grumble grumble TORCH complex

17 Mar

At least a couple times during my sub-I, I was taking sign-out from the intern who admitted new patients overnight and, although I listened to the presentation of a patient with the quintessential fever, sore throat, fatigue, and lymphadenopathy, it often took me until the final assessment and differential diagnosis to interrupt the presentation.  At the top of the differential was infectious mononucleosis, caused by Epstein-Barr virus (EBV) 90% of the time but, rarely, also caused by Cytomegalovirus (CMV).  I remember both the intern and I coming to the same realization as soon as the words “likely EBV” were spoken.  Bah!!  Unfortunately, I could not directly care for that patient.

CMV is part of the TORCH complex, a group of diseases that are vertically transmitted from mother to fetus and can cause some significant health issues, birth defects, or even death.  The complex is an acronym of member diseases:

  • Toxoplasmosis
  • Other (helpful, right?  includes Coxsackievirus, Chickenpox, Parvovirus, HIV, Chlamydia, Syphilis, and probably more I’m forgetting)
  • Rubella
  • Cytomegalovirus
  • Herpes Simplex Virus-2

What I learned my first day in the NICU is that over 1/100 healthy full-term infants is also an asymptomatic carrier of CMV.  The proportion of premature or ill infants in the NICU carrying CMV is likely much higher.  So I’ve been potentially endangering my second-born to increased risk of hearing loss, visual impairment, and diminished mental and motor capabilities.  Between this experience and my little genetic scare this fall, I feel like mother of the year.

And then last week I got a call from Ari’s babysitter that she (the babysitter) came down with Parvovirus (see “other” above).  Although she’s maybe one of the most responsible sitters on the planet, unfortunately, by the time you develop symptoms of this infection, you’re no longer contagious; you’re most contagious the 5-10 days beforehand.  Can you see my head hitting the wall repeatedly?  This fetus can’t catch a break.  She’s now at risk of developing severe anemia and fetal hydrops.  Yuck!

So, we talked to a lot of people.  We contacted our PCP and the midwives.  John consulted colleagues and friends, while I sat down with the chief of neonatology.  The fact that we have access to such ridiculously overly qualified resources to help us guide our personal healthcare is a privilege and a fortune that is not lost on us.  We came to the conclusion that, due to the fact that I’m a grown adult woman who has a child in daycare, I’ve likely been exposed to both viruses previous and am hopefully immune at this point.

In the end, I got serology testing late last week to see if I either have an acute infection of either virus or have antibodies demonstrating that I’ve been previously exposed and am no longer at risk of being infected.  Many women in pediatrics who have or plan to have children choose to have these simple (though, like everything, not cheap) blood tests performed because there is simply no avoiding these viruses while working with children.  I probably should have been tested long ago–again, uber responsible parenting and family planning right here.

And now I wait.

Luckily we had some good distraction in the form of Ari’s pop-pop this weekend.  And lots and lots good food and outdoor galavanting.

photo (92)

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3 Responses to “grumble grumble TORCH complex”

  1. Anonymous March 17, 2014 at 11:28 pm #

    So crazy that I am reading this post today, because I was just talking to my OB about the same issue. I’m an MS3 and I had a patient with CMV last week for a couple days. I was very cautious but am now kicking myself for not just making someone else take that patient.

    Anyway, I’m going to the lab to see if I have IgG and/or IgM against CMV. Just curious are these the tests they recommended you have? I know they’re not perfect. Ugh actually wish I knew a little less about congenital infections at this point..would save the worry. Good luck to you. Happy serologies. :):)

    • annaojesus March 18, 2014 at 4:43 pm #

      Hi there! Thank you so much for your comment! Ugh! What an awful position to be in. Luckily, the chance that we’ve been exposed is so high, you’re probably better off being cautious around someone with known CMV–not that you should try your luck :/ Everyone I’ve worked with has been super understanding, so I hope you don’t worry about declining to see a patient if it would make you more comfortable.

      Yes, those are the tests I got. You’re right, they are annoyingly imperfect. I just got mine back, positive for both IgG and IgM, and the interpretation is frustrating! I could have an acute infection now, or it could be a reactivation, or I could have been infected 12 months ago. Who knows?! We could get an avidity test, but even if my IgG had high avidity, that could mean that I got infected in the first trimester, which might make me worry even more! So I think at this point we’re going to just try to not worry and know that our chances of a poor outcome are still ridiculously low. And the positive is that we know we should be protected for further pregnancies :)

      Have you thought about also getting serology testing for Parvo? Since you’re in school and will be a resident, it might make sense…

      Thank you so much for your well wishes, and I wish you the best of luck with your testing, and your clerkships/electives!

      xo

      On Mon, Mar 17, 2014 at 11:28 PM, anna in med school wrote:

      >

Trackbacks/Pingbacks

  1. cmv: the fallout | anna in med school - March 25, 2014

    […]  You’d think I’d learn, but when we found out our babysitter had parvovirus, I though, might as well get tested for both parvo and CMV, since they’re both ubiquitous infections in the pediatric population.  Chances are, […]

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