Gebelikte rutin TORCH taraması gerekli midir?

Yıl 2020, Cilt: 2 Sayı: 4, 115 - 121, 28.12.2020

İbrahim Kale , Rahime Bayık Gizem Berfin Uluutku , Başak Ergin

https://doi.org/10.46969/ezh.732840

Cited By: 3

Öz

AMAÇ: Ümraniye Eğitim ve Araştırma Hastanesi’nin gebe polikliniğine başvuran gebelerde Toksoplasma Gondii, Rubella ve Sitomegalovirus’a karşı olan bağışıklık durumunu tespit etmek ve Türkiye’nin diğer bölgelerindeki seroprevalans oranları ile karşılaştırmaktır.
GEREÇ VE YÖNTEM: 01/01/2017- 30/10/2019 tarihleri arasında hastanemizin gebe polikliniğine başvuran tüm gebelerin Toksoplasma Gondii, Rubella ve Sitomegalovirus’e karşı olan antikor düzeyleri retrospektif olarak hastane kayıtlarından çıkarıldı. Çalışmaya sadece her üç virus için IgM ve IgG antikorlarının birlikte bakıldığı gebeler dahil edildi. IgM ve IgG birlikte pozitif olduğu gebelerin varsa IgG avidite sonuclarına ulaşıldı. Bu serolojik testler Elisa yöntemi ile Abbott Architect i2000 SR cihazında üretici firmanın önerileri doğrultusunda çalışılmıştır.
BULGULAR: Hastane kayıtlarından Toxoplasma gondii için 7535, Rubella için 9093 ve CMV için 2652 gebenin test sonuçlarına ulaşıldı. Toxoplasma gondii IgM pozitifliği %0.6, Rubella IgM pozitifliği %0.3 ve Cytomegalovirus IgM pozitifliği %2.3, Toxoplasma gondii IgG pozitifliği %24, Rubella IgG pozitifliği %86.4 ve Cytomegalovirus IgG pozitifliği %99 olarak saptandı. Toxoplasma gondii IgG Avidite test sonuçları %5.3 düşük, %10.5 sınır ve % 84.2 yüksek değer olarak saptandı. Rubella IgG ve CMV IgG avidite sonuçlarının hepsi yüksek avidite olarak tespit edildi.
SONUÇ: Toxoplasma IgG seroprevalansı yüksek olmadığı için ve gebelikte geçirilen akut Toxoplasmozis enfeksiyonun tedavisi olduğu için gebelere Toxoplasma taraması önerilmelidir. Ülkemizde Rubella virusüne karşı bağışıklığın halen istenilen düzeyde olmamasından dolayı gebelikte Rubella virusüne karşı taramanın önemli olduğunu düşünmekteyiz. Ülkemizde CMV IgG seroprevalansının yüksek olmasından dolayı gebelerde rutin CMV taramasının gereksiz olduğunu düşünmekteyiz.

Anahtar Kelimeler

antenatal tarama, toxoplasma, rubella, cytomegalovirus

Is routine TORCH screening necessary for pregnancy follow-up?

Öz

Aim: This study aimed to determine the seroprevalence rates of Toxoplasma gondii, Rubella and Cytomegalovirus
(CMV) among the pregnant women who presented to the Ümraniye Training and Research Hospital and to compare the
seroprevalence rates with the other studies fromTurkey.
Material and method: The antibody levels of all pregnant women presented to the prenatal outpatient clinic between
January 1, 2017 and October 30, 2019, for Toxoplasma gondii, Rubella, CMV were obtained retrospectively. Only pregnant
women with immunoglobulin M (IgM) and immunoglobulin G (IgG) antibody results of the three viruses were included in
the study. If IgM and IgG were both found to be positive, the IgG avidity results were obtained using the Abbott Architect
i2000 SR device with enzyme-linked immunosorbent assay (ELISA), following the manufacturer's recommendations.
Results: Serological results of pregnant women for Toxoplasma gondii (n = 7535), Rubella (n = 9093), and CMV (n = 2652)
were obtained from the hospital records. IgM positivity was found to be 0.6% for Toxoplasma gondii, 0.3% for Rubella, and
2.3% for CMV. IgG positivity was found to be 24% for Toxoplasma gondii, 86.4% for Rubella, and 99% for CMV. IgG avidity
test results for Toxoplasma gondii were 5.3% low, 10.5% borderline, and 84.2% high. Rubella IgG and CMV IgG avidity results
were all determined following high avidity.
Conclusion: Because Toxoplasma IgG seroprevalence is not high, and the treatment of acute toxoplasmosis infection
during pregnancy is possible, Toxoplasma screening should be recommended to all pregnant women. Because the
immunity to the Rubella virus is still not at the desired level in our country, we believe screening against Rubella is vital
during pregnancy. We also believe that routine CMV screening is unnecessary in pregnant women owing to the high
seroprevalence of CMV IgG in our country.

Anahtar Kelimeler

antenatal screening, toxoplasma, rubella, cytomegalovirus

Kaynakça

• Brabin BJ. Epidemiology of infection in pregnancy. Rev Inf Dis 1985; 7:579603.
• Kızılkaya Beji N. (Ed). Women's Health and Diseases. Nobel Medical Bookstores, İstanbul, 2015.
• Gezer A. (Çev Ed). Maternal-Fetal Evidence Based Clinical Guidelines. Berghella V. (Ed). Maternal-Fetal Evidence Based Clinical Guidelines. İstanbul: İstanbul Medical Publishing, 2009.
• Dhakal R, Gajurel K, Pomares C, Talucod J, Press CJ, Montoya JG. Significance of a positive toxoplasma immunoglobulin M test result in the United States. J Clin Microbiol 2015; 53:3601-3605.
• Patel KK, Shrivastava G, Bhatambare G, Bajpai T. Antenatal detection of Ig M and Ig G antibodies to Toxoplasma gondii in a hospital from central India. Int J Health Sys Disaster Man 2014; 2:133–135.
• Devakumar D, Bamford A, Ferreira MU, et al. Infectious causes of microcephaly: epidemiology, pathogenesis, diagnosis, and management. Lancet Infect Dis 2018; 18:1-13.
• Gibson CS, MacLennan AH, Goldwater PN, Haan EA, Priest K, Dekker GA; South Australian Cerebral Palsy Research Group. Neurotropic viruses and cerebral palsy: population based case-control study. BMJ 2006; 332:76–80.
• Tastad KJ, Schleiss MR, Lammert SM, Basta NE. Awareness of congenital cytomegalovirus and acceptance of maternal and newborn screening. PLoS One 2019; 14:e0221725.
• Ornoy A, Diav-Citrin O. Fetal effects of primary and secondary cytomegalovirus infection in pregnancy. Reprod Toxicol 2006; 21:399-409.
• Silasi M, Cardenas I, Kwon JY, Racicot K, Aldo P, Mor G. Viral infections during pregnancy. Am J Reprod Immunol 2015; 73:199-213.
• Bessieres M, Berrebi A, Cassaing S, et al. Diagnosis of congenital toxoplasmosis: prenatal and neonatal evaluation of methods used in Toulouse University Hospital and incidence of congenital toxoplasmosis. Mem Inst Oswaldo Cruz 2009; 104:389–392.
• Vogel N, Kirisits M, Michael E, et al. Congenital toxoplasmosis transmitted from an immunologically competent mother infected before conception. Clin Infect Dis 1996; 23:1055–1060.
• Prusa AR, Kasper DC, Olischar M, Husslein P, Pollak A, Hayde M. Evaluation of serological prenatal screening to detect Toxoplasma gondii infections in Austria. Neonatology 2013; 103:27–34.
• Wallon M, Peyron F, Cornu C, et al. Congenital toxoplasma infection: monthly prenatal screening decreases transmission rate and improves clinical outcome at age 3 years. Clin Inf Dis 2013; 56:1223–1231.
• WHO Global Measles and Rubella Strategic Plan 20122020 [Internet]. Geneva (Switzerland): WHO; 2012 [consulted on 8 February2017]. Available from: http://apps.who.int/iris/bitstream/10665/44855/1/9789241503396_ eng.pd (Erişim: 10.10.2020).
• Gurlek B, Colak S. Antenatal Toxoplasma Gondii, Rubella and Cytomegalovirus infection screening among pregnant women attending tertiary university hospital. Gynecol Obstet Reprod Med 2019; 25:74-80.
• Duran İ, Nazik S, Nazik H, Duran Ş. Evaluation of toxoplasma and rubella seropositivity in pregnancy. Balıkesir Med J 2017; 1:22-25.
• Kasap B, Öner G, Küçük M, et al. Evaluation of toxoplasmosis, rubella, cytomegalovirus and hepatitis prevalence of pregnant women in Muğla. J Tepecik Edu Res Hos 2017; 27:31-36.
• Parlak M, Çim N, Nalça Erdin B, Güven A, Bayram Y, Yıldızhan R. Seroprevalence of Toxoplasma, Rubella, and Cytomegalovirus among pregnant women in Van. Turk J Obstet Gynecol 2015; 12:79-82.
• Doğan K, Güraslan H, Özel G, Aydan Z, Yaşar L. Seroprevalence rates of Toxoplasma gondii, rubella, cytomegalovirus, syphilis, and hepatitis B, seroprevalences rate in the pregnant population in İstanbul. Turkiye Parazitoloji Derg 2014; 38:228-233.
• Numan O, Vural F, Aka N, Alpay M, Coskun AD. TORCH seroprevalence among patients attending Obstetric Care Clinic of Haydarpasa Training and Research Hospital affiliated to Association of Istanbul Northern Anatolia Public Hospitals. North Clin Istanb 2015; 2:203-209.
• Karacan M, Batukan M, Cebi Z, et al. Screening cytomegalovirus, rubella and toxoplasma infections in pregnant women with unknown pre-pregnancy serological status. Arch Gynecol Obstet 2014; 290:1115-1120.
• Collinet P, Subtil D, Houfflin-Debarge V, Kacet N, Dewilde A, Puech F. Routine CMV screening during pregnancy. Eur J Obstet Gynecol Reprod Biol 2004; 114:3–11.
• Kenneson A, Cannon MJ. Review and meta-analysis of the epidemiology of congenital cytomegalovirus (CMV) infection. Rev Med Virol 2007; 17:253–76.
• Mohammadi A, Karbasi B, Shahbazi R, Foroughi A, Mokhber-Alsafa L. Cytomegalovirus Seroepidemiology: A Population-based Study in Alborz Province, Iran. Arch Razi Inst 2019; 74:165-173.
• Dollard SC, Staras SA, Amin MM, Schmid DS, Cannon MJ. National prevalence estimates for cytomegalovirus IgM and IgG avidity and association between high IgM antibody titer and low IgG avidity. Clin Vaccine Immunol 2011; 18:1895-1899.
• Aynioglu A, Aynioglu O, Altunok ES. Seroprevalence of toxoplasma gondii, rubella and cytomegalovirus among pregnant females in north-western Turkey. Acta Clin Belg 2015; 70:321-324.
• Bakacak M, Bostancı MS, Köstü B, et al. Seroprevalance of Toxoplasma gondii, rubella and cytomegalovirus among pregnant women. Dicle Med J 2014; 41:326-331.
• Çeltek NY, Tetikçok R, Günal Ö, et al. Seroprevalence for rubella, CMV and Toxoplasmosis among pregnant women in central Black Sea region of Turkey. Med J Tokat Gaziosmanpasa Univ 2014; 6:54-62.
• Inci A, Yener C, Güven D. The investigation of toxoplasma, rubella and cytomegalovirus seroprevalancies in pregnant women in a state hospital. Pamukkale Med J 2014; 7:143-146.
• Karabulut A, Polat Y, Türk M, Isik Balci Y. Evaluation of rubella, Toxoplasma gondii and cytomegalovirus seroprevalemces among pregnant women in Denizli province. Turk J Med Sci 2011; 41:159-164.
• Madendağ Y, Eraslan Şahin M, Çöl Madendağ İ, Şahin E, Açmaz G, Müdderris İİ. Investigation of toxoplasma, cytomegalovirus and rubella seroprevalence in pregnant women admitted to our hospital. Perinat J 2018; 26:7-10.
• Ocak S, Zeteroglu S, Ozer C, Dolapcioglu K, Gungoren A. Seroprevalence of Toxoplasma gondii, rubella and cytomegalovirus among pregnant women in southern Turkey. Scand J Infect Dis 2007; 39:231–234.
• Şimşek M, Keşli R, Demir C, Çetinkaya Ö, Arıöz DT. Investigation seroprevalence of toxoplasma, rubella, cytomegalovirus and herpes simplex virus type 2 in pregnant women followed in the application and research hospital, Afyon Kocatepe University. Ortadogu Med J 2016; 8:1-6.
• Sirin MC, Agus N, Yilmaz N, et al. Seroprevalence of Toxoplasma gondii, rubella virus and cytomegalovirus among pregnant women and the importance of avidity assays. Saudi Med J 2017; 38:727-732.
• Tamer GS, Dundar D, Caliskan E. Seroprevalence of Toxoplasma gondii, rubella and cytomegalovirus among pregnant women in western region of Turkey. Clin Invest Med 2009; 32:43-47.