This pilot case-control study at a tertiary-care hospital over a four-month period was aimed at evaluating the possible usefulness of screening of TORCH (Toxoplasma gondii, rubella virus, cytomegalovirus, and Herpes simplex virus) in females with bad obstetric history. The study included 12 women with bad obstetric history and a similar number of matched controls with previous normal pregnancies. A serological evaluation of TORCH infections was carried out by detecting IgG and IgM antibodies against these infections by ELISA test-kit. Statistical analysis was not done to compare the results relating to the two groups due to a small number of cases and controls included in the study. Ten (83.3%) of the 12 cases with bad obstetric history and two (16.7%) of the 12 healthy controls were serologically positive at least for one of the TORCH agents. The seropositivity rate in women with bad obstetric history was quite high compared to that in the normal healthy controls. The results suggest that a previous history of pregnancy wastage and the serological evaluation of TORCH infections during current pregnancy must be considered while managing cases with bad obstetric history

Dutta, Renu

Kumari, Namrata

Morris, Norman

English

PubMed

This pilot case-control study at a tertiary-care hospital over a
four-month period was aimed at evaluating the possible usefulness of
screening of TORCH (Toxoplasma gondii, rubella virus, cytomegalovirus,
and Herpes simplex virus) in females with bad obstetric history. The
study included 12 women with bad obstetric history and a similar number
of matched controls with previous normal pregnancies. A serological
evaluation of TORCH infections was carried out by detecting IgG and IgM
antibodies against these infections by ELISA test-kit. Statistical
analysis was not done to compare the results relating to the two groups
due to a small number of cases and controls included in the study. Ten
(83.3%) of the 12 cases with bad obstetric history and two (16.7%) of
the 12 healthy controls were serologically positive at least for one of
the TORCH agents. The seropositivity rate in women with bad obstetric
history was quite high compared to that in the normal healthy controls.
The results suggest that a previous history of pregnancy wastage and
the serological evaluation of TORCH infections during current pregnancy
must be considered while managing cases with bad obstetric history

University of Toronto Research Repository

Is Screening of TORCH Worthwhile in Women with Bad Obstetric History:
An Observation from Eastern Nepal

TSpace Repository

Bioline International

©INTERNATIONAL CENTRE FOR DIARRHOEALDISEASE RESEARCH, BANGLADESHJ HEALTH POPUL NUTR 2011 Feb;29(1):77-80ISSN 1606-0997 | $ 5.00+0.20Correspondence and reprint requests should be addressed to:Dr. Namrata Kumari Assistant ProfessorDepartment of MicrobiologyIndira Gandhi Institute of Medical Sciences Campus D3/4 Sheikhpura, Patna 14, BiharIndiaEmail:irainrai@yahoo.co.inFax: 0612-2297225SHORT REPORTIs Screening of TORCH Worthwhile in Women with Bad Obstetric History: An Observation from Eastern NepalNamrata Kumari1, Norman Morris2, and Renu Dutta31Department of Microbiology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India, 2Department of Obstetrics and Gynaecology and 3Department of Microbiology, B.P. Koirala Institute of Health Sciences, Dharan, NepalABSTRACTThis pilot case-control study at a tertiary-care hospital over a four-month period was aimed at evaluating the possible usefulness of screening of TORCH (Toxoplasma gondii, rubella virus, cytomegalovirus, and Her-pes simplex virus) in females with bad obstetric history. The study included 12 women with bad obstetric history and a similar number of matched controls with previous normal pregnancies. A serological evalu-ation of TORCH infections was carried out by detecting IgG and IgM antibodies against these infections by ELISA test-kit. Statistical analysis was not done to compare the results relating to the two groups due to a small number of cases and controls included in the study. Ten (83.3%) of the 12 cases with bad obstetric history and two (16.7%) of the 12 healthy controls were serologically positive at least for one of the TORCH agents. The seropositivity rate in women with bad obstetric history was quite high compared to that in the normal healthy controls. The results suggest that a previous history of pregnancy wastage and the serologi-cal evaluation of TORCH infections during current pregnancy must be considered while managing cases with bad obstetric history. Key words: Bad obstetric history; Case-control studies; TORCH screening; NepalINTRODUCTIONBad obstetric history (BOH) implies previous unfa-vourable foetal outcome in terms of two or more consecutive spontaneous abortions, history of in-trauterine foetal death, intrauterine growth retar-dation, stillbirth, early neonatal death and/or con-genital anomalies. Cause of BOH may be genetic, hormonal, abnormal maternal immune response, and maternal infection (1). Primary infections caused by TORCH—Toxoplasma gondii, rubella vi-rus, cytomegalovirus (CMV), and Herpes simplex virus (HSV)—is the major cause of BOH (2). The prevalence of these infections varies from one geographical area to another (3). These maternal infections are initially unapparent or asympto-matic and are, thus, difficult to diagnose on clini-cal grounds (4,5). 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 (1). Enzyme-linked immunosorbent as-say (ELISA) for IgM antibodies against these infec-tions is highly sensitive and specific (6). The con-ventional single serum assays do not make a clear distinction between a recent primary and chronic infection. The tendency of specific IgM to persist for a long time even at high levels has been veri-fied in several studies (7,8). After its introduction in serodiagnosis of Toxoplasma-associated infections, the measurement of IgG avidity has proved to be a highly-useful procedure, especially in combination with conventional serological assays (9).However, this pilot study was aimed at evaluating the possible usefulness of conventional screening of TORCH in females with BOH in eastern Nepal.MATERIALS AND METHODSStudy setting and design This pilot case-control study was carried out over a four-month period at a tertiary referral hospital in Nepal.Kumari N et al.Screening of TORCH in women with bad obstetric historyJHPN78Twelve women with BOH and a similar number of matched controls (without any BOH and previous normal pregnancies) attending our antenatal clinic were included in the study. Cases were selected depending on a previous history of having 2-3 pregnancy wastages, intrauterine deaths, preterm deliveries, intrauterine growth retardation, and un-explained early neonatal deaths. Factors considered for selecting matched controls were age (±2 years), similar gravidity, same period of gestation in present pregnancy, and same number of livebirths opposed to bad obstetric complaints in the cases group. Detailed examinations and con-ventional laboratory investigations were carried out in both the groups. After taking consent from each woman, 3 mL of venous blood was collected in a container with strict aseptic precautions. The serum, thus, obtained was used for serological eval-uation of TORCH infections. TORCH IgG and IgM antibodies were detected from the serum by ELISA test-kit (Calbiotech Inc, Canada) following the in-structions of the manufacturer. The kits for detec-tion of antibodies were based on sandwich ELISA method. Absorbance was taken at wavelength of 450 nm, and results were calculated according to the instructions. TORCH antibody index was calcu-lated by dividing the value of each sample by cali-brator values. The antibody index of 1.0 or greater was considered positive for antibodies.The results of the two groups (cases and controls) were compared (Table 1). Statistical analysis was not done to compare the results relating to the two groups due to a small number of cases and controls included in the study.Ethical approvalThe Ethical Committee of the Institute granted ethical clearance to the study.RESULTSDifferent presentations of BOH cases and matched controls with their TORCH status are shown in Ta-ble 1, and seropositivity of TORCH agents in the two groups is shown in Table 2. Five cases showed mixed seropositivity. Mixed seropositivity was not found in any of the controls. A maximum number of BOH cases was found in females aged 18-24 years.Ten (83.3%) of the 12 BOH cases and two (16.7%) of the 12 healthy controls were serologically posi-tive at least for one of the TORCH agents. The sero-positivity rate in women with BOH was quite high compared to that in the normal healthy controls.In the BOH cases, the seropositivity for T. gondii was 50%, rubella virus 50%, HSV-2 33.3%, and CMV 8.3% whereas, in the control cases, the seropositiv-ity for T. gondii was 16.7% only and that of the re-maining ones was 0%.DISCUSSIONTo the best of our knowledge, baseline data on sero-positivity in the local population are not available from any part of Nepal. In the present study, T. gon-dii (50%), rubella virus (50%), HSV-2 (33.3%), and CMV (8.3%) were found in pregnant women with BOH. These data are very high compared to those available from the neighbouring country (India) (3,7). It might be due to the fact that the number of cases and controls included in the present study is very less, and, as such, it may not be reflect the true picture of TORCH infections. However, the difference between the two groups was quite sig-nificant numerically.Although IgG of the samples was determined, the interpretation is mainly based on the value of IgM as paired sera were not tested.Further, the cost of the whole TORCH-panel test being very high, most general population of an un-derdeveloped country, such as Nepal, cannot com-fortably afford. By including vaccination against rubella virus (MMR vaccine) in the national im-munization schedule, the incidence of congenital rubella can be reduced to a large extent. Moreover, this component can be deleted from the TORCH-panel investigations, thereby reducing their cost.ConclusionsBased on the findings of the study, it is concluded that a previous history of pregnancy wastage and the serological reactions for TORCH infections dur-ing current pregnancy must be considered while managing BOH cases to reduce the adverse foetal outcome. Keeping consideration of the high cost of the test panel, selected tests (of the whole panel) are recommended on an individual case basis. In-corporation of rubella immunization into the na-tional immunization schedule is recommended. Toxoplasma-associated infection can be prevented by educating the public about avoidance of inges-tion of raw or insufficiently-cooked meat and poul-try and keeping proper hygiene. An extensive study covering a large population should be conducted to know the seropositivity of TORCH agents and also to know the real status of these infections in BOH cases.Kumari N et al.Volume 29 | Number 1 | February 2011 79Screening of TORCH in women with bad obstetric historyTable 1. Different presentations of BOH cases and matched controls with TORCH statusCase vs controlAge (years)Parity Live- birth(s)Abort-ion(s)Still-birth(s)Neonatal death(s)TORCH statusCaseControl24261202100010All negativeT. gondii positiveCaseControl22211202101000Rubella virus posi-tiveAll negativeCaseControl29282202001010T. gondii, CMV, and HSV positiveAll negativeCaseControl23252202000020Rubella virus posi-tiveAll negativeCaseControl22242303100020T. gondii andrubella viruspositiveAll negativeCaseControl20211303200010Rubella virus and HSV positiveAll negativeCase Control  18 200 20 22 00 00 0T. gondii and rubella virus posi-tive, HSV positiveAll negativeCaseControl24251202101 000T. gondii positiveAll negativeCaseControl30313  303000030Rubella virus positiveAll negativeCaseControl35370202200000All negativeT. gondii positiveCaseControl18 20020220000 0T. gondii positive and HSV positiveAll negativeCaseControl22230202200000T. gondii positiveAll negativeAll=T. gondii, rubella, and HSV; BOH=Bad obstetric history; CMV=Cytomegalovirus; HSV=Herpes sim-plex virus 2; T. gondii=Toxoplasma gondii; TORCH=Toxoplasma gondii, rubella virus, cytomegalovirus, and Herpes simplex virusTable 2. Seropositivity of TORCH agents in the two groupsTORCH agentSeropositivity in BOH group (n=12)Seropositivity in control group(n=12)No.  % No.  % Toxoplasma gondii 6 50 2 16.7Rubella virus 6 50 0 0Cytomegalovirus       1 8.3 0 0Herpes simplex virus 2 4 33.3 0 0BOH=Bad obstetric history; TORCH=Toxoplasma gondii, rubella virus, cytomegalovirus, and Herpes simplex virusKumari N et al.Screening of TORCH in women with bad obstetric historyJHPN80REFERENCES 1. Turbadkar D, Mathur M, Rele M. Seroprevalence of torch infection in bad obstetric history. Indian J Med Microbiol 2003;21:108-10.2. McCabe R, Remington JS. Toxoplasmosis: the time has come. N Engl J Med 1988;318:313-5.3. Kapil A, Broor S. Primary cytomegalovirus infection in pregnant and nonpregnant women in India. In-dian J Med Microbiol 1992;10:53-5.4. Daftary SN, Chakravarti S. Obstetric disorder in preg-nancy. Holland and Brews Manual of obstetrics. 15th ed. New Delhi: B.I. Churchill Livingstone, 1991:138.5. Newton E. Diagnosis of perinatal TORCH infections. Clin Obstet Gynecol 1999;42:59-70.6. Thapliyal N, Shukla PK, Kumar B, Upadhyay S, Jain G. TORCH infection in women with bad obstetric history—a pilot study in Kumaon region. Indian J Pathol Microbiol 2005;48:551-3.7. Pinon JM, Thoannes H, Gruson N. An enzyme-linked immune-filtration assay used to compare infant and maternal antibody profiles in toxoplasmosis. J Immu-nol Methods 1985;77:15-23.8. Del Bono V, Canessa A, Bruzzi P, Fiorelli MA, Terragna A. Significance of specific immunoglobulin M in the chronological diagnosis of 38 cases of toxoplasmic lymphadenopathy. J Clin Microbiol 1989;27:2133-5.9. Hedman K, Lappalainen M, Seppaia I, Makela O. Recent primary toxoplasma infection indicated by a low avidity of specific IgG. J Infect Dis 1989;159:736-40.

An enzyme-linked immune-filtration assay used to compare infant and maternal antibody profiles in toxoplasmosis.

Diagnosis of perinatal TORCH infections.

Obstetric disorder in pregnancy.

Primary cytomegalovirus infection in pregnant and nonpregnant women in India.

Recent primary toxoplasma infection indicated by a low avidity of specific IgG.

Seroprevalence of torch infection in bad obstetric history.

Significance of specific immunoglobulin M in the chronological diagnosis of 38 cases of toxoplasmic lymphadenopathy.

TORCH infection in women with bad obstetric history—a pilot study in Kumaon region.

Toxoplasmosis: the time has come.

Is Screening of TORCH Worthwhile in Women with Bad Obstetric History: An Observation from Eastern Nepal

Is Screening of TORCH Worthwhile in Women with Bad Obstetric History: An Observation from Eastern Nepal

Abstract

Similar works

Full text

Available Versions

University of Toronto Research Repository

TSpace Repository

Bioline International