Introduction

The most common congenital infections are summarized by the mnemonic TORCH: Toxoplasma gondii, Others, Rubella, Cytomegalovirus, and Herpes simplex virus. "Others" includes treponema pallidum, varicella-zoster virus, Epstein-Barr virus, human immunodeficiency virus, and lymphocytic choriomeningi-tis virus. There is an additional "other," namely West Nile virus.

These are all agents that produce a relatively mild illness in the mother. More virulent agents result in a spontaneous abortion or stillbirth. They are transmitted transplacentally, and have a direct toxic effect. Additionally, in the first trimester, when the fetus has immature, developing organs, there may be a teratogenic effect. Diagnosis can be made by elevated levels of IgM and IgA antibodies, and if the fetus is unable to eliminate the organism, this may lead to chronic infection and immune tolerance.

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