TORCH Infection Past Paper PDF 2024-2025 Tanta University

Tanta University. Faculty of Nursing. Obstetrics and Gynecological Nursing Department. 3rd level , 5th semester, 2024-2025. Under Supervision of: - Assistant Lecturer /Aya Nasr Prof. Dr/ Manal Hassan Assistant Lecturer / Walaa Elseady Dr/ Nahed...

Tanta University. Faculty of Nursing. Obstetrics and Gynecological Nursing Department. 3rd level , 5th semester, 2024-2025. Under Supervision of: - Assistant Lecturer /Aya Nasr Prof. Dr/ Manal Hassan Assistant Lecturer / Walaa Elseady Dr/ Nahed El-Nabawy Demonstrator / Maha Mohamed Dr/ Ekbal Ebrahim Demonstrator/ Heba El-Sayed Dr/ Doaa Samir 1  ‫رؤية ورسالة كلية التوريض‬ ‫رؤية البرناهج ‪-:‬‬ ‫تحم‪ٛ‬ك انتً‪ٛ‬ض ف‪ ٙ‬انتعه‪ٛ‬ى انتًش‪ٚ‬ع‪ ٙ‬نك‪ٕٚ ٙ‬اكت انتمذو ف‪ ٙ‬انعهٕو انحذ‪ٚ‬خخ ٔ تحم‪ٛ‬ك إحت‪ٛ‬بربد انًزتًع ٔ‬ ‫‪-‬يتطهجبد عٕق انعًم انًحه‪ٛ‬خ ٔ اإلله‪ًٛٛ‬خ ٔ انذٔن‪ٛ‬خ‪.‬‬ ‫رسالة البرناهج ‪-:‬‬ ‫‪ٓٚ -‬ذف انجشَبيذ إن‪ ٙ‬تخش‪ٚ‬ذ أخصبئ‪ ٙ‬تًش‪ٚ‬ط يؤْم ثبنكفبءاد انتًش‪ٚ‬ع‪ٛ‬خ انت‪ ٙ‬تغبعذِ عه‪ ٙ‬تمذ‪ٚ‬ى سعب‪ٚ‬خ‬ ‫تًش‪ٚ‬ع‪ٛ‬خ شبيهخ تهج‪ ٙ‬إحت‪ٛ‬بربد انًزتًع يٍ خالل انجحج انعهً‪ ٔ ٙ‬انًًبسعخ انمبئًخ عه‪ ٙ‬دالئم األثحبث‪.‬‬ ‫رؤية ورسالة قسن توريض النساء و التوليذ للعام الجاهعي ‪0202 -0202‬م‬ ‫رؤية القسن‪:‬‬ ‫‪ٚ‬تطهع انٗ اٌ ‪ٚ‬كٌٕ لغى تًش‪ٚ‬ط انُغبء ٔ انتٕن‪ٛ‬ذ يٍ االلغبو انعهً‪ٛ‬خ انًتً‪ٛ‬ضح عهٗ يغتٕٖ انكه‪ٛ‬خ يٍ خالل‬ ‫اعذاد يًشض ٔيًشظخ يتً‪ٛ‬ض‪ ٍٚ‬لبدس‪ ٍٚ‬عهٗ انًُبفغخ انفعبنخ ف‪ ٙ‬عصش تكُٕنٕر‪ٛ‬ب انًعهٕيبد‪.‬‬ ‫رسالة القسن‪:‬‬ ‫‪ٚ‬غعٗ لغى تًش‪ٚ‬ط انُغبء ٔ انتٕن‪ٛ‬ذ انٗ اكغبة انطالة انًعهٕيبد ٔانًٓبساد ٔاالتزبْبد اال‪ٚ‬زبث‪ٛ‬خ انالصيخ‬ ‫ٔانت ‪ ٙ‬تًكُٓى يٍ تمذ‪ٚ‬ى سعب‪ٚ‬خ تًش‪ٚ‬ع‪ٛ‬خ يتطٕسح ف‪ ٙ‬يزبل صحخ انًشأح ٔحذ‪ٚ‬خ‪ ٙ‬انٕالدح ٔثزنك ‪ٚ‬غبْى ف‪ٙ‬‬ ‫تطٕ‪ٚ‬ش يُٓخ انتًش‪ٚ‬ط ٔخذيخ انًزتًع ٔتًُ‪ٛ‬خ انج‪ٛ‬ئخ كًب اٌ انمغى ‪ٚ‬غبعذ عهٗ تًُ‪ٛ‬خ ٔتشز‪ٛ‬ع انمذساد انتعه‪ًٛٛ‬خ‬ ‫ٔانجحخ‪ٛ‬خ انًجُ‪ٛ‬خ عهٗ االدنخ ٔانجشاْ‪ ٍٛ‬نذٖ انطالة ٔاععبء ْ‪ٛ‬ئخ انتذس‪ٚ‬ظ ثًب ‪ٚ‬تٕاكت يع احت‪ٛ‬بربد‬ ‫انًزتًع‪.‬‬ ‫اهذاف القسن‬ ‫‪ٓٚ‬ذف انمغى انٗ تمذ‪ٚ‬ى ثشايذ تعه‪ًٛٛ‬خ يٍ شبَٓب اعذاد كٕادس يٍ انطالة لبدسح عهٗ تمذ‪ٚ‬ى سعب‪ٚ‬خ تًش‪ٚ‬ع‪ٛ‬خ‬ ‫شبيهخ نهًشأح ثًختهف انًشاحم انعًش‪ٚ‬خ ٔعهٗ رً‪ٛ‬ع يغتٕ‪ٚ‬بد انصحخ ٔانًشض يجُ‪ٛ‬خ عهٗ تحه‪ٛ‬م ٔتحذ‪ٚ‬ذ‬ ‫االحت‪ٛ‬بربد انزغًبَ‪ٛ‬خ ٔان ُفغ‪ٛ‬خ ٔانج‪ٛ‬ئ‪ٛ‬خ نهًشأح ٔاالعشح ٔانًزتًع‪ٔ.‬رنك ثبعتخذاو انًعهٕيبد ٔانتمُ‪ٛ‬خ انحذ‪ٚ‬خخ‬ ‫ٔتطج‪ٛ‬ك َظش‪ٚ‬بد ٔاثحبث عهٕو انتًش‪ٚ‬ط ٔانعهٕو االعبع‪ٛ‬خ ٔاالرتًبع‪ٛ‬خ ٔاالَغبَ‪ٛ‬خ كأعبط نهًًبسعخ‬ ‫انتًش‪ٚ‬ع‪ٛ‬خ انًُٓ‪ٛ‬خ‪.‬‬ ‫تتلخص اهذاف القسن فيوا يلي‪- :‬‬ ‫‪ ‬دساعخ يحتٕ٘ انتشش‪ٚ‬ح نهزٓبص انتُبعه‪ ٙ‬انذاخه‪ٔ ٙ‬انخبسر‪ٔ ٙ‬عهى ٔظبئف األععبء‪.‬‬ ‫‪ ‬دساعخ انحبنخ انصح‪ٛ‬خ نهًشأح خالل فتشاد اإلَزبة ٔانت‪ ٙ‬تشتًم عهٗ انحًم‪ ،‬انٕالدح‪ ،‬انُفبط‬ ‫ٔاأليشاض انُغبئ‪ٛ‬خ ٔسعب‪ٚ‬خ حذ‪ٚ‬خ‪ ٙ‬انٕالدح ٔ‪ٚ‬تى انتشك‪ٛ‬ض عهٗ انشعب‪ٚ‬خ انصح‪ٛ‬خ يٍ خالل تطج‪ٛ‬ك‬ ‫انعًه‪ٛ‬خ انتًش‪ٚ‬ع‪ٛ‬خ‪.‬‬ ‫‪2‬‬  ‫دساعخ انزٓبص انتُبعه‪ٔ ٙ‬انشعب‪ٚ‬خ انطج‪ٛ‬خ نهغ‪ٛ‬ذح ٔأيشاض انُغبء انشبئعخ يٍ ح‪ٛ‬ج األعجبة ٔغشق‬ ‫‪‬‬ ‫انعذٖٔ ٔاالَتشبس‪ ،‬األعشاض‪ ،‬انعالد ٔانًعبعفبد‪.‬‬ ‫دساعخ كم يب ْٕ رذ‪ٚ‬ذ ف‪ ٙ‬تًش‪ٚ‬ط أيشاض انُغبء ٔانتٕن‪ٛ‬ذ ٔتطج‪ٛ‬مّ عُذ انحبرخ إن‪.ّٛ‬‬ ‫‪‬‬ ‫االستمبء ثصحخ األو ٔانزُ‪ ٍٛ‬أحُبء انحًم ٔتمذ‪ٚ‬ى انعُب‪ٚ‬خ انتًش‪ٚ‬ع‪ٛ‬خ انكبيهخ نٓى خالل يشاحم انحًم‬ ‫‪‬‬ ‫انًختهفخ‪.‬‬ ‫إعطبء انتخم‪ٛ‬ف انصح‪ ٙ‬انشبيم نهًمجه‪ ٍٛ‬عهٗ انضٔاد‪.‬‬ ‫‪‬‬ ‫تمذ‪ٚ‬ى انعُب‪ٚ‬خ انتًش‪ٚ‬ع‪ٛ‬خ انشبيهخ نألو ٔانزُ‪ ٍٛ‬أحُبء انٕالدح‪.‬‬ ‫‪‬‬ ‫تم‪ٛٛ‬ى االحت‪ٛ‬بربد األعبع‪ٛ‬خ ٔانعشٔس‪ٚ‬خ نألو أحُبء فتشح انُفبط ٔإعطبء انشعب‪ٚ‬خ انتًش‪ٚ‬ع‪ٛ‬خ نٓب‪.‬‬ ‫‪‬‬ ‫تمذ‪ٚ‬ى انًشٕسح انصح‪ٛ‬خ نهغ‪ٛ‬ذاد عٍ ٔعبئم تُظ‪ٛ‬ى األعشح‪.‬‬ ‫‪‬‬ ‫تطج‪ٛ‬ك َتبئذ األثحبث انتًش‪ٚ‬ع‪ٛ‬خ انمبئًخ عهٗ انذن‪ٛ‬م انت‪ ٙ‬تغبعذ ف‪ ٙ‬تخف‪ٛ‬ف يعب‪ٚ‬مبد انغ‪ٛ‬ذاد خالل‬ ‫‪‬‬ ‫انفتشح يب حٕل عٍ ان‪ٛ‬أط‪.‬‬ ‫رئيس القسن‬ ‫أ‪.‬د‪/‬هنال عبذ هللا جاهين‬ ‫‪3‬‬  Objective General objectives: By the end of this seminar, the student will be aware of the basic knowledge about TORCH infection. Intended learning outcomes (ILOS): I. Knowledge and understanding:  Define TORCH infection.  Understand causative organism, mode of transmission, signs and symptoms, prevention and treatment of toxoplasmosis.  Identify causative organism, mode of transmission, signs and symptoms and complication of rubella.  Know causative organism, mode of transmission, signs and symptoms, prevention and treatment of cytomegalovirus.  Determine causative organism, mode of transmission, signs and symptoms, and complication of herpes. II. Intellectual skills:  Discuss preventive and treatment measures of TORCH infection. III. Professional and practical skills:  Illustrate types of cervical cauterization  Demonstrate TORCH infection. 4 Outlines 1. Introduction. 2. Definition of TORCH infection. 3. Abbreviation of TORCH mean :  T: Toxoplasmosis.  O: Others (such as syphilis, hepatitis, and HIV).  R: Rubella.  C: Cytomegalovirus.  H: Herpes simplex virus. For each: -  Mode of transmission.  Signs and Symptoms.  Diagnosis.  Complications.  Nursing interventions. 4. References. 5  Introduction The term TORCH complex or TORCHes infection refers to the congenital infections of toxoplasmosis, others(Syphilis, Hepatitis B), rubella, Cytomegalovirus (CMV), and herpes simplex. That can be passed to your baby during pregnancy, at delivery or after birth. It is the intrauterine transmission of these infections to the fetus which produces multiple symptoms when the child is born. In general, TORCH infections are responsible for 2 to 3% of all congenital disorders, or disorders present at birth. These infections can cause a variety of complications, including preterm birth, delayed development of the fetus (i.e., intrauterine growth restriction), physical malformations (e.g., deafness, patent ductus arteriosus), and sometimes, loss of the pregnancy. 6 Definition of TORCH infection :- It is a group of infections caused by organisms that can cross the placenta or ascend through birth canal and had adversely affect fetal growth and development. “TORCH” is an acronym meaning:  (T)oxoplasmosis.  (O)thers (such as syphilis, hepatitis, and HIV).  (R)ubella (also known as German Measles).  (C)ytomegalovirus.  (H)erpes Simplex. 1- Toxoplasmosis Definition: It is an infection caused by a parasite called Toxoplasma gondii. It can be found in cat feces, undercooked meat, and contaminated food and water. Causative organism: The protozoan toxoplasma gondii. Mode of transmission: 1. Exposure to feces of infected cats. 2. Eating raw or inadequately prepared meat or animal products. 3. Eating inadequately washed vegetables that have come in contact with contaminated soil. Fig(1):https://www.invitra.com/en/wp-content/uploads/2014/09/toxoplasmosis-diagram.png 7  Symptoms: Symptoms are often influenza-like:  Swollen lymph nodes: - commonly found in the neck followed by axillae and then groin and resolve within one to two months in 60% of patients.  Muscle aches: -pain that last for a month or more.  Rarely, a patient with a fully functioning immune system may develop eye damage or nasal lesions from toxoplasmosis. ▪ Headache. ▪ Fever. ▪ Generally feeling unwell. Complications: 1- Spontaneous abortion. 2- Prematurity, 3- Still birth. 4- Neonatal death. 5- Disorders including microcephaly, hydrocephalus, convulsions, blindness, and mental retardation. Nursing intervention: a) Explain methods of prevention to childbearing woman through: - 1- Wash hand after working with soil or change cat litter. 4- Wear gloves when handle with materials contaminated with cat feces,soil. 2- Fruits and vegetables should be washed carefully. 3- Avoid touching mouth or eyes while handling raw meat. 5- Cook meat throaty, avoid eaten raw meat and freeze meat promptly. 6- Have cat tested for toxoplasmosis and avoid changing cat litter during pregnancy. 8  7- Provide written information to all women of childbearing age to reinforce instruction. b) Counsel patient regarding disease, including risk to fetus; support her in making an informed decision on therapeutic abortion versus drug therapy. c) Explain drug regimen, monitor hematological tests to detect side effect, teach the patient to report side effect e.g., nausea, vomiting, bad taste, anorexia, headache , dizziness, weakness, skin rash, jaundice , mental depression, convulsion. D) Report all cases of toxoplasmosis to local health department. 2- Other ( syphilis – hepatitis – AIDS) 1- Syphilis Causative organism: sexually transmitted disease caused by the spirochete bacterium Treponema pallidum. Mode of transmission: 1- Through sexual contact with infected person (90-96%) 2- Congenital syphilis via transmission from mother to child in uterus (transplacentally) 3- Blood transfusion. Fetal effects: If the woman untreated, the infection may cross the placenta to the fetus and result in:-  Spontaneous abortion.  Intrauterine growth restriction.  Stillbirth.  Premature labor. 9  Congenital syphilis major signs of congenital anomalies are enlarged liver and spleen, skin lesions, rashes, pneumonia, and hepatitis). Fig(2):https://www.google.com/url?sa=i&url=https%3A%2F%2Fwww.icliniq.com%2Farticles%2Finfectiousdiseases%2Fsyphili Nursing intervention: - 1. Explain the risk factors and long-term effects if syphilis is not treated. 2. Evaluate the patient for other sexual transmitted disease. 3. Stress importance of receiving all three doses if syphilis is greater 1 year in duration. 4. Evaluate for congenital syphilis by evaluating presence of syphilis antibody in cord fluid, evaluating presence of signs and symptoms after the first week e.g. (jaundice, anemia, snuffles, copper hue rash) 5. Administrate treatment as require. 2-Hepatitis B Causative organism: viral infection caused by HBV (hepatitis B virus). Mode of transmission: 1- Exposure to infectious blood or body fluids as saliva, seminal fluid and milk. 2- Unprotected sexual contact with infected person. 3- Transfusions of contaminated blood. 4- Re-use of contaminated needles & syringes. 10  5- Vertical transmission from mother to child during childbirth. Fetal effect: 1- Prematurity. 2- Low birth weight. 3- Neonatal death. 4- Neonatal hepatitis in infants whose mothers are infected in the last trimester. Nursing intervention: - 1- Screen all patients for hepatitis. 2-Teach all patients modes of transmission of hepatitis B e.g. (sexual contact, sharing needles). 3-Encourage adequate rest and diet. 4- Utilize strict precaution, and encourage all obstetric health care workers in high risk area to receive the hepatitis B vaccine. 5-Prevent infection of neonate through: -  Remove maternal blood from the newborn immediately.  Vigorously suction nasopharynx and aspirate stomach.  Handle the newborn with gloves, until the baby has been bathed.  Bath the baby thoroughly when stable (before 12hours of age).  Encourage immunization with HBIG after bathing to prevent infections from skin surface contamination. 3-AIDS (Acquired immunodeficiency syndrome) Causative organism: human immunodeficiency virus (HIV). Mode of transmission: 1- Sexual transmission: can occur when infected sexual secretions of one partner come into contact with the genital, oral, or rectal mucous membranes of another. 2-Blood or blood product: if infected blood comes into contact with any open wound. 3-Mother-to-child: the transmission of the virus can occur in utero (during 11 pregnancy), intrapartum (at childbirth), or via breast feeding. Nursing intervention: 1- Assess history for risk factors. 2- Provide clear information about AIDS, ZDV therapy. 3- Prevention of transmission by using standard precautions is critical. 4- HIV antibody testing of all pregnant women. 3- Rubella(German Measles) Causative organism: Rubella Virus. Mode of transmission:  Direct contact with nose or throat secretions from infected individuals.  Placenta (from the infected mother to fetal blood circulation). Symptoms: 1- Incubation period 14 days (range, 12 to 23 days). 2- Rash is the first symptom in young children (The rash usually occurs initially on the face and then progresses from head to foot). 3- Low-grade fever. Less than 38.3°c (101°f). 4- Runny nose. 5- Malaise, lymphadenopathy. 6- Conjunctivitis. 7- Upper respiratory symptoms. 8- Maculopapular rash 14 to 17 days after exposure. 9- Arthralgia (joint pain). 10- Arthritis. 11- Swollen lymph nodes (located behind the ears and the back of the neck. 12- Photophobia (a condition in which the eyes are more sensitive to light than normal). 12  Fig(3):https://img.medscapestatic.com/pi/meds/ckb/65/44365tn.jpg Fetal effects: Stillbirth. Spontaneous abortion. Intrauterine growth restriction. Mental retardation. Congenital rubella syndrome, which is characterized by:  Deafness.  Permanent hearing impairment.  Clouding of the eyes (i.e., cataracts).  Rash.  Heart defects.  Bone marrow defect.  Thrombocytopenia. Prevention: 1. Rubella infections are prevented by active immunizations programs 2. The vaccine is now given as part of the MMR vaccine. The WHO recommends the first dose is given at 12 to 18 months of age with a second 13  dose at 36 months. 3. Pregnant women are usually tested for immunity to rubella early, Women found to be susceptible are not vaccinated until after the baby is born because the vaccine contains live virus. Nursing intervention: 1- Ensure that all pregnant women are tested for rubella. 2- Teach measure to prevent rubella to all women of childbearing age. 3- Perform a rubella antibody test prior to pregnancy. 4- Ensure that unprotected pregnant women receive rubella vaccination in the postpartum period to protect future pregnancies, after inoculation teach the patient to use a reliable methods of birth control for at least 3months. 5- Avoid contact with persons known or suspected to have rubella. 4- Cytomegalovirus Definition of CMV: Cytomegalovirus (from the Greek cyto-, "cell", and -megalo-, "large") is a herpes viral genus of the Herpes viruses group: in humans it is commonly known as HCMV or Human Herpes virus 5 (HHV-5). Causative organism: Human cytomegalovirus (HCMV) or human herpes virus 5 (HHV-5). Mode of transmission: 1- Direct contact with infected bodily fluids, including saliva, blood, breast milk, tears, mucus, semen, and vaginal fluids. 2- Through sexual contact. 3- From breast milk to nursing infants. 4- Through transplanted organs and blood transfusions. 14  Fetal effect: A congenital CMV infection in a developing fetus can present with: 1- Rashes, deafness. 2- Inflammation of the eye (i.e., chorioretinitis). 3- Seizures. 4- Unusually small head (i.e., microcephaly). 5- Intracranial calcifications. Nursing intervention: Teach all patients measure to prevent CMV. 1- Avoid contact with person with viral infection (especially known or suspected CMV infection). 2- Use good hand washing technique. 3- Isolate infected newborns: virus is shed in saliva and urine. 5- Herpes simples virus Definition: The herpes simplex virus, also known as HSV, is an viral infection that causes genital (HSV-2) and oral herpes(HSV-1). Herpes can appear in various parts of the body, most commonly on the genitals or mouth. Fig(4):https://www.google.com/url?sa=i&url=https%3A%2F%2Fwww.invitra.com%2Fen%2Fgenitalherpes%2F&psig= 15 Causative organism: Oral Genital herpes herpes herpes herpes simplex virus simplex virus type1 (HSV-1). type2 (HSV-2). Mode of Transmission:  HSV-1: through direct contact with a herpes sore, saliva, or other bodily secretions. direct contact include : o Kissing. o Oral sex. o Other skin-to-skin contact. Can be transmitted from a mother with genital to her infant during delivery to causes neonatal herpes. HSV-2: through sexual contact with infected person. Fig(5):https://content.ca.healthwise.net/resources/13.5/en-ca/media/medical/hw/h9992546_001.jpg Symptoms: 1- Watery blisters in the skin or mucous membranes of the mouth, lips or genitals. 2- Pain or itching around the genitals. 3- Painful urination. 4- Lesions heal with a scab characteristic of herpetic disease. 16 Nursing intervention: 1. Advise woman to inform health care providers of her infection. 2. A possible association exists between herpes and cervical cancer. Thus women should understand importance of yearly pap smears. 3. Advise the patient of possibility of caesarean section if active lesion is present at the time of delivery to prevent neonatal infection. 4. For active herpes patient or suspicious lesion in labor:  Institute strict isolation precaution (gowns, gloves, double bagging of contamination articles).  Avoid use of fetal scalp electrode.  Allow breast feeding if no breast lesions are present, use strict aseptic isolation procedures. 5. Instruct the mother or any one with oral harps to avoid kissing or touching the baby and employ good hand washing technique. 17  References Iwanowicz Palus G.J., Świst D., Skurzak A., Polska P., Stobnicka D.(2023). Impact of TORCH infection on women’s health. Med Og Nauk Zdr. Palma S, Roversi MF, Bettini M, Mazzoni S, Pietrosemoli P, Lucaccioni L, Berardi A, Genovese E.(2021). Hearing loss in children with congenital cytomegalovirus infection: an 11-year retrospective study based on laboratory database of a tertiary paediatric hospital. Acta Otorhinolaryngol Ital. ;39(1):40-45. Singh L, Mishra S, Prasanna S, Cariappa MP.(2022). Seroprevalence of TORCH infections in antenatal and HIV positive patient populations. Med J Armed Forces India.71(2):135-8. Stegmann BJ, Carey JC.(2021).TORCH Infections. Toxoplasmosis, Other (syphilis, varicella-zoster, parvovirus B19), Rubella, Cytomegalovirus (CMV), and Herpes infections. Curr Womens Health Rep. 253-8. 18