Question
(10/12/2011):
Title:
TORCH IgM test around 8th week with raised CMV.
My wife
had undergone TORCH IgM test around 8th week and it had raised CMV
1.2, where normal range is 0.8.
Doctor
advised for repeat test in three different labs and finally we landed
with two tests positive and two tests negative and now it is 11th
week.
We are
confused what to do.
Another
doctor said to undergo IgG and now she will decide on IgG basis.
Now please
guide me what to do.
Sachin
Answer:
TORCH
is an acronym for a group of infectious diseases - (toxoplasmosis,
rubella, cytomegalovirus, and herpes) that can cause illness in pregnant
women and birth defects in the baby.
TORCH
profile looks for antibodies produced against diseases caused by microorganisms,
it is not carried out routinely, it is requested when there are specific
risk factors, such as when the pregnant woman lives with cats and
has been in contact with people infected with rubella.
TORCH
profile allows acting against the risk that these infections may interfere
with fetal development.
Confirmation
of an active infection may require more specific tests.
There
are other laboratory tests that detect the possibility of abnormalities
in the baby.
These
tests are noninvasive; they pose no risk to the fetus, and are carried
out through a blood sample from the mother to determine the presence
of substances such as proteins, enzymes and hormones during pregnancy,
some substances of fetal origin and other of maternal origin.
Any change
in them may indicate abnormalities in the fetus and / or pregnancy.
These
substances are called biochemical markers.
There
is a variety of tests available that can be performed depending on
the stage or trimester of pregnancy.
The screenings
during the first quarter are carried out between the 11th and 14th
week of pregnancy to detect the risk of Down syndrome.
A false
positive test for IgM rubella antibodies may occur because the test
components cross react with other proteins in the body.
In the
case of a false positive another IgG test to establish a baseline
level of antibody should be order to repeat the IgG test again in
2-3 weeks to look for a significant increase in the amount (titer)
present, which would indicate a recent rubella infection.
Experience
of a clinical case in 1998:
Patient
27 years
Second
pregnancy
CMV-IgG
de 182 UA/ml (negative = < 15 UA/ml)
CMV-IgM
positive: 1.44 (positive value > 0.5).
Result
of a repeated exam few days later:
CMV-IgG:
> 250 UA/ml
CMV-IgM
positive (0.98) persists.
A seroconversion
(development of detectable specific antibodies) is evident.
It is
determined by the PCR technique, (Polymerase chain reaction) the DNA
for CMV in whole blood and urine with a result of the test being positive.
The patient
decides to continue the pregnancy.
In the
fourth month of pregnancy there is a persistent positivity of CMV-IgG
and IgM.
An amniocentesis is performed to obtain amniotic fluid.
It is
determined the CMV-DNA in amniotic fluid with negative results. The
amniotic fluid karyotype was normal, 46/XX.
An ultrasound
performed on the 5th month of pregnancy shows a fetus of normal characteristics.
On December
24, 1998, a normal child is born, normal to all neonatal examinations.
Ten months
later the psychomotor development is completely normal, with hearing
tests and vision assessment tests completely normal.
Researching
in amniotic fluid for CMV through PCR technique appears to be the
most suitable.
On the
other hand, based on the low incidence of children suffering real
sequela, and the appearance in the scientific literature for studies
where treatment is advocated in utero with "Ganciclovir"
, a consideration for pregnancy interruption for women who acquire
a primary CMV infection during pregnancy should be considered twice.
Do you
have any other questions? Enter
your health question
