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TORCH – IgG (4 Parameters)

Bacterial/ Viral

4 parameters

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Antibodies to TORCH pathogens.

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Parameters

  • List of Tests
    • Cytomegalo Virus (CMV) - IgG
    • Herpes Simplex Virus (HSV I & II) - IgG
    • Rubella - IgG
    • Toxoplasma Gondii - IgG

TORCH – IgG (4 Parameters)

  • Why is it done?
    • The TORCH – IgG panel screens for immunity and past or current exposure to four major intrauterine and perinatal pathogens: Toxoplasma gondii, Other (syphilis), Rubella, Cytomegalovirus (CMV), and Herpes Simplex Virus (HSV I & II)
    • Primarily used for pregnant women during prenatal screening to assess fetal risk from congenital infections that can cause developmental abnormalities, intellectual disability, or birth defects
    • Recommended for women planning pregnancy to determine immunity status and guide vaccination or prevention strategies
    • Indicated in patients with immunocompromised status (HIV/AIDS, transplant recipients) to identify reactivation risk or need for prophylaxis
    • Used when newborns present with symptoms suggestive of congenital infection (microcephaly, intrauterine growth restriction, rash, jaundice, thrombocytopenia)
    • The four individual tests work together to provide comprehensive coverage of the most common causes of congenital infections and neonatal complications
    • IgG antibodies indicate past infection, immunity, or chronic infection rather than acute infection; combined interpretation of all four tests provides risk stratification for obstetric management
    • Cytomegalovirus (CMV) - IgG: Assesses immunity to CMV, the most common congenital viral infection globally; highest risk of transmission in first trimester with worst fetal outcomes
    • Herpes Simplex Virus (HSV I & II) - IgG: Determines prior exposure to HSV I (typically oral) or HSV II (typically genital); important for neonatal transmission risk assessment at delivery
    • Rubella - IgG: Confirms immunity from prior vaccination or natural infection; critical for first trimester congenital rubella syndrome prevention
    • Toxoplasma Gondii - IgG: Evaluates exposure to intracellular parasite; indicates need for dietary counseling and prevention measures to avoid primary infection during pregnancy
  • Normal Range
    • Cytomegalovirus (CMV) - IgG: Negative/Not Detected < 0.90 AU/mL (or Index < 0.9); Positive/Detected ≥ 1.10 AU/mL (or Index ≥ 1.1); Borderline/Equivocal 0.90-1.10 AU/mL (requires repeat testing)
    • Herpes Simplex Virus (HSV I & II) - IgG: Negative/Not Detected < 0.90 AU/mL (or Index < 0.9); Positive/Detected ≥ 1.10 AU/mL (or Index ≥ 1.1); Borderline/Equivocal 0.90-1.10 AU/mL; reported separately for HSV I and HSV II
    • Rubella - IgG: Negative/Not Immune < 10 IU/mL; Positive/Immune ≥ 10 IU/mL (protective antibody titer); Borderline 8-10 IU/mL may require verification; units measured in International Units per milliliter (IU/mL)
    • Toxoplasma Gondii - IgG: Negative/Not Detected < 2.0 IU/mL; Low Positive 2.0-3.9 IU/mL (may indicate acute infection, requires IgM testing); Positive ≥ 4.0 IU/mL (indicates immunity or past infection); units in International Units per milliliter (IU/mL)
    • Normal interpretation: Negative results indicate no immunity (seronegative); Positive results indicate past infection or vaccination-induced immunity (seropositive)
    • Reference ranges may vary slightly between laboratories and testing methodologies (ELISA, chemiluminescence, or other immunoassays); always consult the laboratory-specific reference range provided with results
  • Interpretation
    • Cytomegalovirus (CMV) - IgG Positive: Indicates past CMV infection or chronic/latent CMV carriage; patient has immunity and low risk of primary infection; however, reactivation possible in immunocompromised patients; if positive during pregnancy with no prior exposure history, may indicate recent primary infection (confirm with IgM testing and viral load)
    • Cytomegalovirus (CMV) - IgG Negative: Indicates no prior CMV infection and no immunity; patient is seronegative and at risk for primary CMV infection; during pregnancy, negative result is reassuring but requires counseling on prevention; immunocompromised patients with negative results have high risk for severe CMV disease if exposed
    • Herpes Simplex Virus (HSV I & II) - IgG Positive for HSV I: Indicates prior infection with oral herpes; congenital transmission risk is very low (< 1%) as most people have antibodies; however, primary infection during pregnancy carries higher risk
    • Herpes Simplex Virus (HSV I & II) - IgG Positive for HSV II: Indicates prior genital herpes infection; pregnant women with HSV II seropositivity have risk of transmission to neonate during vaginal delivery (1-5% risk); neonatal HSV infection can cause serious disseminated disease, encephalitis, or death; cesarean delivery may be recommended if active lesions present
    • Herpes Simplex Virus (HSV I & II) - IgG Negative: Indicates no prior infection with either HSV I or HSV II; patient is seronegative and susceptible to both; during pregnancy, higher risk of severe primary infection; delivery mode can be vaginal unless other obstetric indications for cesarean section exist
    • Rubella - IgG Positive (≥ 10 IU/mL): Indicates immunity from prior vaccination (MMR vaccine) or natural infection; protective antibodies present; minimal risk of congenital rubella syndrome if exposed during pregnancy; seropositive status is reassuring in pregnancy planning
    • Rubella - IgG Negative (< 10 IU/mL): Indicates no prior rubella infection and no immunity; patient is susceptible and should be vaccinated (MMR vaccine) prior to pregnancy as vaccine cannot be given during pregnancy; if negative during pregnancy, high risk of congenital rubella syndrome with catastrophic fetal consequences (cardiac defects, cataracts, deafness, intellectual disability); vaccination recommended postpartum if not pregnant
    • Toxoplasma Gondii - IgG Positive (≥ 4.0 IU/mL): Indicates past infection or immunity; patient has been exposed to Toxoplasma; lifelong immunity typically develops; in non-immunocompromised patients, reactivation is rare; in immunocompromised patients, cyst reactivation can cause encephalitis requiring prophylaxis
    • Toxoplasma Gondii - IgG Negative (< 2.0 IU/mL): Indicates no prior toxoplasma infection and no immunity; patient is seronegative and at risk for primary infection; during pregnancy, primary infection poses highest risk to fetus causing severe manifestations; dietary counseling essential (avoid undercooked meat, unwashed vegetables, contact with cat feces)
    • Toxoplasma Gondii - IgG Low Positive (2.0-3.9 IU/mL): Borderline range suggesting possible acute or recent infection; IgM testing recommended to distinguish acute from past infection; if IgM positive, indicates recent primary infection with high fetal transmission risk
    • False positive results may occur with cross-reactivity from other infections; borderline results require repeat testing or confirmatory testing with different methodology
    • False negative results rare but possible in early seroconversion period; if high clinical suspicion remains with negative results, repeat testing after 2-4 weeks or obtain IgM antibodies to assess for acute infection
  • Associated Organs
    • Cytomegalovirus (CMV) - IgG: Affects immune system (lymphoid tissues), CNS (brain, meninges), eyes (retinitis), lungs (pneumonitis), gastrointestinal tract, and liver; in congenital CMV, causes microcephaly, ventriculomegaly, periventricular calcifications, and progressive hearing loss in neonates
    • Cytomegalovirus (CMV) - IgG abnormality implications: In immunocompromised patients (CD4 < 50 cells/μL), CMV reactivation causes retinitis (leading cause of blindness in AIDS patients), esophagitis, colitis, and encephalitis; in pregnant women, congenital infection causes developmental delays and permanent disability in 10-15% of infected newborns
    • Herpes Simplex Virus (HSV I & II) - IgG: Affects nervous system (dorsal root ganglia, brain), skin (recurrent lesions), mucous membranes (oral, genital), and eyes (keratitis); can cause CNS complications including encephalitis and meningitis
    • Herpes Simplex Virus (HSV II) - IgG abnormality implications: Neonatal HSV II infection causes disseminated disease affecting liver, lungs, CNS, and can lead to encephalitis, hepatitis, multi-organ failure, and death if untreated; maternal primary infection in third trimester carries highest transmission risk (30-50%) compared to recurrent infection (< 2%)
    • Rubella - IgG: Affects respiratory tract (initial infection), lymph nodes, and in congenital cases, affects heart, eyes, ears, brain, and endocrine system; congenital rubella syndrome causes permanent damage
    • Rubella - IgG abnormality implications: Congenital rubella syndrome causes cardiac defects (patent ductus arteriosus, pulmonary artery stenosis), sensorineural hearing loss (most common manifestation), ocular defects (cataracts, glaucoma, retinopathy), microcephaly, intellectual disability, growth restriction, and thrombocytopenia; devastating consequences if primary infection occurs in first trimester
    • Toxoplasma Gondii - IgG: Affects CNS (brain tissue, cysts), eyes (retinitis, chorioretinitis), and muscle tissue; intracellular parasite that establishes latency in tissue cysts
    • Toxoplasma Gondii - IgG abnormality implications: Congenital toxoplasmosis causes chorioretinitis (leading cause of preventable blindness in congenital infections), intracranial calcifications, ventriculomegaly, microcephaly, seizures, and severe neurologic sequelae; worst outcomes occur with primary maternal infection in first trimester; in immunocompromised patients, reactivation causes CNS mass lesions and encephalitis (most common opportunistic CNS infection in AIDS)
    • Overall TORCH panel impact: Tests evaluate organs critical for fetal development; abnormal results directly correlate with specific congenital anomalies and developmental disabilities; combined positive results require comprehensive prenatal counseling and management strategies
  • Follow-up Tests
    • Cytomegalovirus (CMV) - IgG Positive: CMV IgM testing to assess for acute or recent infection; CMV viral load/PCR testing (plasma, cerebrospinal fluid, urine, or amniotic fluid depending on clinical context) to determine active viral replication; ultrasound imaging to assess for fetal abnormalities if positive during pregnancy; repeat testing in 2-4 weeks if borderline positive results to confirm seroconversion
    • Cytomegalovirus (CMV) - IgG Negative in Pregnancy: Baseline negative status reassuring; repeat testing not routinely needed; counseling on prevention (hand hygiene, avoid contact with saliva and urine of children); immunocompromised patients should have CD4 count assessment and may require CMV prophylaxis guidelines
    • Herpes Simplex Virus (HSV I & II) - IgG Positive: HSV I and HSV II IgM testing if acute infection suspected; HSV viral culture or PCR from lesion if primary infection or recurrence present; HSV viral PCR on amniotic fluid or neonatal specimens if congenital infection suspected; type-specific serology important as HSV II carries higher neonatal transmission risk
    • Herpes Simplex Virus (HSV II) - IgG Positive in Pregnancy: Serial viral cultures during late pregnancy (starting at 36 weeks) if available to guide delivery route; regular assessment for prodromal symptoms or lesions; neonatal follow-up with ophthalmologic and neurologic examinations after delivery; antiviral prophylaxis often recommended in third trimester to reduce recurrence and transmission risk
    • Herpes Simplex Virus (HSV) - IgG Negative in Pregnancy: Negative status allows planned vaginal delivery if no obstetric contraindications; counseling on HSV prevention and recognition of primary infection symptoms; repeat HSV serologies optional if high-risk sexual exposure in third trimester (some recommend testing at 32-36 weeks in high-risk populations)
    • Rubella - IgG Negative: Immediate MMR vaccination (if not pregnant); if pregnant, vaccination deferred until postpartum period; counseling on staying home if exposed to rubella; close contacts should be vaccinated; repeat rubella serology recommended 4-8 weeks after vaccination to confirm immune response
    • Rubella - IgG Positive: No further testing needed; immunity confirmed; vaccination status already adequate; routine follow-up not required unless working in healthcare setting where titer monitoring may be requested
    • Rubella - IgG Borderline (8-10 IU/mL): Repeat testing in 2-4 weeks to clarify immunity status; if remains borderline, consider vaccination; some laboratories may request confirmation with different testing methodology
    • Toxoplasma Gondii - IgG Positive: Toxoplasma IgM testing to distinguish acute from past infection; if IgM positive, perform toxoplasma avidity testing (high avidity indicates past infection, low/negative avidity suggests acute infection); toxoplasma PCR on amniotic fluid if primary infection suspected during pregnancy; ultrasound for fetal abnormalities
    • Toxoplasma Gondii - IgG Low Positive (2.0-3.9 IU/mL): Repeat testing to confirm results; IgM testing essential to assess for acute infection; if persistently borderline and IgM negative, likely represents past infection with repeat baseline established for comparison if tested again
    • Toxoplasma Gondii - IgG Negative: Dietary counseling on prevention (avoid undercooked meat, unwashed produce, contact with cat feces); repeat testing not needed unless high-risk exposure occurs; immunocompromised patients with negative results should receive prophylaxis guidance
    • General Follow-up Recommendations: Repeat complete TORCH panel if testing performed in first trimester and results negative; consider retesting in second or third trimester to detect seroconversion; if any positive IgG result identified, coordinate with obstetrics and maternal-fetal medicine for risk stratification and management planning
    • Immunocompromised Patient Follow-up: CD4 count assessment for HIV-positive patients; CMV prophylaxis or monitoring based on CD4 counts (< 50 cells/μL requires prophylaxis); toxoplasma prophylaxis if CD4 < 100 cells/μL; annual follow-up testing if previously seronegative; monitoring for clinical manifestations of opportunistic infections
  • Fasting Required?
    • No fasting is required for the TORCH – IgG (4 Parameters) test package
    • This is a serology test measuring antibodies (IgG) to specific pathogens and does not require any special fasting period; food or drink consumption does not affect antibody levels or test results
    • No medications need to be avoided before testing; antibody levels are not affected by common medications, though immunosuppressive agents in severely immunocompromised patients may affect antibody production
    • Test can be performed at any time of day; no specific timing restrictions apply (unlike tests affected by diurnal variation)
    • Patient preparation: Routine blood draw procedure applies; wear loose-fitting clothing that allows easy access to upper arm for phlebotomy
    • Hydration status: Normal hydration is helpful for phlebotomy success but excessive hydration is not necessary
    • Recent vaccinations: If MMR vaccine recently administered (within 4 weeks), inform laboratory staff; vaccine-derived antibodies may temporarily elevate rubella IgG results, though true immunity markers should persist; discuss timing with healthcare provider for optimal test interpretation
    • Blood specimen collection: Single venipuncture for serum separation; no special collection tube additives needed beyond standard serum separator tube (SST); specimen stable at room temperature for several hours before processing
    • Stress or physical activity: Routine activities and stress do not affect antibody levels; no need to avoid exercise before testing or arrange special rest period
    • Timing considerations: For pregnancy planning, test should be performed prior to conception for optimal counseling time; during pregnancy, first trimester testing recommended for prenatal screening; if previously seronegative during early pregnancy, repeat testing in third trimester may identify seroconversion indicating active infection

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