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Serological Screening of TORCH Agents as an Etiology of Spontaneous Abortion in Dhulikhel Hospital, Nepal

Received: 2 March 2014     Accepted: 8 April 2014     Published: 10 April 2014
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Abstract

The role of TORCH infections as a cause of spontaneous abortions is still debatable with conflicting results where geographical variation may play a significant role. This study was undertaken to discover the association of TORCH infections in women with spontaneous abortions by serological testing. The descriptive case control study was conducted from January to December, 2012. A serological evaluation was carried out to determine the presence of Toxoplasma gondii, Rubella, Cytomegalovirus (CMV) and Herpes Simplex Virus (HSV) specific immunoglobulin G (IgG) and immunoglobulin M (IgM) antibodies, using commercial diagnostic kits by enzyme-linked immunosorbent assay (ELISA) technique. Mean age of the study and control subjects were 24.8+/-6.4 and 23.8+/-3.8 years respectively where 72.8% of the study subjects were of the age between 20 to 35 years and 23% of the women with spontaneous abortion were below 20 years. Most of the cases were of incomplete abortions (43%) followed by complete abortions (26%). Only 1.3% of both IgG and IgM seropositivity against TORCH agents were noted among the study subjects whereas highest IgG seropositivity was detected with Rubella (86.8%) followed by HSV-I (72.8%). An infection susceptibility rate of 77.9% to Toxoplasma gondii, 11.7% to Rubella, 51.9% to CMV, 36.4% to HSV-I and 84.4% to HSV-II was noted. No significant difference in relation to age and type of abortion was found in seropositivity between the study and the control subjects. This study, probably the first of its kind from Nepal, suggests that current infection with TORCH agents might not be the possible etiology of spontaneous abortion. Serological TORCH screening may not be conclusive.

Published in American Journal of Biomedical and Life Sciences (Volume 2, Issue 2)
DOI 10.11648/j.ajbls.20140202.11
Page(s) 34-39
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2014. Published by Science Publishing Group

Keywords

Screening, TORCH Agents, Spontaneous Abortion, Immunoglobulin, Seropositivity

References
[1] J.D. Pizzo, “Congenital infections (TORCH)”, Pediatrics in Review 2011, vol. 32(12), pp. 537-542.
[2] V. Kumar,A.K. Abbas, N. Fausto, J. Aster, Robbins & Cotran, Pathologic Basis of Disease, Elsevier, 8th ed., 2009.
[3] Y. Maruyama, H. Sameshima, M. Kamitomo, et al., “Fetal manifestations and poor outcomes of congenital cytomegalovirus infections: possible candidates for intrauterine antiviral treatments,” J Obstet Gynecol, vol. 33, pp. 619-623, 2007.
[4] Z. Li, C. Yan, P. Liu, R. Yan, Z. Feng, “The prevalence of the serum anti-bodies to TORCH among women before pregnancy or in the early period of pregnancy in Beijing,” International Journal of Clinical Chemistry and Diagnostic Laboratory Medicine, vol. 403, pp. 212-215, 2009.
[5] D. Turbadkar, M Mathur, M. Rele. “Seroprevalence of torch infection in bad obstetric history,” Indian Journal of Medical Microbiology, vol.21, pp. 108-110, 2003.
[6] M.E. Paul, “Disorders of reproduction,” Primary Care, vol. 21, pp. 367-386, 1994.
[7] P.R. Summers, “Microbiology relevant to recurrent miscarriage,” Indian Journal of Medical Residents, vol. 100, pp. 19-22, 1994.
[8] B.J. Stegmann, J.C. Carey, “TORCH infections. Toxoplasmosis, Other (syphilis, varicella-zoster, parvovirus B19), Rubella, Cytomegalovirus (CMV), and Herpes infections,” Current Women’s Health Report, vol. 2, pp. 253-258, 2002.
[9] C.P. Griebel, J. Halvorsen, T.B. Golemon, A.A. Day “Management of spontaneous abortion,” American Family Physician, vol. 72, pp. 1243-1250, 2005.
[10] G.M. Stirrat, “Recurrent miscarriage II: clinical associations, causes, and management,” The Lancet, vol. 336, pp. 728-733,1990.
[11] M.L. Li, C. Hui, T.J. Ping, et al. “Evaluation of etiological characteristics of Chinese women with recurrent spontaneous abortion: a single center study,” Chinese Medical Journal, vol. 124, pp. 1310-1315, 2011.
[12] N. Kumari, N. Morris, R. Dutta, “Is screening of TORCH worthwhile in women with bad obstetric history: an observation from Eastern Nepal,” Journal of Health Population and Nutrition, vol. 29, pp. 77-80, 2011.
[13] S. Lamichhane, S. Malla, S. Basnyat, et al. “Seroprevalence of IgM antibodies against the agents of TORCH infection among the patients visiting National Public Health Laboratory, Teku, Kathmandu,” Journal of Nepal Health Research Council, vol. 2, pp. 1-25, 2007.
[14] N. Thapliyal, P.K. Shukla, B. Kumar, S. Upadhyay, G. Jain, “TORCH infection in women with bad obstetric history—a pilot study in Kumaon region,” Indian Journal of Pathology and Microbiology, vol. 48, pp. 551-553, 2005.
[15] E. Jauniaux, R.G. Farquharson, O.B. Christiansen, “Evidence based guidelines for the investigation and medical treatment of recurrent miscarriage,” Human Reproduction, vol. 21, pp. 2216-2222, 2006.
[16] A. Cullen, S. Brown, M. Cafferkey, N. O’Brien, E. Griffin, “Current use of TORCH screen in the diagnosis of congenital infection,” Journal of Infection, vol. 36, pp. 185-188, 1998.
[17] B.D. Navolan, I.M. Ciohat, A.E. Tigla, D. Vasies, V. Dumitrascu, “ Risk assessment for TORCH complex infection agents during pregnancy-preliminary study,” Timisoara Medical Journal, vol. 22, pp. 15-19, 2012.
[18] A.M. Alsamarai, Z. Khalil, M. Aljumaili, “Seroepidemiology of Toxoplasma, Rubella, Cytomegalovirus and Herpes Simplex Virus -2 in women with bad obstetric history. PART I: Toxoplasma and Rubella infections,” Our Dermatology Online, vol. 4, pp. 522-535, 2013.
[19] G.O. Ajayi, S.A. Omilabu, “Prenatal diagnoses of cytomegalovirus (CMV), rubella, toxoplasmosis, varicella, parvovirus, herpes simplex and syphilis. The Lagos programme experience,” Clinical and Experimental Obstetrics and Gynecology, vol. 37, pp. 37-38, 2010.
[20] C. A. Jones, “Vertical transmission of genital herpes: prevention and treatment options,” Drugs, vol. 69, pp. 421-434, 2009.
[21] D. Leland, M.L. French, M.B. Kleiman, R.L. Schreiner, “The use of TORCH titers,” Pediatrics, vol 72, pp. 41-43, 1983.
[22] S.K. Rai, H. Shibata, K. Sumi, “Toxoplasma antibody prevalence in Nepalese pregnant women with bad obstetric history,” Southeast Asian Jorunal of Tropical Medicine and Public Health, vol. 29, pp. 739-743, 1998.
[23] D. Acharya, S. Shrestha, B. Bogati, “Immune status in infection by cytomegalovirus in women with bad obstetric history,” International Journal of Infection and Microbiology, vol. 2, pp. 3-6, 2013.
[24] T. Kubo, S.K. Rai, M. Nakanishi, T. Yamano, “Seroepidemiological study of herpes viruses in Nepal,” Southeast Asian Journal of Tropical Medicine and Public Health, vol 22, pp.323-325, 1991.
[25] R.N. Kaur, D. Gupta, M.K. Nair, M.D. Mathur, “Screening for TORCH infections in pregnant women: a report from Delhi,” Southeast Asian Journal of Tropical Medicine and Public Health, vol. 30, pp. 284-286, 1999.
[26] G.M. Bhopale, “Review, pathogenesis of Toxoplasma,” Comparative Immunology, Microbiology and Infectious Diseases, vol. 26, pp. 213-222, 2003.
[27] J. Kishor, R. Mishra, A. Paisal, Y. Pradeep, “Adverse reproductive outcome induced by Parvovirus B19 and TORCH infections in women with high-risk pregnancy,” Journal of Infections in Developing Countries, vol. 5, pp. 868-873, 2011.
[28] A.H. Razzak, S.A. Wais, A.Y. Sayid, “Toxoplasmosis: the innocent suspect of pregnancy wastage in Iraq,” Eastern Mediterranean Health Journal, vol. 11, pp. 525-632, 2005.
[29] A. Garcia-Enguidanos, M.E. Calle, J. Valero, S. Luna, V. Dominguez-Rojas, “Risk factors in miscarriage: a review,” European Journal of Obstetrics & Gynecology and Reproductive Biology, vol. 102, pp. 111-119, 2002.
[30] S.A. Abdel-Fattah, A. Bhat, S. Illanes, J.L. Bartha, D. Carrington, “TORCH test for fetal medicine indications: only CMV is necessary in the United Kingdom,” Prenatal Diagnosis, vol. 25, pp. 1028-1031, 2005.
[31] S.M. Garland, G.L. Gilbert, “Investigation of congenital infection- the TORCH screen is not a legitimate test,” Medical Journal of Australia, vol. 159, pp. 346-348, 1993.
[32] N.A. Khan, S.N. Kazzi, “Yield and costs of screening growth retarded infants for TORCH infections,” American Journal of Perinatology, vol. 17, pp. 131-135, 2000.
[33] K. Hedman, M. Lappalainen, I. Seppaia, O. Makela, “Recent primary toxoplasma infection indicated by a low avidity of specific IgG,” Journal of Infectious Diseases, vol. 159, pp. 736-740, 1989.
[34] W.E. Owen, T.B. Martins, C.M. Litwins, W.L. Roberts, “Performance characteristics of six IMMUNITE 2000 TORCH assays,” American Journal of Clinical Pathology, vol. 126, pp. 900-905, 2006.
[35] O. Liesenfield, J.G. Montaya, N.J. Tathineni, “Confirmatory serologic testing for acute toxoplasmosis and rate of induced abortions among women reported to have positive Toxoplasma IgM antibody titer,” American Journal of Obstetrics and Gynecology, vol. 184, pp. 140-145, 2001.
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    Dhruba Acharya, Abha Shrestha, Bikash Bogati, Kishor Khanal, Shrinkhala Shrestha, et al. (2014). Serological Screening of TORCH Agents as an Etiology of Spontaneous Abortion in Dhulikhel Hospital, Nepal. American Journal of Biomedical and Life Sciences, 2(2), 34-39. https://doi.org/10.11648/j.ajbls.20140202.11

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    ACS Style

    Dhruba Acharya; Abha Shrestha; Bikash Bogati; Kishor Khanal; Shrinkhala Shrestha, et al. Serological Screening of TORCH Agents as an Etiology of Spontaneous Abortion in Dhulikhel Hospital, Nepal. Am. J. Biomed. Life Sci. 2014, 2(2), 34-39. doi: 10.11648/j.ajbls.20140202.11

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    AMA Style

    Dhruba Acharya, Abha Shrestha, Bikash Bogati, Kishor Khanal, Shrinkhala Shrestha, et al. Serological Screening of TORCH Agents as an Etiology of Spontaneous Abortion in Dhulikhel Hospital, Nepal. Am J Biomed Life Sci. 2014;2(2):34-39. doi: 10.11648/j.ajbls.20140202.11

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  • @article{10.11648/j.ajbls.20140202.11,
      author = {Dhruba Acharya and Abha Shrestha and Bikash Bogati and Kishor Khanal and Shrinkhala Shrestha and Prabin Gyawali},
      title = {Serological Screening of TORCH Agents as an Etiology of Spontaneous Abortion in Dhulikhel Hospital, Nepal},
      journal = {American Journal of Biomedical and Life Sciences},
      volume = {2},
      number = {2},
      pages = {34-39},
      doi = {10.11648/j.ajbls.20140202.11},
      url = {https://doi.org/10.11648/j.ajbls.20140202.11},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajbls.20140202.11},
      abstract = {The role of TORCH infections as a cause of spontaneous abortions is still debatable with conflicting results where geographical variation may play a significant role. This study was undertaken to discover the association of TORCH infections in women with spontaneous abortions by serological testing. The descriptive case control study was conducted from January to December, 2012. A serological evaluation was carried out to determine the presence of Toxoplasma gondii, Rubella, Cytomegalovirus (CMV) and Herpes Simplex Virus (HSV) specific immunoglobulin G (IgG) and immunoglobulin M (IgM) antibodies, using commercial diagnostic kits by enzyme-linked immunosorbent assay (ELISA) technique. Mean age of the study and control subjects were 24.8+/-6.4 and 23.8+/-3.8 years respectively where 72.8% of the study subjects were of the age between 20 to 35 years and 23% of the women with spontaneous abortion were below 20 years. Most of the cases were of incomplete abortions (43%) followed by complete abortions (26%). Only 1.3% of both IgG and IgM seropositivity against TORCH agents were noted among the study subjects whereas highest IgG seropositivity was detected with Rubella (86.8%) followed by HSV-I (72.8%). An infection susceptibility rate of 77.9% to Toxoplasma gondii, 11.7% to Rubella, 51.9% to CMV, 36.4% to HSV-I and 84.4% to HSV-II was noted. No significant difference in relation to age and type of abortion was found in seropositivity between the study and the control subjects. This study, probably the first of its kind from Nepal, suggests that current infection with TORCH agents might not be the possible etiology of spontaneous abortion. Serological TORCH screening may not be conclusive.},
     year = {2014}
    }
    

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    T1  - Serological Screening of TORCH Agents as an Etiology of Spontaneous Abortion in Dhulikhel Hospital, Nepal
    AU  - Dhruba Acharya
    AU  - Abha Shrestha
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    JO  - American Journal of Biomedical and Life Sciences
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    PB  - Science Publishing Group
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    AB  - The role of TORCH infections as a cause of spontaneous abortions is still debatable with conflicting results where geographical variation may play a significant role. This study was undertaken to discover the association of TORCH infections in women with spontaneous abortions by serological testing. The descriptive case control study was conducted from January to December, 2012. A serological evaluation was carried out to determine the presence of Toxoplasma gondii, Rubella, Cytomegalovirus (CMV) and Herpes Simplex Virus (HSV) specific immunoglobulin G (IgG) and immunoglobulin M (IgM) antibodies, using commercial diagnostic kits by enzyme-linked immunosorbent assay (ELISA) technique. Mean age of the study and control subjects were 24.8+/-6.4 and 23.8+/-3.8 years respectively where 72.8% of the study subjects were of the age between 20 to 35 years and 23% of the women with spontaneous abortion were below 20 years. Most of the cases were of incomplete abortions (43%) followed by complete abortions (26%). Only 1.3% of both IgG and IgM seropositivity against TORCH agents were noted among the study subjects whereas highest IgG seropositivity was detected with Rubella (86.8%) followed by HSV-I (72.8%). An infection susceptibility rate of 77.9% to Toxoplasma gondii, 11.7% to Rubella, 51.9% to CMV, 36.4% to HSV-I and 84.4% to HSV-II was noted. No significant difference in relation to age and type of abortion was found in seropositivity between the study and the control subjects. This study, probably the first of its kind from Nepal, suggests that current infection with TORCH agents might not be the possible etiology of spontaneous abortion. Serological TORCH screening may not be conclusive.
    VL  - 2
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Author Information
  • Department of Microbiology, Kathmandu University School of Medical Sciences, Kavre, P.O.Box- 11008, Nepal

  • Department of Obstetrics and Gynecology, Kathmandu University School of Medical Sciences, Kavre, Nepal

  • Department of Microbiology, Dhulikhel Hospital-Kathmandu University Hospital, Kavre, Nepal

  • Department of Community Medicine, Kathmandu University School of Medical Sciences, Kavre, Nepal

  • Department of Community Programs, Dhulikhel Hospital- Kathmandu University Hospital, Kavre, Nepal

  • Department of Biochemistry, Kathmandu University School of Medical Sciences, Kavre, Nepal

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