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Seroprevalence of torch infection in bad obstetric history D Turbadkar, M Mathur, M Rele - Indian J Med Microbiol
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 ~  Abstract
 ~  Materials and Me...
 ~  Results
 ~  Discussion
 ~  References

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Year : 2003  |  Volume : 21  |  Issue : 2  |  Page : 108-110
 

Seroprevalence of torch infection in bad obstetric history


Department of Microbiology, LTMMC, Sion, Mumbai - 400 022, India

Correspondence Address:
Department of Microbiology, LTMMC, Sion, Mumbai - 400 022, India

 ~ Abstract  

Primary infection with TORCH complex [Toxoplasma, Rubella, Cytomegalovirus (CMV), and Herpes simplex virus II (HSV-II)] in pregnant women can lead to adverse outcome which are initially inapparent or asymptomatic and thus difficult to diagnose on clinical grounds. Over a one-year period 380 serum samples were collected from pregnant women having bad obstetric history, attending antenatal clinic. In the present study we have shown the prevalence of Toxoplasma, Rubella, CMV, HSV-II infection in pregnant women by demonstrating the presence of IgM and IgG antibodies by ELISA test. It was found that, IgM antibodies were positive in 40 (10.52%) for Toxoplasma, 102 (26.8%) for Rubella, 32 (8.42%) for CMV and 14 (3.6%) for HSV-II. IgG antibodies were positive in 160 (42.10%) for Toxoplasma, 233 (61.3%) for Rubella, 346 (91.05%) for CMV 145 (33.58%) for HSV-II. Hence all antenatal cases with bad obstetric history should be routinely screened for TORCH as early diagnosis and appropriate intervention, will help in proper management of these cases.

How to cite this article:
Turbadkar D, Mathur M, Rele M. Seroprevalence of torch infection in bad obstetric history. Indian J Med Microbiol 2003;21:108-10


How to cite this URL:
Turbadkar D, Mathur M, Rele M. Seroprevalence of torch infection in bad obstetric history. Indian J Med Microbiol [serial online] 2003 [cited 2014 Mar 6];21:108-10. Available from: http://www.ijmm.org/text.asp?2003/21/2/108/7985


Bad obstetric history (BOH) implies previous unfavourable foetal outcome in terms of two or more consecutive spontaneous abortion, history of intrauterine foetal death, intrauterine growth retardation, still births, early neonatal death and/or congenital anomalies. Cause of BOH may be genetic, hormonal, abnormal maternal immune response and maternal infection.
Recurrent pregnancy wastage due to maternal infections transmissible in utero at various stage of gestation can be caused by a wide array of organisms which include the TORCH complex (Toxoplasma gondii, Rubella virus, Cytomegalovirus, Herpes simplex virus) and other agents like Chlamydia trachomatis, Treponema pallidum, Niesseria gonorrhoeae, HIV etc. Toxoplasmosis acquired during pregnancy may cause damage to the fetus.[1] Seroepidemiological studies have shown that 10-20 percent of women in childbearing age in India are susceptible to Rubella infection.[2] Infection with Rubella during pregnancy may lead to congential malformation in 10-54 percent of cases.[3] The infection caused by CMV in adult is usually asymptomatic but its significance is many times increased when it occurs during pregnancy. However, the rate of primary CMV infection is significantly higher for pregnant women from low socioeconomic group.[4] The mother is the usual source of transmission of HSV to the fetus or newborn. Primary HSV infection during first half of pregnancy is associated with increased frequency of spontaneous abortion, still birth, and congenital malformation.[5]
These maternal infections with adverse outcome are initially inapparent or asymptomatic and are thus difficult to diagnose on clinical grounds. Therefore, diagnosis of acute TORCH infection in pregnant women is usually established by demonstration of seroconversion in paired sera or by demonstration of specific IgM antibodies. This study reports the results of screening for IgG and IgM antibodies against TORCH complex in a group of patients with bad obstetric history.

 ~ Materials and Methods   Top

A total of 380 sera samples were collected from pregnant women with bad obstetrical history attending the antenatal clinic in a general public hospital. Patients included in our study were those with history of still births, habitual abortions, intrauterine growth retardation and neonatal deaths.
Toxoplasma gondii, Rubella virus, CMV and HSV-II IgM and IgG antibodies were tested at 1:40 dilution of serum by sandwich ELISA (Premier Medical Corp, USA) according to manufacturer's instructions. TORCH index of each determination was calculated by dividing the value of each sample by calibrator values and TORCH M index of 1.0 or greater was considered positive for antibodies.

 ~ Results   Top

In our study, out of 380 pregnant women with BOH, a total of 102 (26.8%) were positive for IgM Rubella. Toxoplasma IgM positive were 40 (10.5%), CMV IgM positive were 32 (8.4%) and 14 (3.6%) were positive for HSV II. [Table - 1] shows the results of IgG and IgM antibody assays in all patients included in the study.

 ~ Discussion   Top

In the present study, Toxoplasma gondii, which is a known etiological agent in recurrent pregnancy wastages was found in 10.5% pregnant women with BOH as reported earlier.[6] Congenital transmission of toxoplasmosis is known to occur during acute phase of maternal infection. IgM antibodies were found in 12% patients in other studies.[7]
Episodes of increased incidence of Rubella are reported to occur every 3-4 years.[8] Since 10-20% of women in child bearing age are susceptible to Rubella,[2] increased incidence of Rubella will lead to increased reporting of pregnant women with Rubella infection. In the present study 26.8% pregnant women were positive for Rubella IgM as has been reported earlier.[10] The observation therefore suggests an increased incidence of Rubella infection in pregnant women.
Primary CMV infection in pregnancy has a higher incidence of symptomatic congenital infection and fetal loss. This infection, being asymtomatic in adults, is difficult to diagnose clinically. Demonstration of IgM antibodies is indicative of primary infection. The present study shows seropositive rate of 8.4% for CMV IgM in women with BOH as has been reported previously.[10] The need of serological evaluation of CMV specific IgM during pregnancy has been supported by various investigators.[4],[10]
Primary infection with HSV II acquired by women during pregnancy accounts for half of the morbidity and mortality from HSV II among neonates. The other half results from reactivation of old infection. Seropositivity rate of HSV IgM among the BOH patients of our study was 3.6%. HSV in asymptomatic women with recurrent infection during pregnancy was found to be 0.6-3% previously.[11]
Mixed infection were noted in 17 out of 40 patients (42.5%) in association with Toxoplasma IgM antibodies in our study. Out of 17 patients of mixed infection 13 were with Rubella, two with CMV and one each with Rubella plus CMV and CMV plus HSV II. Similar observation of mixed infection has been made earlier.[12]
We recommend that all antenatal cases with BOH be routinely screened for TORCH complex as early diagnosis and appropriate intervention of these infections will help in proper management of these cases. 

 ~ References   Top

1. Sharma P, Gupta T, Ganguly NK, Mahajan RC, Malla N. Increasing Toxoplasma seropositivity in women with bad obstetric history and in new borns. Natl Med J 1997;10:65-66.  Back to cited text no. 1    
2. Seth P, Manjunath N, Balaya S. Rubella infection: the Indian scene. Rev Infect Dis 1985;7 (Suppl. 1):S64.  Back to cited text no. 2    
3. Peekham C. Congenital infections in the United Kingdom before 1970; the prevaccine era. Rev Infect Dis 1985; (7 Suppl. 1):S11.  Back to cited text no. 3    
4. Stagno S, Pass RF, Cloud G, et al: Primary cytomegalovirus in pregnancy. Incidence transmission to fetus and clinical outcome. JAMA 1986;256:1904-1986.  Back to cited text no. 4    
5. Sergio S, Whitley RJ. Herpes infections of preganacy. N Eng J Med 1985;313:1327-1330.  Back to cited text no. 5    
6. Yashodhara P, Ramlaxmi BA, Naidu AN, Raman L. Prevalence of specific IgM due to Toxoplasma, Rubella, Cytomegalovirus and C.trachomoatis infection during pregnancy. Indian J Med Microbiol 2001;19:79-82.  Back to cited text no. 6    
7. Bhatia VN, Meenaskshi K, Agarwal SC. Toxoplasmosis in South India - a serological study. Indian J Med Res 1974;62:1818.  Back to cited text no. 7    
8. Banatvala JE, Best JM. Rubella. In: Principles of bacteriology, virology and immunity. Vol 4, GS Wilsonm, AA Miles, MT Parker. Eds. (Edward Arnold, London) 1984:p271.  Back to cited text no. 8    
9. Kishore J, Broor S, Seth P. Acute Rubella infection in pregnant women in Delhi. Indian J Med Res 1990;91:245-246.  Back to cited text no. 9    
10. Kapil S, Broor S. Primary cytomegalovirus infection in pregnant and nonpregnant women in India. Indian J Med Microbiol 1992;10:53.  Back to cited text no. 10    
11. Vontver LA, Hickok DE, Brown Z, Reid L, Corey L. Recurrent genital herpes simplex virus infection in pregnancy: infant outcome and frequency of asymptomatic recurrences. Am J Obstet Gynecol 1982;143:75.  Back to cited text no. 11  [PUBMED]  
12. Mookherjee N, Gogate A, Shah PK. Microbiology evaluation of women with bad obstetric history. Indian J Med Res 1995;102:103-107.  Back to cited text no. 12    
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