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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.



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