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Correspondence to Dr Justin Penner, Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, London W2 1NY, UK; [email protected]
Background
Early recognition of congenital infections remains the cornerstone of management and coordination of care, as perinatally acquired infections can be associated with significant long term sequelae if diagnosis is delayed.1 Testing practices for congenital infections vary. Differences in laboratory and direct examinations make for fragmented investigation practices.2 Furthermore, the classic ‘TORCH’ (toxoplasmosis, ‘other’, rubella, cytomegalovirus (CMV), herpes simplex virus (HSV)) serological ‘screen’ fails to incorporate important direct diagnostic tests and has the potential to miss key diagnoses including emerging and re-emerging congenital infections. In particular, the absence of ‘S’ in the ‘TORCH’ acronym leads to a lack of consideration for congenital syphilis, an infection with increasing incidence in the UK.3 4 As presentations of congenital syphilis can vary from asymptomatic to single-system or multi-system involvement, often overlapping with the clinical presentations of other congenital infections,5 6 we advocate for a standardised ‘SCORTCH’ (syphilis, CMV, ‘other’, rubella, toxoplasmosis, chickenpox (varicella zoster virus (VZV)), HSV and blood-borne viruses) approach. The goal of this newly titled ‘SCORTCH’ diagnostic toolkit is to increase primary carer education, awareness, recognition and testing of congenital infections.
A head to toe approach for recognising congenital infections
Broadening the original concept of the ‘TORCH screen’ has been proposed, acknowledging the complexity of the diagnostic approach to congenital infections.7–9 There are multiple pathogens potentially responsible for congenital infections, while overlapping clinical presentations and changing epidemiology leads to diagnostic challenges for the clinician. Overall, a high index of suspicion is required. We advocate for consideration of all possible antenatal infections given the consequences of failing to diagnose and treat perinatally acquired infections early.
An initial thorough review of the maternal antenatal history including maternal health, travel, high risk behaviours, as well as booking serology and ultrasound findings for abnormal (e.g. echogenic bowel in CMV) or absent results should be standardised. Often overlooked is the importance of obtaining placental specimens for further testing when congenital infection is possible. A comprehensive evaluation of the newborn for signs of congenital infection and the mother for evidence of active or past infection are required in order to institute comprehensive testing that is both accurate and timely....