Gebelikte Toxoplasma Gondii, Rubella virus ve Cytomegalovirus Enfeksiyonlarının Araştırılması, Avidite Testlerinin Perinatal Takip Sonuçlarının Retrospektif Değerlendirilmesi

Yıl 2022, Cilt: 12 Sayı: 5, 716 - 721, 30.09.2022

Mehmet Keçecioğlu , Begüm Nalça Erdin , Tuğba Kula Atik , Alev Çetin Duran

https://doi.org/10.16899/jcm.1125694

Cited By: 1

Öz

Amaç: Bu çalışmada Toxoplasma Gondii, Rubella virus ve Cytomegolovirus (CMV) IgM ve IgG sonuçları, avidite testleri ve perinatal takip sonuçlarının retrospektif olarak araştırılması amaçlandı.
Gereç ve Yöntem: 2017-2018 yıllarında Kadın Hastalıkları ve Doğum Polikliniğine başvuran gebelerin Toxoplasma Gondii, Rubella virus, CMV IgG ve IgM test sonuçları ve IgG avidite indeksleri retrospektif olarak incelendi. Bu enfeksiyonlardan herhangi biri için IgM sonucu pozitif olduğunda, IgG avidite indeksleri, ultrason (USG) bulguları, doğum öncesi sonuçları, amniyosentez sonuçları, IgM pozitifliği görülen gebelik haftası ve bu enfeksiyonlara yönelik uygulanan tedaviler geriye dönük olarak araştırıldı. Bu gebelerin bebeklerinin doğum şekli ve ağırlığı, APGAR skoru ve yoğun bakım ihtiyacı gibi bilgiler incelendi.
Bulgular: 6719 hastanın %24,1'inin Toxoplasma IgG, %98,9'unun Rubella virus IgG ve %98,7'sinin CMV IgG pozitif olduğu görüldü. IgM pozitifliği incelendiğinde bu oranın Toksoplazma için %0,46 (n=31), Rubella virus için %0,16 (n=11) ve CMV için %0,7 (n=47) olduğu görüldü. Sadece Toxoplasma Gondii için 9 düşük avidite testi sonucu saptandı ancak TORCH ile ilişkili perinatal enfeksiyon kanıtı bulunamadı.
Sonuç: Sonuç olarak, gebelikte Toksoplazma, Rubella virus ve CMV enfeksiyonlarının taranması halen tartışmalı bir konu olup, ülkeler arasında farklı öneriler ve uygulamalar mevcuttur ve Türkiye'de ulusal bir tarama programı bulunmamaktadır. Seroprevalansın bilinmesi ulusal tarama stratejilerinin oluşturulmasında ve gebelere bu enfeksiyonlardan korunma konusunda danışmanlık verilmesinde büyük önem taşımaktadır. Bu açıdan bakıldığında çalışmamız bu konuda Balıkesir bölgesinde yapılmış ilk çalışma olması açısından bu verilere katkı sağlaması açısından değerlidir.

Anahtar Kelimeler

TORCH, konjenital infeksiyon, avidite

Destekleyen Kurum

yok

Proje Numarası

yok

Teşekkür

yok

Investigation of Toxoplasma Gondii, Rubella virus and Cytomegalovirus Infections in Pregnancy, Retrospective Evaluation of Avidity Tests and Perinatal Follow-up Results

Öz

Aim: In this study, it was aimed to investigate Toxoplasma Gondii, Rubella virus and Cytomegalovirus (CMV) IgM and IgG results, the avidity tests and perinatal follow-up results retrospectively.
Material and Method: Test results of pregnant women who applied to Gynecology and Obstetrics Polyclinics in 2017-2018 were analyzed retrospectively.When IgM result was positive for any of these infections, IgG avidity indices, ultrasound (USG) findings, prenatal screening results, amniocentesis results, week of gestation that IgM positivity was observed, and if any treatments applied for these infections, were examined from the file records of pregnant women.
Results: It was observed that 24.1% of 6719 patients were Toxoplasma IgG, 98.9% were Rubella IgG and 98.7% were CMV IgG positive. When the IgM positivity was examined, it was seen that this rate was 0.46% (n=31) for Toxoplasma, 0.16% (n=11) for Rubella and 0.7% (n=47) for CMV. There was only 9 low avidity test results for Toxoplasma Gondii. But there was no evidence of perinatal infection associated with these infectious agents .
Conclusion: In conclusion, screening for toxoplasma, rubella and CMV infections during pregnancy is still a controversial subject and there is no national screening programme in Turkey. Knowing the seroprevalence is of great importance in establishing national screening strategies and providing consultancy to pregnant women about protection from these infections. From this point of view our study is valuable in that it contributes to these data as the first study conducted in Balıkesir region on this subject

Anahtar Kelimeler

TORCH, congenital infection, avidity

Proje Numarası

yok

Kaynakça

• Leeper C, Lutzkanin A 3rd. Infections during pregnancy. Prim Care 2018;45:567-86.
• Pereira L. Congenital viral infection: traversing the uterine-placental interface. Annu Rev Virol 2018;5:273-99.
• Tanimura K, Yamada H. Potential biomarkers for predicting congenital cytomegalovirus infection. Int J Mol Sci 2018;19:3760-73.
• Neu N, Duchon J, Zachariah P. TORCH infections. Clin Perinatol 2015;42:77-103.
• Vynnycky E, Adams EJ, Cutts FT, et al. Using seroprevalence and immunisation coverage data to estimate the global burden of congenital Rubella syndrome, 1996-2010: A systematic review. PLoS One 2016;11:e0149160.
• Pappas G, Roussos N, Falagas ME. Toxoplasmosis snapshots: global status of Toxoplasma Gondii seroprevalence and implications for pregnancy and congenital toxoplasmosis. Int J Parasitol 2009;39:1385-94.
• Johnson Karen E. Overview of TORCH infections. https://www.uptodate.com/contents/overview-of-torch-infections.
• Doğum Öncesi Bakım Yönetim Rehberi T.C. Sağlık Bakanlığı Türkiye Halk Sağlığı Kurumu Kadın ve Üreme Sağlığı Daire Bakanlığı Ankara,2014. https://sbu.saglik.gov.tr/Ekutuphane/kitaplar/dogumonubakim.pdf.
• Warnecke JM, Pollmann M, Borchardt-Lohölter V, et al. Seroprevalences of antibodies against TORCH infectious pathogens in women of childbearing age residing in Brazil, Mexico, Germany, Poland, Turkey and China. Epidemiol Infect 2020;148:e271.
• 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;38:727-32.
• Türkmen Albayrak H, Bakır A, Güney M, Yavuz MT. Evaluation of Toxoplasma Gondii, Rubella virus and Cytomegalovirus Infections. Anatol J Family Med 2020;3:136–40.
• Avcioglu F, Behcet M, Kurtoglu GM. Evaluation of Toxoplasma, Rubella, and Cytomegalovirus serological results in women of childbearing age. Rev Assoc Med Bras 2020:66:789-93.
• 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.
• Aşcı Z, Akgün S. The evaluation of Toxoplasma Gondii (T. gondii) serology results among cases who admitted to the serology laboratory of a hospital in Afyon City. Turkiye Parazitol Derg 2015;39:9-12.
• Demiroğlu T, Akın Polat Z, Çelik C. Investigation of the risk factors affecting Toxoplasma Gondii seropositivity in women of reproductive age applying to the Maternity Clinic of Kilis State Hospital. Turkiye Parazitol Derg 2015;39:299-304.
• Maldonado YA, Read JS, Committee on Infectious Diseases. Diagnosis, Treatment, and Prevention of Congenital Toxoplasmosis in the United States. Pediatrics 2017;139:e20163860.
• 17.Willke Topcu A, Soyletir G, Doğanay M. In: Willke Topcu A, Soyletir G, Doğanay M, editors. Infectious Diseases and Microbiology. İstanbul, Nobel Publishing; 2008.
• Ryan KJ, Ray CG. In: Ryan KJ, Ray CG, editors. Sherris Medical Microbiology. United States of America: The McGraw-Hill Companies; 2010.
• Enders G, Daiminger A, Lindemann L, et al. Cytomegalovirus (CMV) seroprevalence in pregnant women, bone marrow donors and adolescents in Germany, 1996-2010. Med Microbiol Immunol 2012;201:303-9.
• Pembrey L, Raynor P, Griffiths P, Chaytor S, Wright J, Hall AJ. Seroprevalence of Cytomegalovirus, Epstein Barr Virus and Varicella Zoster Virus among Pregnant Women in Bradford: A Cohort Study. PLoS One 2013;8:e81881.
• Guerra B, Lazzarotto T, Quarta S, et al. Prenatal diagnosis of symptomatic congenital cytomegalovirus infection. Am J Obstet Gynecol. 2000;183:476-82.
• Azam AZ, Vial Y, Fawer CL, Zufferey J, Hohlfeld P. Prenatal diagnosis of congenital cytomegalovirus infection. Obstet Gynecol 2001;97:443-8.
• 23.Cahill AG, Odibo AO, Stamilio DM, Macones GA. Screening and treating for primary cytomegalovirus infection in pregnancy: where do we stand? A decision-analytic and economic analysis. Am J Obstet Gynecol 2009; 201:466.e1.
• Walker SP, Palma-Dias R, Wood EM, Shekleton P, Giles ML. Cytomegalovirus in pregnancy: to screen or not to screen. BMC Pregnancy Childbirth 2013;13:96-103.
• American College of Obstetricians and Gynecologists. Practice bulletin no. 151: Cytomegalovirus, parvovirus B19, varicella zoster, and toxoplasmosis in pregnancy. Obstet Gynecol 2015;125:1510-25.
• Society for Maternal-Fetal Medicine (SMFM), Hughes BL, Gyamfi-Bannerman C. Diagnosis and antenatal management of congenital cytomegalovirus infection. Am J Obstet Gynecol 2016; 214:5-11.
• Tanimura K, Tairaku S, Morioka I, et al. Universal Screening With Use of Immunoglobulin G Avidity for Congenital Cytomegalovirus Infection. Clin Infect Dis 2017;65:1652-8.
• Vauloup-Fellous C, Picone O, Cordier AG, et al. Does hygiene counseling have an impact on the rate of CMV primary infection during pregnancy? Results of a 3-year prospective study in a French hospital. J Clin Virol 2009;46:49-53.
• Adler SP, Finney JW, Manganello AM, Best AM. Prevention of child-to-mother transmission of cytomegalovirus by changing behaviors: a randomized controlled trial. Pediatr Infect Dis J 1996;15:240-6.
• Revello MG, Tibaldi C, Masuelli G, et al. Prevention of Primary Cytomegalovirus Infection in Pregnancy. EBioMedicine 2015;2:1205-10.
• Mendelson E, Aboudy Y, Smetana Z, Tepperberg M, Grossman Z. Laboratory assessment and diagnosis of congenital viral infections: Rubella, cytomegalovirus (CMV), varicella-zoster virus (VZV), herpes simplex virus (HSV), parvovirus B19 and human immunodeficiency virus (HIV). Repr Toxicology 2006;21:350-82.
• Genco F, Sarasini A, Parea M, Prestia M, Scudeller L, Meroni V. Comparison of the LIAISON®XL and ARCHITECT IgG, IgM, and IgG avidity assays for the diagnosis of Toxoplasmagondii, cytomegalovirus, and rubella virus infections. New Microbiol 2019;42:88-93.
• Doğan K, Guraslan 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 Parazitol Derg 2014;38:228-33.
• Bakacak M, Bostancı MS, Köstü B, et al. Seroprevalance of Toxoplasma Gondii, rubella and cytomegalovirus among pregnant women. Dicle Med J 2014;41:326-31.
• Voekt CA, Rinderknecht T, Hirsch H, Blaich A, Hösli IM. Ultrasound indications for maternal STORCH testing in pregnancy. Swiss Med Wkly 2017;147:w14534.