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Test ID: TRCHG ToRCH Profile IgG, Serum

Reporting Name

Torch Profile IgG, S

Useful For

Determination of immune status of individuals to the rubella virus following vaccination or prior exposure

 

As an indication of past or recent infection with Toxoplasma gondii, cytomegalovirus, or herpes simplex virus (HSV)

 

Distinguishing between infection caused by HSV types 1 and 2, especially in patients with subclinical or unrecognized HSV infection

Clinical Information

Toxoplasma gondii:

Toxoplasma gondii is an obligate intracellular protozoan parasite that is capable of infecting a variety of intermediate hosts including humans. Infected definitive hosts (cats) shed oocysts in feces that rapidly mature in the soil and become infectious.(1) Toxoplasmosis is acquired by humans through ingestion of food or water contaminated with cat feces or through eating undercooked meat containing viable oocysts. Vertical transmission of the parasite through the placenta can also occur, leading to congenital toxoplasmosis. Following primary infection, T gondii can remain latent for the life of the host; the risk for reactivation is highest among immunosuppressed individuals.

 

Seroprevalence studies performed in the United States indicate that approximately 9% to 11% of individuals between the ages of 6 and 49 have antibodies to T gondii.(2) Infection of immunocompetent adults is typically asymptomatic. In symptomatic cases, patients most commonly present with lymphadenopathy and other nonspecific constitutional symptoms, making definitive diagnosis difficult to determine.

 

Severe-to-fatal infections can occur among patients with AIDS or individuals that are otherwise immunosuppressed. These infections are thought to be caused by reactivation of latent infections and commonly involved the central nervous system.(3)

 

Transplacental transmission of the parasites resulting in congenital toxoplasmosis can occur during the acute phase of acquired maternal infection. The risk of fetal infection is a function of the time at which acute maternal infection occurs during gestation.(4) The incidence of congenital toxoplasmosis increases as pregnancy progresses; conversely, the severity of congenital toxoplasmosis is greatest when maternal infection is acquired early during pregnancy. A majority of infants infected in utero are asymptomatic at birth, particularly if maternal infection occurs during the third trimester, with sequelae appearing later in life. Congenital toxoplasmosis results in severe generalized or neurologic disease in about 20% to 30% of the infants infected in utero; approximately 10% exhibit ocular involvement only and the remainder are asymptomatic at birth. Subclinical infection may result in premature delivery and subsequent neurologic, intellectual and audiologic defects.

 

Rubella:

Rubella (German or 3-day measles) is a member of the Togavirus family, and humans remain the only natural host for this virus. Transmission is typically through inhalation of infectious aerosolized respiratory droplets, and the incubation period following exposure can range from 12 to 23 days.(5) Infection is generally mild, self-limited and characterized by a maculopapular rash beginning on the face and spreading to the trunk and extremities, fever, malaise, and lymphadenopathy.(6)

 

Primary, in utero rubella infections can lead to severe sequelae for the fetus, particularly if infection occurs within the first 4 months of gestation. Congenital rubella syndrome is often associated with hearing loss, cardiovascular and ocular defects.(7)

 

The United States 2-dose measles, mumps, rubella (MMR) vaccination program, which calls for vaccination of all children, leads to seroconversion in 95% of children following the first dose.(5) A total of 4 cases of rubella were reported to the Centers for Disease Control and Prevention (CDC) in 2011 without any cases of congenital rubella syndrome.(8) Due to the success of the national vaccination program, rubella is no longer considered endemic in the United States (cdc.gov/rubella). However, immunity may wane with age as approximately 80% to 90% of adults will show serologic evidence of immunity to rubella.

 

Cytomegalovirus:

Cytomegalovirus (CMV) is a member of the Herpesviridae family of viruses and usually causes asymptomatic infection after which it remains latent in patients, primarily within bone marrow derived cells.(9) Primary CMV infection in immunocompetent individuals may also manifest as a mononucleosis-type syndrome, similar to primary Epstein-Barr virus infection, with fever, malaise, and lymphadenopathy.

 

CMV is a significant cause of morbidity and mortality among bone marrow or solid organ transplant recipients, individuals with AIDS, and other immunosuppressed patients due to virus reactivation or from a newly acquired infection.(10,11) Infection in these patient populations can affect almost any organ and lead to multi-organ failure. CMV is also responsible for congenital disease among newborns and is 1 of the ToRCH infections (toxoplasmosis, other infections including syphilis, rubella, CMV, and herpes simplex virus [HSV]).

 

CMV seroprevalence increases with age. In the United States, the prevalence of CMV-specific antibodies increases from approximately 36% to over 91% in children between the ages of 6 and 11 and adults over 80 years old, respectively.(12)

 

Herpes Simplex Virus Types 1 and 2:

HSV types 1 and 2 are members of the Herpesviridae family and produce infections that may range from mild stomatitis to disseminated and fatal disease. Clinical conditions associated with HSV infection include gingivostomatitis, keratitis, encephalitis, vesicular skin eruptions, aseptic meningitis, neonatal herpes, genital tract infections, and disseminated primary infection.

 

Infections with HSV types 1 and 2 can differ significantly in their clinical manifestations and severity. HSV type 2 primarily causes urogenital infections and is found almost exclusively in adults. HSV type 1 is closely associated with orolabial infection, although genital infection with this virus can be common in certain populations.

 

The diagnosis HSV infections is routinely made based on clinical findings and supported by laboratory testing using polymerase chain reaction (PCR) or viral culture. However, in instances of subclinical or unrecognized HSV infection, serologic testing for IgG-class antibodies to type-specific HSV glycoprotein G (gG) may be useful. There are several circumstances in which it may be important to distinguish between infection caused by HSV types 1 and 2.(13) For example, the risk for reactivation is highest for HSV type 2 and the method of antiviral therapy may be different depending on the specific type of HSV causing disease. In addition, the results of HSV type specific IgG testing is sometimes used during pregnancy to identify risks of congenital HSV disease and allow for focused counseling prior to delivery.(14,15)

Interpretation

Toxoplasma gondii:

A positive Toxoplasma IgG result is indicative of current or past infection with T gondii. A single positive Toxoplasma IgG result should not be used to diagnose recent infection.

 

Equivocal Toxoplasma IgG results may be due to very low levels of circulating IgG during the acute stage of infection. A second specimen should be submitted for testing if clinically indicated.

 

Individuals with negative Toxoplasma IgG results are presumed to not have had previous exposure to T gondii. However, negative results may be seen in cases of remote exposure with subsequent loss of detectable antibody. Seroconversion from negative to positive IgG is indicative of T gondii infection subsequent to the first negative specimen.

 

Rubella:

Positive: The presence of detectable IgG-class antibodies to rubella indicates prior exposure through infection or immunization. Individuals testing positive for IgG-class antibodies to rubella are considered immune.

 

Equivocal: Submit an additional specimen for testing in 10 to 14 days to demonstrate IgG seroconversion if recently vaccinated or if otherwise clinically indicated.

 

Negative: The absence of detectable IgG-class antibodies to rubella suggests no prior exposure to this virus or the lack of a specific immune response to immunization.

 

Cytomegalovirus:

Positive cytomegalovirus (CMV) IgG results indicate past or recent CMV infection. These individuals may transmit CMV to susceptible individuals through blood and tissue products.

 

Equivocal CMV IgG results may occur during acute infection or may be due to nonspecific binding reactions. Submit an additional specimen for testing if clinically indicated.

 

Individuals with negative CMV IgG results are presumed to not have had prior exposure or infection with CMV and are therefore considered susceptible to primary infection.

 

Herpes Simplex Virus:

The presence of IgG-class antibodies to herpes simplex virus (HSV) types 1 or 2 indicates previous exposure and does not necessarily indicate that HSV is the causative agent of an acute illness.

Report Available

Same day/1 to 3 days

Day(s) Performed

Monday through Saturday

Clinical Reference

1. Tenter AM, Heckeroth AR, Weiss LM: Toxoplasma gondii: from animals to humans. Int J Parasitol. 2000;30(12-13):1217-1258

2. Jones JL, Kruszon-Moran D, Sanders-Lewis K, Wilson M: Toxoplasma gondii infection in the United States, 1999-2004, decline from the prior decade. Am J Trop Med Hyg. 2007;77(3):405-410

3. Luft BJ, Remigton JS: Toxoplasmic encephalitis in AIDS. Clin Infect Dis. 1992;15(2):211-222

4. Wong SY, Remington JS: Toxoplasmosis in pregnancy. Clin Infect Dis. 1994;18(6):853-861

5. AAP Committee on Infectious Diseases: Rubella. In: Pickering LK, Baker CJ, Kimberlin DW, eds. Red Book. 2012 Report of the Committee on Infectious Diseases. 29th ed. American Academy of Pediatrics; 2012

6. Best JM: Rubella. Semin Fetal Neonatal Med. 2007;12(3):182-192

7. Duszak RS: Congenital rubella syndrome-major review. Optometry. 2009:80(1):36-43

8. Notifiable Diseases and Mortality Tables. MMWR Morb Mortal Wkly Rep. 2012;61(34):466-479

9. Soderberg-Naucler C, Fish KN, Nelson JA: Reactivation of latent human cytomegalovirus by allogeneic stimulation of blood cells from healthy donors. Cell. 1997;91:119-126

10. Kusne S, Shapiro R, Fung J: Prevention and treatment of cytomegalovirus infection in organ transplant recipients. Transpl Infect Dis. 1999;1(3):187-203

11. Rubin RH: Importance of CMV in the transplant population. Transpl Infect Dis. 1999;1(1):3-7

12. Staras SA, Dollard SC, Radford KW, et al: Seroprevalence of cytomegalovirus infection in the United States, 1998-1994. Clin Infect Dis. 2006;43(9):1143-1151

13. Ashley RL, Wald A: Genital herpes: review of the epidemic and potential use of type-specific serology. Clin Microbiol Rev. 1999;12:1-8

14. Ashley RL, Wu L, Pickering JW, et al: Premarket evaluation of a commercial glycoprotein G-based enzyme immunoassay for herpes simplex virus type-specific antibodies. J Clin Microbiol. 1998;36:294-295

15. Brown ZA, Selke S, Zeh J, et al: The acquisition of herpes simplex virus during pregnancy. N Engl J Med. 1997;337:509-515

16. Binnicker MJ, Jespersen DJ, Harring JA: Comparative evaluation of three multiplex flow immunoassays to enzyme immunoassay for the detection and differentiation of IgG-class antibodies to Herpes Simplex Virus types 1 and 2. Clin Vaccine Immunol. 2010;17(2):253-257

Method Name

Multiplex Flow Immunoassay

Specimen Type

Serum


Ordering Guidance


To evaluate recent or acute infection with Toxoplasma gondii, order TXM / Toxoplasma gondii Antibody, IgM, Serum.

 

For patients presenting with presumed acute infection with herpes simplex virus (HSV), order HERPB / Herpes Simplex Virus 1 and 2, Qualitative PCR, Blood.

 

IgG antibodies in patients younger than 6 months of age are typically the result of passive transfer from the mother. To assess possible infection in patients less than 6 months old, consider ordering the IgM testing.



Specimen Required


Container/Tube:

Preferred: Serum gel

Acceptable: Red top

Submission Container/Tube: Plastic vial

Specimen Volume: 2 mL

Collection Instructions: Centrifuge and aliquot serum into plastic vial.


Specimen Minimum Volume

1.2 mL

Specimen Stability Information

Specimen Type Temperature Time Special Container
Serum Refrigerated (preferred) 14 days
  Frozen  14 days

Reference Values

Toxoplasma ANTIBODY, IgG

Negative

 

Toxoplasma IgG

≤9 IU/mL (Negative)

10-11 IU/mL (Equivocal)

≥12 IU/mL (Positive)

 

RUBELLA ANTIBODY, IgG

Vaccinated: Positive (≥1.0 AI)

Unvaccinated: Negative (≤0.7 AI)

 

CYTOMEGALOVIRUS

Negative

 

HERPES SIMPLEX VIRUS (HSV), TYPE 1 AND TYPE 2 ANTIBODIES, IgG

Herpes Simplex Virus (HSV) Type 1, IgG

Negative

 

Herpes Simplex Virus (HSV) Type 2, IgG

Negative

Test Classification

This test has been cleared, approved, or is exempt by the US Food and Drug Administration and is used per manufacturer's instructions. Performance characteristics were verified by Mayo Clinic in a manner consistent with CLIA requirements.

CPT Code Information

86644-CMV

86695-Herpes simplex, type 1

86696-Herpes simplex, type 2

86762-Rubella

86777-Toxoplasma

LOINC Code Information

Test ID Test Order Name Order LOINC Value
TRCHG Torch Profile IgG, S In Process

 

Result ID Test Result Name Result LOINC Value
HS1G HSV Type 1 Ab, IgG, S 51916-5
HS2G HSV Type 2 Ab, IgG, S 43180-9
RBG Rubella Ab, IgG, S 40667-8
CMVG Cytomegalovirus Ab, IgG, S 13949-3
TOXG Toxoplasma Ab, IgG, S 40677-7
DEXG6 Toxoplasma IgG Value 8039-0
DEXG2 Rubella IgG Antibody Index 5334-8

Profile Information

Test ID Reporting Name Available Separately Always Performed
TOXGP Toxoplasma Ab, IgG, S Yes Yes
RBPG Rubella Ab, IgG, S Yes Yes
CMVG Cytomegalovirus Ab, IgG, S Yes Yes
HS1G HSV Type 1 Ab, IgG, S No Yes
HS2G HSV Type 2 Ab, IgG, S No Yes

Forms

If not ordering electronically, complete, print, and send Infectious Disease Serology Test Request (T916) with the specimen.

Mayo Clinic Laboratories | Microbiology and Infectious Disease Catalog Additional Information:

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