TORCH – IgM (4 Parameters)

Bacterial/ Viral

4 parameters

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Details

Antibodies to TORCH pathogens.

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Parameters

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

TORCH – IgM (4 Parameters)

Why is it done?
- The TORCH-IgM panel detects acute or recent infections caused by four major pathogens: Toxoplasma gondii, Other agents (represented by HSV), Rubella virus, Cytomegalovirus (CMV), and Herpes simplex virus, collectively known as TORCH infections
- Primarily used for screening pregnant women or women planning pregnancy to identify active infections that may cause congenital abnormalities or fetal complications
- IgM antibodies specifically indicate acute or recent infection (typically within 3-6 months), as opposed to IgG which indicates past or chronic infection
- Used to evaluate newborns with suspected congenital infections presenting with fever, rash, hepatosplenomegaly, or developmental delays
- Recommended during preconception counseling to assess immunity status and plan preventive measures for women of childbearing age
- Cytomegalovirus IgM: Detects acute CMV infection, commonly seen in immunocompromised patients or congenital infections
- Herpes Simplex Virus IgM: Identifies primary or initial HSV infection (HSV-1 or HSV-2), useful in patients with genital ulcers, oral lesions, or encephalitis
- Rubella IgM: Confirms acute rubella infection in unvaccinated individuals or confirms vaccine effectiveness; critical in pregnancy planning
- Toxoplasma Gondii IgM: Detects acute toxoplasmosis, particularly important in pregnant women and immunocompromised patients to prevent fetal infection
Normal Range
- Cytomegalovirus (CMV) IgM: Normal range is Negative (<0.80 Index Value or <1:10 antibody titer depending on assay method)
- Herpes Simplex Virus (HSV I & II) IgM: Normal range is Negative (<0.80 Index Value or <1:10 antibody titer)
- Rubella IgM: Normal range is Negative (<0.90 Index Value or negative serology)
- Toxoplasma Gondii IgM: Normal range is Negative (<0.90 Index Value or <1:16 antibody titer)
- Result Interpretation: Negative results indicate absence of acute infection (recent infection unlikely); however, absence does not completely exclude recent infection as IgM may appear late in illness
- Index values typically range from 0.00 to 8.00+; values <0.80-0.90 generally reported as Negative, while values ≥0.90-1.00 may be borderline or equivocal requiring repeat testing
- Normal results do not exclude chronic infection (IgG antibodies) or latent infection; serological methods include ELISA, chemiluminescence immunoassays, and viral culture
Interpretation
- CMV IgM Positive: Indicates acute CMV infection, primary infection, or CMV reactivation; concerning in pregnant women as it can cause congenital CMV with hearing loss, intellectual disability, and microcephaly
- CMV IgM Negative: Suggests no acute CMV infection; chronic or past infection possible if IgG is positive; immunocompromised patients may have false-negative results
- HSV IgM Positive: Indicates primary HSV infection (either HSV-1 or HSV-2); suggests recent initial exposure; significant in pregnant women as transmission risk exists, particularly if infection occurs near delivery
- HSV IgM Negative: Rules out acute primary HSV infection; recurrent herpes may not produce detectable IgM due to amnestic immune response
- Rubella IgM Positive: Indicates acute or recent rubella infection; critical finding in pregnant women as rubella causes congenital rubella syndrome with cardiac defects, cataracts, deafness, and intellectual disability
- Rubella IgM Negative: No acute rubella infection; protective immunity present if IgG is positive; suggests previous vaccination or past infection
- Toxoplasma Gondii IgM Positive: Indicates acute or recent toxoplasmosis infection; major concern in pregnancy as it can cause miscarriage, premature delivery, congenital toxoplasmosis with chorioretinitis, intracranial calcifications, and hydrops fetalis
- Toxoplasma Gondii IgM Negative: No acute toxoplasmosis; chronic infection possible if IgG is positive; source is typically raw meat consumption or cat exposure
- Borderline/Equivocal Results: Index values between 0.80-1.10 should be repeated after 1-2 weeks; rising titers confirm acute infection while stable titers suggest false positive or recent vaccination
- False positives may occur due to: recent vaccination (rubella), rheumatoid factor, antinuclear antibodies, or cross-reactivity between similar pathogens
- False negatives may occur in: early acute infection (window period before antibody development), immunocompromised patients (impaired antibody production), or late chronic infection when IgM has waned
Associated Organs
- CMV: Affects reproductive system (placenta, fetus), nervous system (CNS involvement, ventriculomegaly), auditory system (sensorineural hearing loss), visual system (chorioretinitis, optic atrophy), liver and spleen (hepatosplenomegaly)
- HSV I & II: Affects reproductive system (genital ulcers, cervicitis), nervous system (meningitis, encephalitis), ocular system (keratitis, conjunctivitis), mucocutaneous areas (oral-labial herpes), and can affect fetus if primary infection near delivery
- Rubella: Affects reproductive system (congenital infection via placenta), cardiovascular system (patent ductus arteriosus, pulmonary artery stenosis), ocular system (cataracts, glaucoma), auditory system (deafness), and nervous system (developmental delays, intellectual disability, autism spectrum)
- Toxoplasma Gondii: Affects nervous system (intracranial calcifications, hydrocephalus, seizures), ocular system (chorioretinitis, blindness), musculoskeletal system (myositis), reproductive system (placental damage, fetal transmission), liver and spleen (hepatosplenomegaly)
- Congenital infections collectively cause: microcephaly, hydrocephalus, intellectual disability, growth restriction, fever, rash, thrombocytopenia, and long-term neurodevelopmental and sensory complications
- In immunocompromised patients: CMV causes severe systemic disease including retinitis, pneumonitis, esophagitis; HSV causes severe mucocutaneous disease; Toxoplasma causes encephalitis
Follow-up Tests
- CMV IgM Positive: Recommend TORCH IgG panel to assess chronic infection status; amniocentesis with CMV PCR if pregnant to detect fetal infection; CMV viral culture or PCR from body fluids; hearing assessment; ophthalmologic examination for chorioretinitis
- HSV IgM Positive: Obtain HSV IgG to differentiate primary from recurrent infection; HSV PCR/culture from lesions; type-specific serology (HSV-1 vs HSV-2); repeat testing at 2 weeks to confirm borderline results; in pregnancy, delivery mode counseling needed
- Rubella IgM Positive: TORCH IgG panel to assess immunity status; RT-PCR or viral culture for confirmation; vaccine contraindication in pregnancy; if pregnant, arrange fetal assessment with ultrasound and amniocentesis; repeat IgM testing if equivocal
- Toxoplasma IgM Positive: Toxoplasma IgG and IgG avidity testing to distinguish acute from chronic infection; consider amniocentesis with Toxoplasma PCR if pregnant (after 18 weeks gestation); referral to maternal-fetal medicine; ophthalmologic screening for chorioretinitis
- Borderline or Equivocal Results: Repeat testing in 1-2 weeks; paired acute and convalescent serum samples for antibody titer comparison; if positive, consider using alternative test method (different immunoassay or different laboratory)
- Prenatal Follow-up: Detailed fetal ultrasound (second and third trimester) for signs of intrauterine infection; fetal growth assessment; amniotic fluid volume evaluation; nuchal translucency measurement
- Congenital Infection Assessment in Newborns: Repeat IgM testing at 48-72 hours; newborn IgG testing; IgG avidity if available; specific pathogen PCR or culture from urine, saliva, CSF; imaging studies (head ultrasound/MRI, eye examination)
- Monitoring Frequency: For confirmed acute infections during pregnancy, follow-up testing typically every 4 weeks; newborns require monthly IgG testing for 6 months to differentiate passive maternal antibodies from active neonatal infection
- Additional Tests: Complete blood count (CBC) for thrombocytopenia and lymphocytosis; liver function tests (AST, ALT, bilirubin); long-term neurodevelopmental follow-up; audiology testing at 1 month, 3 months, and 12 months; ophthalmology assessment
Fasting Required?
- Fasting Required: No - The TORCH IgM panel does not require fasting as it is a serological test measuring antibodies in blood serum
- Dietary Restrictions: No specific dietary restrictions required before testing; patients may eat and drink normally before blood collection
- Medications: No medications need to be withheld before testing; all routine medications may be taken as prescribed; however, inform healthcare provider of any immunosuppressive therapy as it may affect antibody levels
- Patient Preparation: No special preparation required; patients should stay hydrated and comfortable; wear loose-fitting clothing on arms for easy blood draw access
- Timing: Test can be collected at any time of day; optimal timing is when acute infection is suspected or within appropriate window for antibody detection (typically 5-10 days after symptom onset for IgM)
- Specimen Collection: Single blood draw (5-10 mL) into standard serum separator tube (SST) or EDTA tube depending on laboratory protocol; no special handling required beyond standard phlebotomy procedures
- Post-Collection: Specimens should be transported to laboratory promptly; serum can be stored at 2-8°C for short-term storage; some laboratories may require serum separation within 2 hours of collection
- Recent Vaccinations: Rubella vaccine may transiently cause positive rubella IgM; inform provider if rubella vaccine received within past 2-4 weeks; other routine vaccinations do not interfere with testing

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