin, erythromycin.

In case of chronic toxoplasmosis, a 5-7-day course of chemotherapy with hingamine or delagil is carried out in combination with tetracycline and folic acid up to 0.01 g/day in between cycles of etiotropic treatment. In addition, antihistamines are simultaneously used for desensitization.

In case of fresh infection, pregnant women are given 1-2 courses of chemotherapy, but not earlier than the second trimester of pregnancy, since the use of many etiotropic drugs can cause disturbances in the development of the fetus.

Epidemiological surveillance

Based on an assessment of the prevalence of infestation among domestic animals (primarily cats) and people. An important role is played by the analysis of the ratio of infestation and morbidity rates among various socio-age groups of the population with the identification of risk factors for infection.

Preventive actions

Prevention of acquired toxoplasmosis includes the following measures.

1. Preventing the possibility of infection from cats (limiting contact with infected domestic cats, combating stray cats).

2. Neutralization of transmission routes of infection [eating only properly heat-treated meat products, avoiding tasting raw minced meat or raw meat, eating cleanly washed vegetables, herbs and fruits (from the ground), thoroughly washing hands after handling raw meat, when contact with the ground, in children after playing on the playground, especially in the sandbox].

Prevention of congenital toxoplasmosis includes measures to prevent infection of women during pregnancy (avoid contact with cats and tasting raw minced meat, wash your hands after preparing raw meat dishes, etc.). Special measures should include medical examination of pregnant women at risk (persons who react negatively to toxoplasmosis, i.e. non-immune). Throughout pregnancy, at intervals of 1-2 months, they are examined immunologically. For this purpose, RSK, RNIF, ELISA, etc. are used. Identified primary seronegative women are prescribed emergency preventive treatment. Children born to these women are subject to mandatory clinical and serological examination for toxoplasmosis and, if indicated, treatment. Children born to mothers with a clearly established primary infection during pregnancy are monitored until the age of 10, including regular clinical and immunological examinations in order to identify symptoms of congenital toxoplasmosis, which could be asymptomatic at birth.

Prevention of Toxoplasma lesions in persons with HIV infection includes screening of HIV-infected persons for the presence of latent endogenous infection and preventive treatment of infected persons.

There are no specific means of preventing toxoplasmosis.

EventsVepidemic focus

They don't.

Rubella [ rubeola )

Rubella (“German measles”) is an anthroponotic viral infection with generalized lymphadenopathy and small-spotted exanthema.

Brief historical information

The clinical differences between rubella and scarlet fever and measles were first described by I. Wagner (1829); Since 1881, rubella has been considered an independent nosology. The viral nature of the infection was proven by Hiro and Tasaka (1938). The pathogen was isolated by P.D. Parkman, E.H. Weller and F.A. Neva (1961). The teratogenic effect was established by N.M. Gregg (1941), R.A. Kantorowicz et al. (1973), O.G. Andzhaparidze and T.I. Chervonsky (1975).

Etiology

The causative agent is an RNA genomic virus of the genus Rubivirus families Togaviridae . All known strains belong to the same serotype. In the external environment, the virus is quickly inactivated under the influence of ultraviolet rays, disinfectants and heat. At room temperature, the virus persists for several hours and tolerates freezing well. It exhibits teratogenic activity.

Epidemiology

Reservoir and source of infection - a person with a clinically pronounced or erased form of rubella. The patient releases the virus into the external environment 1 week before 1 the appearance of the rash and within 5-7 days after the appearance of the rash. Big epi- 1 children with congenital rubella have demiological significance. With the latter, the pathogen is detected in the mucus of the nasopharynx and urine (less often in feces) for several weeks, sometimes up to 12-20 months.

Transmission mechanism - aerosol, transmission path - airborne. For infection, longer and closer contact with the patient is necessary than with measles and chickenpox. There is a vertical route of transmission (transplacental transmission of the virus), especially in the first 3 months of pregnancy. Hands and care items are not of epidemiological significance. The exception is toys, which can be used to transmit the virus from mouth to mouth among young children.

Natural susceptibility to infection high. Serological surveys indicate a large percentage (30% or more in some regions of the country) of seronegative women of childbearing age, especially at the age of 20-29 years. The results of a serological examination of pregnant women in Moscow indicate a high susceptibility of women of childbearing age to the rubella virus, especially in age group 20-29 years old (from 8 to 30% seronegative were identified in different years). When examining 1,550 pregnant women in Moscow who found themselves in foci with a risk of infection, 181 seronegative women (11.7%) were identified, 18 of them contracted rubella. Selective serological studies conducted among the child and adolescent population of the city showed that from 59.5 to 42.1% of people of this age are not protected from rubella. Specific ATs to the virus among this age group were detected on average in 46.6% of cases, and only in half of the cases in a high titer (1:800-1:3200). Only by the age of 16-18 years, 2/3 of the examined children and adolescents (71-72%) had protective AT titers to the rubella virus.

Basic epidemiological signs. Rubella is one of the infections that can be eliminated in the near future, according to the WHO program. In a number of countries (USA, Sweden, etc.) it is detected at an extremely low level. Given the health significance of congenital rubella syndrome, the 48th session of the WHO Regional Committee for Europe (1998) included rubella among the infections that will determine the goals of the Health for All in the 21st Century program. By 2010, the incidence of congenital rubella syndrome should be reduced to less than 0.01 per 1000 births.

In the pre-vaccination period, rubella with a high incidence was recorded everywhere. Due to the absence to date of a widespread immunization program for the population in Russia, a tendency towards an increase in morbidity is noted. According to WHO, of all rubella cases registered in Europe, 83% occur in the CIS countries, with 57% of them in the Russian Federation. Rubella is characterized by periodic increases in incidence: moderate (every 3-5 years) and more intense (every 10-12 years). IN last years a shift in incidence to older ages has been noted: mainly schoolchildren and women of childbearing age are affected. They note a high incidence in organized preschool and school groups, among students of secondary and higher educational institutions. The incidence increases significantly in spring and summer.

Rubella is considered to be a mild disease. However, this definition is valid for the course of this infection in children. The disease in adults is characterized by a more severe course (often accompanied by prolonged fever, articular syndrome, and the development of organ pathology). Congenital rubella poses a particular problem. When pregnant women are infected, it can cause serious complications and the birth of a child with various severe developmental defects. According to various authors, the risk of developing congenital defects (vision, hearing, cardiovascular system, etc.) ranges from 12 to 70%, or 10% of the total number of congenital anomalies. When infected in the first 3 months of pregnancy, fetal infection develops in 90% of cases. In addition, it has been established that with congenital rubella, late complications (panencephalitis, diabetes mellitus, thyroiditis) can also develop. The adverse effect of rubella infection on the fetus is also manifested by spontaneous abortions (10-40%), stillbirth (20%) and death in the neonatal period (10-25%).

Of particular concern is the steady increase in the incidence of morbidity in women of childbearing age, resulting in an increase in the number of cases of congenital rubella syndrome, which manifests itself as congenital deformities. The number of cases of congenital rubella syndrome averages 0.13% of all diseases. According to WHO, rubella kills only about 300,000 children every year. The cost of treating and maintaining a child with congenital rubella syndrome is, according to conservative estimates, about $200,000. At the current level of rubella incidence in the Russian Federation, at least 360 cases of congenital rubella should be registered annually. However, registration of cases of congenital rubella in the country is practically not carried out.

Pathogenesis

Due to the lack of an experimental model for reproducing rubella, the pathogenesis of the disease has been little studied. Infection occurs through the mucous membranes of the upper respiratory tract, infection through the skin is possible. Following this, the virus penetrates the regional lymph nodes, where it reproduces and accumulates, which is accompanied by the development of lymphadenopathy. Subsequent viremia with hematogenous dissemination throughout the body occurs during the incubation period. The pathogen, having a tropism for the epithelium of the skin and lymphatic tissue, settles on the epithelium of the skin and in the lymph nodes. Viremia usually ends with the appearance of exanthema. At this time, virus-neutralizing antibodies are already detected in the blood of patients; subsequently, their concentration increases, and the developing immune reactions lead to the elimination of the pathogen from the body and recovery. After an illness, AT persists for life, which ensures the stability of post-infectious immunity.

When rubella develops in pregnant women during the period of viremia, the pathogen with the blood of the pregnant woman easily overcomes the placental barrier and infects the fetus. At the same time, due to viral damage to the endothelium of the blood vessels of the placenta, the nutrition of the fetus is disrupted. By damaging the genetic apparatus of cells, the virus selectively suppresses the mitotic activity of individual cell populations of the embryo and, possibly, has a direct cytopathogenic effect on them. This leads to slower growth and disruption of the normal formation of fetal organs with the subsequent development of congenital defects. The impact of the virus on embryonic tissues at different stages of pregnancy is ambiguous; it turns out to be most pronounced in relation to organs and systems that are at the stage of infection in the process of active formation.

Therefore, the widest range of fetal malformations occurs when infected in the early stages of pregnancy.

Clinical picture

Incubation period is the same in children and adults and lasts 10-25 days. Subsequent catarrhal period in children, as a rule, it is not expressed; in these cases, the diagnosis of rubella can often be established only after the appearance of exanthema. In adults during this period, there may be an increase in body temperature (in severe cases up to high numbers), malaise, headache, myalgia, loss of appetite. Catarrhal phenomena can be expressed in the form of a slight runny nose and dry cough, a sore throat, photophobia and lacrimation. On examination, some patients are found to have conjunctivitis and redness of the mucous membrane of the pharynx. Enlargement and tenderness of the lymph nodes, especially the occipital and posterior cervical ones, are equally characteristic of both children and adults, but this symptom is not found in all patients. Subsequently, lymphadenopathy persists for quite a long time (up to 2-3 weeks). The duration of the catarrhal period is 1-3 days.

Then comes period of exanthema; manifestations of this main syndrome develop in 75-90% of patients already on the first day of illness, while rashes are more often observed in children. The elements of the rash are round or oval pink or red small spots with smooth edges (Fig. 11, see color insert). They are located on unchanged skin and do not rise above its surface. In adults, the rashes tend to merge; in children, they rarely merge. Sometimes the appearance of a rash is preceded by itchy skin. Initially (but not always), elements of the rash appear on the face and neck, behind the ears and on the scalp. Then, during the day, they spread to various parts of the body without a specific pattern. The location of the rash is especially typical on the back, buttocks and on the extensor surfaces of the upper and lower extremities. There is no exanthema on the soles and palms. In some cases, simultaneously with exanthema, one can note the appearance of enanthema on the mucous membranes of the oral cavity in the form of small single spots (Forchheimer spots). In adult patients, the exanthema is more abundant and longer lasting; its elements can merge, forming erythematous fields. The confluent nature of the rash, as well as its absence in some patients (in 20-30% of cases, according to the literature) make it extremely difficult to make a clinical diagnosis.

During exanthema, body temperature may remain normal or rise slightly. Enlarged and moderately painful peripheral lymph nodes are clearly visible in all areas accessible to palpation, but especially in the occipital, parotid and posterior cervical areas. Some patients complain of joint and muscle pain. In some patients, dyspeptic symptoms, enlargement of the liver and spleen are noted, and in women - signs of polyarthritis. Typically, manifestations of exanthema last no more than 4 days. The rash can fade quickly and disappear without a trace.

Summarizing the differences in the clinical manifestations of the disease in children and adults, we can once again note that the course of rubella in adults is generally similar to its manifestations in children. At the same time, in adults, the symptoms of the catarrhal period are more pronounced and prolonged, the disease is much more severe, the rash is usually more abundant, its elements can merge, which makes differential diagnosis difficult. The manifestation of one of the leading syndromes of the disease - lymphadenopathy - in adults occurs slowly and gradually; in some patients this syndrome may be absent altogether. The frequency of clinically evident rubella and asymptomatic infection in children is correlated as 1: 1 , in adults - 1:2.

Differential diagnosis

Rubella is differentiated from measles, scarlet fever, allergic exanthems and enteroviral infections.

With rubella, the catarrhal period is not expressed or expressed moderately. Characterized by enlargement and pain of the lymph nodes, especially the occipital and posterior cervical ones. Exanthema develops in most cases already on the first day of illness and quickly (within 24 hours) spreads to various parts of the body. The location of the rash is especially typical on the back, buttocks and extensor surfaces of the upper and lower extremities. In adults, the rash may be confluent or absent, which makes it extremely difficult to make a clinical diagnosis.

In pregnant women who have been in contact with a person with rubella, suspicion of this disease should arise in all cases when even minimal clinical manifestations develop between the 15th and 21st days after contact.

Laboratory diagnostics

A hemogram for rubella often reveals leukopenia, lymphocytosis, and increased ESR. Plasma cells are sometimes found in adults. In general, changes in the hemogram are subject to significant fluctuations depending on the age of the patients and the severity of the disease.

Serological diagnosis of rubella is carried out using RTGA, RSK, ELISA and RIA in paired sera with an interval of at least 10 days. However, the results are of value only for retrospective confirmation of the diagnosis. It is advisable to determine the concentration of antiviral IgM and IgG. In pregnant women, these studies, as well as the staging of the blast transformation reaction of lymphocytes, must be carried out to establish infection and the possibility of transmission of the virus to the fetus. The first test of the blood serum of a pregnant woman who has been in contact with a patient with rubella is carried out as early as possible, but no later than the 12th day after contact. In this case, the detection of AT, predominantly IgG, indicates a previous illness and the possibility of continuing pregnancy. The absence of AT in the first serum and their appearance in the blood (mainly IgM) when re-examined after 10-12 days indicates an active infection with a risk of damage to the fetus.

Complications

Complications are rarely observed. Among them, the most common are pneumonia, otitis, arthritis, and sore throats; thrombocytopenic purpura occurs less frequently. The development of complications is usually associated with the addition of secondary bacterial infections. Severe encephalitis, meningoencephalitis and encephalomyelitis are observed extremely rarely (mainly in adults). Rubella in pregnant women has no specific differences in the clinical picture and does not pose a serious danger to the expectant mother, but the fetus is at great risk, since the formation of various malformations and intrauterine diseases is possible (cataracts, deafness, heart defects, microcephaly, hepatitis, pneumonia , meningoencephalitis, anemia, etc.). The possibility of giving birth to a child with congenital rubella syndrome when a woman becomes ill at 3-4 weeks of pregnancy is realized in 60% of cases, at 9-12 weeks - in 15%, at 13-14 weeks - in 7% of cases.

Treatment

For uncomplicated forms, symptomatic therapy is prescribed; it can be done at home. Most patients do not require active therapeutic measures. In more severe cases, pathogenetic and symptomatic drugs are used (see Special Part, Chapter 3, section “Measles”).

Epidemiological surveillance

They monitor the manifestations of the epidemic process, the structure of the immune layer, and identify risk groups for embryopathies (women of childbearing age who do not have AT to the rubella virus).

Preventive actions

Until recently, vaccination against rubella was not carried out in the Russian Federation. In accordance with the order of the Ministry of Health of the Russian Federation No. 229 dated June 27, 2001, vaccination against rubella is included in the national compulsory vaccination calendar. Unfortunately, the tactics and strategy for vaccinating women of childbearing age have not yet been determined. For specific prevention, live vaccines have been developed and successfully used in a number of countries, usually including measles and mumps viruses in addition to the rubella pathogen. There are also mono-vaccines. Children aged 15-18 months and girls aged 12-14 years are subject to vaccination. Widespread vaccination has made it possible to sharply reduce the incidence of rubella and prevent the development of congenital rubella. In the USA, vaccination against rubella has been carried out since 1969. Over the years, the incidence has been reduced to isolated cases; congenital rubella is almost completely absent. The following foreign vaccines containing the live attenuated strain of the Wistar RA 27/3 virus have been registered and approved for use in Russia: mumps-measles-rubella vaccine MMR-2 (Merck Sharp Dome, USA), recently registered Priorix vaccine (Smith Klein Beecham), mumps -rubella vaccine RUVAX and rubella vaccine RUDIVAX (Aventis-Pasteur, France).

In order to really begin the fight against rubella, it is necessary to find funds to purchase a vaccine. Despite certain costs, they will fully pay for themselves in the near future. It is known that for 1 US dollar invested today in vaccination against rubella, 7.7 dollars are currently spent on fighting this disease. The economic effect doubles if a trivaccine (measles-rubella-mumps) is used.

Many years of experience show that the most promising program is one that combines double immunization of children aged 12-16 months and 6 years with the associated measles-rubella-mumps vaccine with subsequent revaccination against rubella in adolescent girls and women of childbearing age. The use of an associated vaccine makes it possible to simultaneously reduce the number of adolescents susceptible to measles, since most of them at the age of 6-7 years did not receive a second dose of LCV. The fact that some adolescents will receive a third dose of VIV or JIV with the trivaccine should not be a cause for concern. This circumstance can also increase AT titers in individuals with “secondary vaccination failure.”

Modeling of the epidemic process with different vaccination regimens showed that vaccination of children of the 2nd year of life can suppress the transmission of rubella and, therefore, significantly reduce the risk of rubella in pregnant women only when more than 80% of those subject to vaccination are covered. The task of eliminating congenital rubella should become a matter of honor for practical health authorities.

Events in the epidemic outbreak

Those sick with rubella are subject to isolation until the 5th day from the moment the rash appears. No restrictive measures are provided for persons who communicated with them; quarantine is not imposed on groups of children's institutions. As an emergency prophylaxis, children and pregnant women who interacted with the patient are administered anti-rubella immunoglobulin. In order to prevent secondary cases of the disease in the outbreak, the following categories of persons (aged 12 months to 35 years) from among those who interacted with the patient are subject to vaccination (re-vaccination) within 72 hours from the moment the first patient is identified:

Have not previously had rubella and have not been vaccinated against it;

have not had rubella before and have been vaccinated against it once (if no more than 6 months have passed since the vaccination);

persons with an unknown infectious and vaccination history for rubella.

Pregnant women in the first trimester of pregnancy are isolated from the patient for 10 days from the onset of the disease (temporary move to another apartment, transfer to another job from children's group etc.) and carry out their serological examination over time: the first sample is taken in the first days of contact, but no later than the 10th day, the second - 2 weeks after contact is established. If women become ill in the first 3 months of pregnancy, it is recommended to terminate it. Dispensary observation is carried out for children with a congenital form of infection. Surveillance includes regular serological and virological studies. Final disinfection of the fireplace is not carried out.

As you know, toxoplasmosis and herpes can be found in almost the majority of the population. Many have immunity to rubella and infection with cytomegalovirus. Therefore, if a person does not have any clinical manifestations of diseases, then there is absolutely no need to take a test for TORCH infection. But there are several recommendations for conducting analysis:

• pregnancy planning;
• pregnancy;
• clinical manifestations of diseases;
• Diagnosis of the fetus for possible infection.

Thanks to the tests, it will be possible to find out for sure whether there is an infection with one or more of the TORCH. It also helps to understand how to treat the disease and how to act in case of infection. a certain person. After all, pregnant women who have not previously encountered these viruses are the most vulnerable to them.

The need for tests for pregnant women

During pregnancy or just planning it, every woman gets tested. This is a necessary and important study, because it helps to identify the presence of diseases that are dangerous for the unborn baby. TORCH includes the following diseases:

• toxoplasmosis;
• rubella;
• cytomegalovirus;
• herpes.

The danger of these infections is primarily for the child. If a woman is in different period During pregnancy, if at least one of them becomes infected for the first time, this will lead to undesirable consequences for the child. Besides the anomalies intrauterine development, the risk of miscarriages increases and stillbirths occur. This is why a blood test for the TORCH complex is so necessary during pregnancy.

The danger of toxoplasmosis

The disease is experienced once in a lifetime and is so mild that it can be completely unnoticed. It is really trivial for an ordinary person, but very insidious for a pregnant woman.

You can only get this infection from cats, because toxoplasma multiplies in their intestines. Subsequently, their eggs are excreted in feces and released into the external environment. You can even get infected from a cute pet while cleaning up after it in the litter box.

The risk for a pregnant woman is only during primary infection. If a woman has had this disease before, then there is nothing to worry about. But having met it for the first time during pregnancy, there is a high possibility of infecting the baby in utero.

Infection with toxoplasmosis most often occurs from an infected cat, which is the definitive host of toxoplasma and transmits it through its feces

When infected in the first trimester, developmental defects most often occur that are completely incompatible with life. Therefore, a miscarriage or frozen pregnancy occurs. Infection in the second trimester causes damage to the brain, central nervous system, and eyes. If infected late in pregnancy, a baby may be born with congenital toxoplasmosis, which may appear several months or years later.

Rubella and its consequences for a pregnant woman

IN childhood This infection is mild, but during pregnancy it is incredibly dangerous. Rubella is often transmitted vertically and leads to dire consequences.

It poses a danger to the young embryonic tissue of the unborn child. Therefore, disturbances occur during fetal development. The most common of these will be heart disease, vision and hearing problems. Damage to the brain, genitourinary system, and skeleton is also possible.

Rubella - insidious infection, which can lead to the most dire consequences for the unborn child in case of illness in a pregnant woman for up to 16 weeks

When the fetus was infected, but there were no developmental defects, the child is born with less weight and subsequently lags behind in physical development.

The rubella virus affects not only the fetus, but also the placenta. Therefore, it becomes infected and the metabolism is disrupted. And this leads to miscarriages, stillbirths and early infant mortality. Children can be born with congenital rubella and must undergo a thorough examination. In the future, he is constantly monitored by specialists.

Cytomegalovirus and pregnancy

If you first become infected during pregnancy, the infection is dangerous for a woman. Her immune system has no response to the infection and the virus passes through the placenta to the baby. The risk of infection reaches 50%. If a woman had the virus before pregnancy, the risk will be only 2% of cases.

When a woman becomes ill in the first half of pregnancy, fetal development pathologies develop and miscarriages occur. If infection occurs on later, then developmental anomalies do not occur. But congenital cytomegaly of the fetus is possible, and premature birth may begin. Polyhydramnios often occurs in pregnant women.

A child born with cytomegaly has an enlarged liver, anemia and pronounced jaundice. Serious damage to the central nervous system, vision, hearing, and dropsy of the brain are possible.

The danger of herpes

Of types 1 and 2 of herpes, the second is more dangerous. When the infection first enters the body during pregnancy, the possibility of infection for the fetus is about 75%. In this case, the virus begins to multiply in the tissues of the unborn child. It gets in the way normal development and the result is defects of various organs, deformity, and brain damage. When the infection was late in pregnancy, doctors recommend allowing birth by cesarean section.

Sometimes a recurrence of herpes occurs during pregnancy. There is no need to worry, because there are already antibodies that help and prevent the virus from harming the child. But if there is a relapse before childbirth, a cesarean section is prescribed. This will help protect the fetus from infection.

Where can I get tested?

Typically, pregnant women are seen by a doctor, so he himself will issue a referral for testing. He can also tell you how to get tested and recommend a specific clinic or diagnostic center. But finding them on your own is not worth the effort for anyone.

Testing for these infections can be done in any clinic or laboratory. Today there are quite a lot of them and there is no need to wait in line for a long time. You just need to donate blood for TORCH infection, wait for the test results and get an answer.

Why do a test before pregnancy?

It is recommended to take a blood test for TORCH infection before pregnancy. It is most convenient to do this a few months before the planned pregnancy. A woman simply needs to know which infections she has already had and which ones she has not encountered yet. This will help in advance and have time to take all therapeutic measures to eliminate the disease or for prevention. There is no need to worry that medications may harm the child.

Also, if antibodies to TORCH viruses are detected, a woman will know for sure that she has already had these diseases and she may not worry in the future, freely planning a pregnancy.

If the analysis indicates that antibodies have been detected, then the woman should pay attention to preventive measures. Vaccination will help against some viruses. It is also recommended to strengthen the immune system, avoid infected people and stay healthy.

Study during pregnancy

It is recommended to test for TORCH infection during pregnancy. If the woman has not done it before, it’s not scary. Testing is done at the beginning of pregnancy. This is done to ensure timely detection of the disease and take all appropriate measures.

This necessary analysis is done at such a time so that in the event of a primary infection there is time for treatment. Also, in case of severe damage to the fetus and its developmental anomalies, a woman will be able to have an abortion without supporting the non-viable fetus. Otherwise, her body will simply provoke a miscarriage.

Methods of analysis

Recently, ELISA and PCR have become increasingly common methods for diagnosing TORCH. The first analysis is carried out by ELISA. It is based on the search for antibodies to viruses. If a positive result is obtained for one or more pathogens, additional research is necessary. They help to accurately determine the activity of the infection.

Most often, ELISA is used to search for antibodies to viruses, as well as PCR to search for DNA of viruses. Polymerase chain reaction helps to detect even the smallest amount of them. The method is capable of detecting them in any biological environment. In addition, the method helps to identify their type.

But each method has its own characteristics. So PCR will not distinguish the acute form from virus carriage. Therefore, it is more convenient for them to use ELISA.

If the results of the analysis are difficult to interpret correctly, then the study must be repeated. In cases where a questionable analysis was obtained during pregnancy, time is very valuable. Therefore, they can use the immunoblot method, which will give the most accurate result. After all, during pregnancy you need to act very accurately and quickly to save the child.

Interpretation of analyzes

The main informants will be IgG and IgM immunoglobulins. They will appear in the body at different stages diseases. Therefore, they help to see the absence or presence of the virus.

IgG immunoglobulin will tell you that a person has already encountered the disease at some point and has developed an immune response to the pathogen. Antibodies usually appear in about a couple of weeks and remain for life.

Immunoglobulin IgM will show the presence in the body acute form illness or will tell you about something recently suffered.

If the two values ​​are negative, then there are no antibodies to the pathogen and the person is not currently suffering from this disease. With two positive values, the person has antibodies, but is currently ill or has only recently been ill. If IgG is positive and IgM is negative, then there are antibodies and this is not dangerous for pregnancy. If IgG is negative and IgM is positive, the body is currently infected.

Don't immediately panic when you see positive results and rush to terminate the pregnancy. It is necessary to carefully consider everything, because the presence of antibodies to these diseases, on the contrary, helps to protect the unborn child of a pregnant woman. If they are not, then you will have to take all preventive measures.

What to do in case of acute infection from TORCH

First of all, do not panic and be sure to consult a doctor. He will identify all the risks, carefully study the test results and tell you about further actions. If the woman is not pregnant, then she will simply treat the infection as expected. The drug and dosage will be selected individually for her. The same applies to men and children.

If a woman is pregnant, the doctor will definitely warn you about possible consequences and prescribe treatment appropriate for this period. To make sure everything is okay with the baby, a woman can do an ultrasound. But this takes some time, because immediately problems with the placenta, developmental anomalies or organ defects may not be visible due to the onset of the disease. She will be monitored throughout the pregnancy and all measures will be taken to prevent adverse consequences.

At the slightest discomfort, a pregnant woman should immediately consult a doctor, since TORCH infections are very insidious and often their symptoms are similar to ARVI

You cannot choose your own treatment, especially during pregnancy. This can negatively affect the fetus, the woman’s health, and the course of the disease. Only individually selected drugs for the characteristics of the body and precise dosage will help cope with the infection. The doctor will tell you how many days to take the medicine, when to stop and visit him again to check your well-being.

Prevention

Ideally the most the best prevention there will be a transfer of TORCH infections in a certain period. Typically, most people have had these diseases and have already developed immunity to them. Therefore, in the future, no prophylaxis will be needed, even for pregnant women. They don’t have to worry about the development and health of their baby, but have a great time during this wonderful period. Naturally, you need to treat yourself more carefully and not deliberately run into people with various infections. There is no need to stand around and wait for the next infection.

If these infections could not be transferred earlier, then you need to be careful at this time and not come into contact with infected people. Some people get vaccinated before pregnancy, which helps them acquire at least some immunity. Then the pregnancy goes smoother, and the woman does not worry.

The most serious test for a woman’s body is the period of pregnancy, during which the chronic diseases and infections easily attach to a weakened body. Some infections are considered relatively harmless, for example, acute respiratory infections. There is a group of infections that are regarded as dangerous to the health of a pregnant woman and fetus; this group includes TORCH - infections (TORCH complex). Under each letter of the abbreviation TORCH, the names of infectious diseases are encrypted, the decoding of which is as follows:

• T – toxoplasmosis
• O – the following infections are encrypted: HIV, chicken pox, hepatitis B, C, syphilis, chlamydia, gonococcal infection, etc.
• R – rubella
• C – cytomegalovirus infection

TORCH - infections differ in specificity negative impact during embryonic development on the formation of organs and systems of the fetus. This complex of infections can lead to intrauterine death fetus, cause abnormalities in its development. There is a high chance of giving birth to a child with developmental defects of the nervous and cardiovascular systems. If during pregnancy tests and Clinical signs prove that a woman has a TORCH complex, then very often the woman is offered.

Planning pregnancy involves taking blood tests in order to determine TORCH - a complex, or rather antibodies to infection. If before a woman’s pregnancy, antibodies to the above infectious diseases are detected in her blood, then she can become pregnant without fear for the health of the child.

Toxoplasmosis

Toxoplasmosis is a widespread disease, which, according to statistics, affects a third of the population of our planet. The causative agent of the disease is toxoplasma. Its owners are cats. In their body, Toxoplasma multiplies, develops and is transmitted to humans, often through dirty hands. With good immunity, a person suffers from a mild form of the disease. Having been ill once, a strong immunity is formed for life. For pregnant women the most dangerous period are the first 12 weeks, when the placenta is not formed. It is during the period of embryonic development that Toxoplasma affects the rudiments of the brain, eyes, liver and spleen. The longer the pregnancy period during which Toxoplasma infection occurred, the less chance there is of possible deformities in the unborn child.

1. Limit contact with animals, especially cats;
2. If there is a cat living in the house that is allowed outside, then the woman during pregnancy should only care for her while wearing gloves;
3. Fruits and vegetables should be washed in a weak solution of soda, then rinsed with water and only then eaten;
4. Meat and products made from it must be well cooked.

Rubella

Another dangerous disease representing the torch complex is rubella. The disease is of an infectious nature, transmitted through the air when talking, coughing, etc. Rubella is a relatively “harmless” disease that most often affects children. For them it proceeds without complications. Clinically, the disease manifests itself as a small rash all over the body and fever. Transferred rubella leaves stable immunity.

What is the danger of rubella for pregnant women? The infection, penetrating the body of the expectant mother, causes a teratogenic effect on fetal tissue. In the first three months, the virus affects the heart muscle, nervous tissue, and also affects hearing and vision. In the second and third trimester, the virus is not so dangerous, but the disease is manifested by the child’s retardation in growth and physical development.

Pregnancy is terminated only in the first trimester; in the second and third, restorative therapy is prescribed, aimed at preventing placental insufficiency. If a woman gets rubella during the 9th month of pregnancy, she may give birth to a child with clinical manifestations he has illnesses. A woman who is planning a pregnancy, for her own peace of mind, needs to take blood tests two months before.

If a woman was not sick in childhood or was not vaccinated, when planning a pregnancy is the time to get vaccinated. 2 months after repeated blood tests, when there is no danger to the fetus, a woman can safely try to get pregnant. Testing is considered mandatory if during pregnancy a woman has been in contact with a person with rubella.

By the way, I would like to add about medications, which, just like TORCH, infections can have a detrimental effect on the fetus. For example, the drug baklosan (synonym baclofen), which is prescribed for neurological diseases, eliminates spasms and convulsions and is absolutely contraindicated during pregnancy. Baklosan (baclofen) causes fetal malformations, and early stages may cause his death. The same applies to most medications, the effect of which can be compared to a torch infection. Some drugs can only be used with caution, for example, phenibut, which is available in tablets. Phenibut is a low-toxic drug that is effective for neuroses and insomnia. Phenibut is often prescribed for stressful situations. Phenibut does not have a teratogenic effect, but it should still be prescribed with extreme caution not only during pregnancy, but also during lactation.

Cytomegalovirus infection is an infectious, viral disease transmitted through sexual contact, blood and breast milk. In most cases, a person is a carrier, and when the immune system is weakened, as in pregnant women, the disease manifests itself. The fetus is especially sensitive to this virus. The embryo can be infected even during conception; if the father is infected, the virus is transmitted through the sperm.

In utero, the fetus becomes infected through the membranes or through the placenta. The baby can become infected by passing through an infected birth canal or through breast milk.

Cytomegalovirus infection affects the central nervous system of the fetus, in particular the development of the brain, which may be underdeveloped or dropsy, and the liver and spleen may also be enlarged. The born child may be deaf, mute, and noticeably developmentally delayed. This disease is a direct indication for induced abortion.

To verify the disease, you need to take a blood test, make a smear from the vagina and cervix and, after waiting for the results, strictly follow medical prescriptions. Typically, antiviral drugs significantly reduce the teratogenic properties of the virus and dramatically increase the chance of giving birth to a healthy child.

Again, as in the case of rubella, a blood test to determine torch infection, in particular cytomegalovirus, should be carried out in non-pregnant women, but during the planning period. In addition to the woman, a man must be tested.

Herpes

Herpes also represents the torch complex. There are two types I and II.

Herpes of the first type manifests itself as a cold on the lips, while the second type affects the genitals. Due to the results obtained, proven by scientists, it has been established that type 1 herpes is not so dangerous for the fetus. When an infection enters the bloodstream before pregnancy, the immune system produces antibodies. During pregnancy, some of the antibodies are transmitted to the woman and the child is not in danger.

Herpes, like the rest of the torch viral infections dangerous in the first trimester. In the later stages, according to the results obtained, it is known that the effect of the virus is dangerous premature birth. Intrauterine infection of one of the torch infections is fraught with fetal death, blindness, deafness, and epilepsy. A married couple must be tested for torch infection.

According to the data obtained from tests performed for torch infections, the doctor prescribes antiviral treatment, which suppresses the activity of the virus and stimulates the production of interferon, which is responsible for immunity.

Other infections of the Torch complex

The remaining infections included in the torch complex under the letter “O” are just as dangerous, but less common.

• Torch complex includes viral diseases that have different transmission mechanisms;
• Complex dangerous diseases is transmitted quickly and becomes dangerous to the fetus in the first trimester of pregnancy;
• It is necessary to take care of the health of the unborn child in advance by undergoing timely tests for a range of infections.

When is it necessary to get tested?

It is advisable to take tests for the torch complex 3 months before planning a pregnancy. If, after examining a woman, blood tests confirm the presence of antibodies, this means that the torch complex is not dangerous for the fetus. If no antibodies are detected in the blood, then a woman from some infections torch You can get vaccinated, and from some, you can protect yourself and your unborn child only by following prevention tips: avoid places with large crowds of people, take immunostimulating drugs approved by your doctor. For a strong immune system, it is useful to move actively, to be more often fresh air and lead healthy image life.

One of the common ways to detect torch complex is enzyme-linked immunosorbent assay and PCR (polymyrase chain reaction). The latest blood test allows you to determine the DNA of the pathogen and determine its type, for example, herpes type 1 or type 2. In order to use the PCR method and conduct an analysis, not only blood is taken for research, but also urine, vaginal discharge, and cervix. The reliability of the test results is 95 percent.

Thus, a woman who has prepared in advance and wishes to give birth healthy child, TORCH infections are not scary, since, at present, it is possible to identify them, prevent them, and, sometimes, cure them or reduce the risk of teratogenic effects on the fetus.

It's no secret that pregnancy is a serious test for the female body. Often during pregnancy, a woman’s chronic diseases worsen, her immunity decreases, and therefore the expectant mother becomes especially vulnerable to all kinds of infectious diseases. Among the infections there are those that are relatively harmless for the mother and fetus (for example, acute respiratory infections) and those that are very dangerous (even HIV).

But there is a group of infections, the peculiarity of which is that, being relatively harmless for adults and even children, they become extremely dangerous for pregnant women.

Based on the first letters of the Latin names of the infections included in it, this group is usually called TORCH infections or infections of the TORCH complex.

Explanation of the abbreviation TORCH:

• T- toxoplasmosis
• ABOUT- other infections
• R- rubella (rubella)
• WITH- cytomegalovirus infection (cytomegalovirus)
• H- herpes (herpes simplex virus)
• The mysterious letter O - others (others) - implies infections affecting the fetus such as hepatitis B and hepatitis C, syphilis, chlamydia, gonococcal infection, listeriosis. Recently, HIV infection, chickenpox, and enterovirus infection were included in this list.

However, as a rule, the group of TORCH infections includes only four listed diseases: toxoplasmosis, rubella, cytomegalovirus and herpes. With this option, the letter O of the abbreviation stands for the second letter of the word toxoplasmosis.

TORCH infections and pregnancy

The peculiarity of TORCH infections is that when they are initially infected during pregnancy, they can have a detrimental effect on all systems and organs of the fetus, especially on its central nervous system, increasing the risk of miscarriage, stillbirth and congenital deformities of the child, the formation of malformations, even to disability.

For all these infections, it is very important whether the woman has had them before, i.e. does she have immunoglobulins G in her blood? If not, then there is a possibility of developing a primary infection during pregnancy and damage to the fetus. In this case, you need to more carefully protect yourself from possible infection and regularly recheck the antibody content in the results of the TORCH analysis.

It is best to donate blood for the presence of antibodies to TORCH infections before pregnancy, when planning it.

Let us repeat that the most dangerous thing for the fetus is the primary infection with TORCH infections during pregnancy, especially in its early stages, so if, during examination for torch infections before pregnancy, antibodies to these infections are detected in a woman’s blood, then the woman can safely become pregnant - her child there is no threat from this side. If, before pregnancy, antibodies to TORCH complex infections are not detected, then the pregnant woman will need to take additional measures in order to protect herself and her unborn baby.

If you have not been tested for TORCH infections before pregnancy, it is absolutely necessary to do this as early as possible in pregnancy. Moreover, tests for TORCH infections must be taken regardless of the well-being of the pregnant woman, since most infections of the TORCH complex are asymptomatic, and until serious complications from the fetus appear, the pregnant woman may not even be aware of their existence. Below we will talk a little more about each of the TORCH infections and their effect on the body of a pregnant woman and the fetus.

Toxoplasmosis

In addition, infection with toxoplasma can occur through dirty hands (this is how children in kindergartens usually become infected), through raw or undercooked (undercooked) meat. For a person with a healthy immune system, toxoplasmosis is not dangerous - you can get sick from it without even noticing it. In addition, the human body develops a stable immunity to toxoplasmosis, so it is a “one-time” disease.

The only situation in which toxoplasmosis poses a serious danger is primary infection with toxoplasmosis during pregnancy. To be fair, it is worth saying that the likelihood of such an infection is not high - according to statistics, no more than 1% of women become infected with toxoplasmosis during pregnancy, 20% of whom transmit toxoplasmosis to the fetus. But still, one percent is one pregnant woman out of a hundred - not so little, by and large.

It is also important that the only danger is toxoplasmosis, which a woman became infected with during her current pregnancy. This means that if a woman has already had toxoplasmosis before pregnancy (at least six months before), toxoplasmosis does not threaten her unborn child. Moreover, in a tragic situation when a woman loses a child due to toxoplasmosis during pregnancy, six months later she can become pregnant without fear of toxoplasmosis.

If, during pregnancy, infection with toxoplasmosis does occur, then much depends on at what stage of pregnancy toxoplasma entered the pregnant woman’s body.

The earlier the pregnancy, the greater the risk of severe consequences if the fetus is infected with toxoplasmosis, but, at the same time, the less likely it is that this infection will occur.

Conversely, in later pregnancy the percentage of transmission of toxoplasmosis to the fetus is very high (about 70%), but the risk of severe damage to the fetus is reduced.

The most dangerous infection is considered to be toxoplasmosis in the first 12 weeks of pregnancy. In these cases, congenital toxoplasmosis often leads to the death of the fetus or to the development of severe damage to the eyes, liver, spleen, and nervous system (especially the brain) of the child. Therefore, when infected with toxoplasmosis, initial stage pregnancy, a pregnant woman is often asked to do artificial interruption pregnancy.

All this once again suggests that tests for the presence of antibodies to toxoplasmosis should be taken not during pregnancy, but before it: if these antibodies are in the blood expectant mother there is, then there is nothing to be afraid of, if the TORCH analysis shows a fresh infection, then you should wait six months, and then calmly get pregnant. If antibodies are not detected, additional safety measures must be taken during pregnancy.

Toxoplasmosis is one of those diseases that is very easy to prevent by observing basic hygiene rules.

Of course, for a pregnant woman without antibodies to toxoplasmosis, these rules become especially strict. Firstly, during pregnancy there should be no contact with cats, especially young ones, because cats infected with toxoplasmosis also develop immunity to it with age. If the cat cannot be placed with friends during the owner’s pregnancy, then the pregnant woman should at least be freed from caring for her. If this is not possible, then all manipulations, especially with cat litter, should be carried out only with rubber gloves. The same applies to working with soil in the garden - if you cannot refuse it completely, then you need to work with gloves. All vegetables, fruits, and herbs should be washed thoroughly. Contact with raw meat should also be avoided, and meat dishes must be properly boiled or fried. After any work in the kitchen, you need to wash your hands especially thoroughly with soap. If these rules are followed, the risk of contracting toxoplasmosis practically disappears. However, for complete peace of mind, you should be tested for toxoplasmosis several times during pregnancy, preferably in the same laboratory.

Rubella

An infectious viral disease that is transmitted to a healthy person from a patient, most often through airborne droplets. Rubella is a completely harmless “childhood” infection; as a rule, it does not lead to any serious consequences.

Rubella manifests itself as a small pink rash all over the body, with an increase in temperature to approximately 38°C. The general condition of the patient is satisfactory.

The insidiousness of rubella is that infection often occurs during the incubation period, when the disease does not yet manifest itself and the person does not know that he is sick. However, after suffering from rubella, the human body develops stable immunity, so secondary infection with rubella does not occur.

When a pregnant woman is infected with rubella, this harmless infection becomes deadly for the fetus. In the initial stage of pregnancy, the rubella virus most often affects the nervous tissue of the fetus, eye tissue, and heart.

In the first trimester, rubella in pregnant women is an indication for termination of pregnancy. If rubella infection occurs in the second or third trimester of pregnancy, then, as a rule, such irreparable consequences for the fetus do not occur, but, nevertheless, growth retardation and other disorders are possible. In such cases, restorative therapy and prevention of placental insufficiency are carried out.

Finally, when infected with rubella last month During pregnancy, a child may be born with manifestations of rubella, after which it proceeds in the same way as in children infected after birth, and usually does not cause serious consequences.

Tests for antibodies to rubella must be taken before a planned pregnancy. If a blood test for the TORCH complex shows that a woman had rubella before pregnancy, then there is no danger to the fetus from this side.

A test for antibodies to rubella is also required if a pregnant woman has had contact with a person with rubella. If this occurs in the first trimester of pregnancy and the analysis shows signs of acute infection, the woman will be advised to terminate the pregnancy.

Since rubella infection cannot be prevented using preventive measures, the most acceptable option is preventive vaccination. It must be done before pregnancy, and for women planning pregnancy who do not have antibodies to rubella in their blood, vaccination is necessary.

Modern rubella vaccines are almost 100 percent effective and have virtually no side effects, apart from a slight increase in temperature and redness at the injection site. Immunity to rubella, which is developed after vaccination, lasts about 20 years.

Cytomegalovirus infection

This is a viral infectious disease discovered only in the twentieth century, the causative agent of which is cytomegalovirus (CMV).

Cytomegalovirus can be transmitted sexually, through blood, breastfeeding. The effect of CMV on a person depends primarily on the condition immune system: with healthy immunity, CMV poses virtually no danger, but if immunity is reduced, then cytomegalovirus becomes more active and can affect almost all systems and organs of an infected person.

Most people infected with CMV experience the infection without even noticing it. Antibodies to CMV are stable and persist for life; recurrent diseases almost never occur.

However, just as in the case of other torque infections, if the primary infection with cytomegalovirus occurs during pregnancy, the consequences can be catastrophic. Infection of the fetus can occur in different ways, and not only from a sick mother, but also from the father during conception, since male sperm also contains CMV.

However, most often CMV enters the fetus either through the placenta or through the membranes, that is, from the mother’s body. Infection of a child can occur during childbirth, when passing through the mother’s infected birth canal, and during breastfeeding, but this option is much less dangerous and, as a rule, does not lead to serious consequences for the child.

When infected intrauterinely, cytomegalovirus infection can lead to intrauterine fetal death or the birth of a child with congenital cytomegalovirus infection.

Congenital cytomegalovirus infection can manifest itself immediately after the birth of a child with such developmental defects as an underdeveloped brain, cerebral edema, hepatitis, jaundice, enlarged liver and spleen, pneumonia, heart defects, and congenital deformities.

The baby may be delayed mental development, deafness, epilepsy, cerebral palsy, muscle weakness.

Sometimes congenital cytomegalovirus infection manifests itself only in the 2-5th year of life infected child blindness, deafness, speech inhibition, delay in mental development, psychomotor disorders.

If a woman was infected with cytomegalovirus infection earlier, and during pregnancy it worsened, then such terrible consequences do not arise.

Therefore, as in the case of all torch infections, a test for antibodies to cytomegalovirus must be taken before pregnancy. If antibodies are not detected, the woman will be advised to conduct a monthly blood test, which will not allow the primary infection, which is most dangerous for the fetus, to be missed.

If antibodies to CMV are detected and it turns out that a pregnant woman is a passive carrier of cytomegalovirus, then she is recommended to make additional efforts to maintain normal immunity. Let us also recall that CMV can be “gifted” to a child not only by the mother, but also by the father, therefore cytomegalovirus infection It is advisable to examine not only the woman planning a pregnancy, but also the future father of her child.

Herpes

Finally, the last of the infections of the TORCH complex is herpes. Strictly speaking, this is not even a disease, but a whole group of viral infectious diseases.

There are two known groups of herpes viruses - herpes types I and II.

• Herpes type I, in particular, manifests itself as the well-known “cold” on the lips.
• Herpes type II in most cases it affects the genitals (so-called urogenital herpes).

How is herpes transmitted?

Herpes is transmitted by airborne droplets and sexually, as well as “vertically”, that is, the infection can pass from a pregnant mother through the placenta to the fetus.

In the case of an advanced chronic course of the disease, herpes of both types can manifest itself as lesions not only of the skin and mucous membranes, but also of the central nervous system, eyes, and internal organs.

As with all TORCH infections, when infected with herpes, a person develops antibodies that largely “suppress” the further progression of the virus, and herpes most often appears only when immunity decreases (such as type I herpes during a cold). If a woman becomes infected with herpes before pregnancy, then these antibodies pass to the fetus along with the virus, and most often the infection does not pose a danger to the fetus.

With primary infection with herpes during pregnancy, especially at its initial stage, when all the organs and systems of the unborn child are formed, the herpes infection can be fatal to the fetus.

In this case, the risk increases threefold non-developing pregnancy and miscarriages, the development of deformities in the fetus is possible. If infection with genital herpes occurs in the second half of pregnancy, then the likelihood of congenital anomalies of the fetus increases, such as microcephaly, retinal pathology, heart defects, and congenital viral pneumonia. Premature birth may occur.

In addition, infection of the fetus with HSV during intrauterine period can cause difficult situations associated with the death of a child after birth, cerebral palsy, epilepsy, blindness, and deafness.

A child can become infected with herpes not only in utero, but also during childbirth, passing through the birth canal of an infected mother. This happens if during pregnancy a woman’s genital herpes worsens, and the rashes are localized on the cervix or in the genital tract. If a pregnant woman is diagnosed with a herpes virus four weeks before giving birth, the birth is usually carried out by planned caesarean section, in order to minimize the risk of infection of the newborn.

If the herpes virus is detected, the doctor will prescribe treatment, after which the infection will not bother either the expectant mother or the unborn baby. If necessary, treatment of herpes is also prescribed during pregnancy; for this, as a rule, antiviral agents are used that suppress the activity of the herpes virus, as well as drugs that strengthen the immune system of a pregnant woman, especially stimulating the body's production of interferon.

Antibodies to herpes

Most often, if the form does not indicate antibodies to HSV1 and HSV 2 separately (and a double price is not charged), blood is taken to determine mixed antibodies to both types of virus. And since we almost all had type 1 herpes in childhood, 98% of the adult population has antibodies to it, and the test will be positive, even if you have never had genital herpes. Therefore, this analysis has almost no value and money can be saved on it. The only indication is that you are pregnant, and it seems to you that you have never had type 1 herpes (fever on the lips). Then they carry out this analysis, and if there really are no antibodies at all, then all the more it is necessary to protect themselves from possible infection even with this “harmless” herpes type 1, because and its primary infection can harm the fetus.

What is a blood test for TORCH? Why give it up? Deciphering the analysis and its cost. What is the risk of TORCH disease - infections for a woman during pregnancy. How to take it correctly and when.

By taking a blood test for TORCH infections, a woman insures herself and her baby. The analysis itself is the most important thing during a woman’s pregnancy. The concept of analysis for TORCH includes the identification of five diseases that can be transmitted from mother to baby. If a woman plans to become pregnant, she needs to donate blood for a TORCH test. This way she can protect herself from miscarriage and prevent various infectious diseases and a heart defect in the baby.

The word itself - TORCH consists of the names of infections:

• T– Toxoplasmosis.
• O– Infections that may occur during pregnancy.
• P (R) – rubella disease.
• C– Cytomegalovirus infection.
• H – Herpes.

All these infections have exactly the same effect on the baby in the womb. They do not harm the expectant mother, but are genetically transmitted to the fetus. That is, the baby can pick up all these infections. And besides, they influence the formation of its organs. Therefore, the development of various defects and complications in the baby is possible.

Doctors recommend taking this TORCH test before planning a pregnancy, approximately 2-3 months before conception. The presence of infection in the body of the expectant mother does not depend on the woman’s condition; as a rule, these infections occur without any special symptoms.

But they pose a real danger to the fetus and its development. Therefore, in all antenatal clinics this procedure is prescribed either in the early stages or before planning conception. First of all, this is a basic test that all pregnant women undergo.

How to take a blood test for infections

For a woman who wants to get tested before planning to conceive, you need to follow simple rules to pass the test correctly.

The blood donation procedure itself is standard. You should not eat in the morning; in the evening it is advisable to exclude fatty foods from your diet.

This procedure detects immunoglobulin antibodies. If it is detected in the blood, then there is no infection. If infections are detected, then planning a child should be postponed until the mother has fully recovered, and if necessary, get all vaccinations and be cured. If a woman is pregnant, then this test is taken early, as soon as she comes to register.

For example, if a woman does not have protection against toxoplasma, she needs to be careful when cutting raw meat and when working with soil in the garden. Minimize communication with strangers; if there are cats at home, it is advisable to get rid of them. If the results show an infection, you should immediately consult a doctor and he will prescribe the necessary treatment.

Decoding the analysis results

You can find out and understand the result of the analysis yourself. You just need to know what the test is called and know its result. As you know, the analysis itself is aimed at identifying antibodies to various infections, that is, the body’s ability to resist them. The table shows an example of test decoding:

Any TORCH infection must be detected in a timely manner, otherwise the life and health of the child is at risk, and he will have to live with pathologies and diseases.

Therefore, when planning the birth of a child, it is imperative that you take all these tests two or three months in advance, and if necessary, undergo a course of treatment. IN antenatal clinic They will tell you everything about this analysis, its cost, and where you need to take it.

Why are TORCH infections dangerous for a pregnant woman?

If TORCH infections are detected during pregnancy, then this is primarily dangerous for the development of the fetus. The greatest danger appears in the early stages. This threatens miscarriage, but if the fetus is preserved, then the child may develop various pathologies.

When contracting an infection in the third trimester, the baby develops inflammation of the organs; as a rule, such children subsequently suffer from damage to the central nervous system.

Depending on when a woman fell ill with any TORCH infection, the severity of the consequences for the baby is determined.

Any of these infections affects the fetus and the development of the baby. Each disease brings something of its own that the baby will then have to live with.

• Rubella – heart defects, hearing defects, eye abnormalities, growth retardation, development of diabetes mellitus.
• Cytomegalovirus – possible fetal death. Primary disease is very dangerous for women. When the fetus is preserved, deformity, epilepsy, and cerebral palsy develop.
• Herpes – can cause miscarriage. It also causes congenital jaundice, enlarged liver, spleen, and abnormalities of the nervous system.

As you can see, this analysis is very important for a woman, and it should be done without fail, despite the fact that it is still not cheap. The cost of analysis varies from 4,500 to 5,000 thousand rubles.