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Stop, think SCORTCH: rethinking the traditional ‘TORCH’ screen in an era of re-emerging syphilis
  1. Justin Penner1,
  2. Hayley Hernstadt1,
  3. James Edward Burns2,
  4. Paul Randell3,
  5. Hermione Lyall1
  1. 1Department of Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, London, UK
  2. 2Centre for Clinical Research in Infection and Sexual Health, University College London, London, UK
  3. 3Department of Virology, Imperial College Healthcare NHS Trust, London, UK
  1. Correspondence to Dr Justin Penner, Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, London W2 1NY, UK; justin.penner{at}nhs.net

Abstract

Background The epidemiology of congenital infections is ever changing, with a recent resurgence in syphilis infection rates seen in the UK. Identification of congenital infection is often delayed; early recognition and management of congenital infections is important. Testing modalities and investigations are often limited, leading to missed diagnostic opportunities.

Methods The SCORTCH (syphilis, cytomegalovirus (CMV), ‘other’, rubella, toxoplasmosis, chickenpox, herpes simplex virus (HSV) and blood-borne viruses) acronym increases the awareness of clinicians to the increased risk of congenital syphilis, while considering other infectious aetiologies including: zika, malaria, chagas disease, parvovirus, enterovirus, HIV, hepatitis B and C, and human T-lymphotropic virus 1, in addition to the classic congenital infections recognised in the ‘TORCH screen’ (toxoplasmosis, ‘other’, rubella, CMV, HSV). The SCORTCH diagnostic approach describes common signs present in infants with congenital infection, details serological testing for mother and infant and important direct diagnostics of the infant. Direct diagnostic investigations include: radiology, ophthalmology, audiology, microbiological and PCR testing for both the infant and placental tissue, the latter also warrants histopathology.

Conclusion The traditional ‘TORCH screen’ focuses on serology-specific investigations, often omits important direct diagnostic testing of the infant, and fails to consider emerging and re-emerging congenital infections. In recognition of syphilis as a re-emerging pathogen and the overlapping clinical presentations of various infectious aetiologies, we advocate for a broader outlook using the SCORTCH diagnostic approach.

  • congenital abnorm
  • neonatology
  • infectious diseases
  • microbiology
  • virology
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Footnotes

  • Contributors HL developed the article concept. JP was the primary author of the manuscript. HH and JEB developed figures. PR assisted with virologic background of the manuscript. All authors participated in the editing process. All authors provided substantial contributions to the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data sharing not applicable as no datasets generated and/or analysed for this study.

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