Gebelerde Toxoplasma gondii, Rubella ve Sitomegalovirüs Seroprevalansı: Ülke Geneli Çok Merkezli Çalışma
Öz
Amaç: Toksoplazma gondii (T. gondii), Rubella ve Cytomegalovirüs (CMV)etkenlerinin neden olduğu TORCH grubu enfeksiyonları sağlıklı yetişkinlerde asemptomatik seyrederken, gebelik döneminde vertikal bulaşla fetal morbidite ve mortalite ile sonuçlanabilir. Günümüzde gebelik sırasında bu enfeksiyon etkenlerinin rutin taraması konusunda net bir fikir birliği yoktur. Çalışmamızda ülke genelinde toxoplazma gondii, rubella ve sitomegalovirus enfeksiyonlarının gebelik dönemindeki seroprevelans durumunun belirlenmesi ve diğer ülkelerin verileriyle karşılaştırılması amaçlanmıştır.
Gereç ve Yöntem: Çalışma çok merkezli, retrospektif, tanımlayıcı kesitsel bir araştırma olarak planlanmıştır. Çalışmamıza 2011-19 yılları arasında, ikinci basamak devlet hastanesi, üçüncü basamak eğitim araştırma hastanesi ve üniversite hastanelerine o yıl kuruma başvuran gebe sayısı, o yıl toksoplazma, rubella ve sitomegalovirus tetkiki yapılan gebe sayısı, IgM ve IgG sonuçları ve ulaşılabilirse toksoplazma ve sitomegalovirus avidite test sonuçları kaydedilmiştir. Rubella IgG negatif olan hastaların yaşları dahil edilmiştir.
Bulgular: Türkiye’nin on farklı ilindeki ikinci ve üçüncü basamak sağlık kuruluşlarından toplam 15 merkezin katıldığı bu çalışmada, bu merkezlere başvurmuş ve gebelik durumu olan toplam 354526 kişiden elde edilen veriler sonucunda; anti toksoplazma IgG seropozitifliği %21, anti rubella IgG seropozitifliği %96.5, anti CMV Ig G seropozitifliği %56.2 bulunmuştur. Çalışmamızda anti rubella IgG negatif gebelerin yaşları değerlendirilmiştir. Rubella IgG negatif 2024 gebenin yaş ortalaması 30.6 yıl (18-54) bulunmuştur. Yaş aralıklarına göre incelendiğinde seronegatifliğin en çok 30-39 yaş aralığında olduğu görülmüştür.
Sonuç: Gebelerde toksoplazma, rubella ve sitomegalovirus enfeksiyonu sıklığı ve yaygınlığı hakkında bilgi sahibi olmak, hastalık yükünün belirlenmesinde, tarama programlarının planlanmasında ve birinci basamak sağlık hizmetlerinin aktif kullanımında kritik bir rol oynamaktadır. Aşılama ile bağışıklığın sağlanabildiği rubella enfeksiyonu için seronegatif bireylerin tespit edilip gebelik öncesi aşılanması önemlidir.
Anahtar Kelimeler
Kaynakça
- Toxoplasma gondii. In: Topçu Ayşe Willke SG, Doğanay Mehmet, editor. Enfeksiyon Hastalıkları ve Mikrobiyolojisi: Nobel Tıp Kitabevleri; 2015. p. 1883-97.
- Kızılkaya Beji N. (Ed). Women’s Health and Diseases. Nobel Medical Bookstores, İstanbul 2015.
- Adgoy ET, Elfatih M, Elhadi B, Zerizgie H, Said SM, Tekle F, et al. Seroprevalence of TORCH in women with spontaneous abortion and stillbirth, in Asmara, Eritrea. Population Medicine. 2020;2:1-5.
- Kourí V, Correa CB, Verdasquera D, Martínez PA, Alvarez A, Alemán Y, et al. Diagnosis and screening for cytomegalovirus infection in pregnant women in Cuba as prognostic markers of congenital infection in newborns: 2007–2008. The Pediatric infectious disease journal. 2010;29(12):1105-10.
- Montoya JG, Boothroyd JC, Kovacs JA. Toxoplasma gondii. Mandell, Douglas, and Bennett’s principles and practice of infectious diseases: Elsevier; 2015. p. 3122-53. e7.
- Yıldız Ç, Akkar ÖB, Karakuş S, Cetin A. Congenital toxoplasmosis. Basic and Clinical Sciences. 2015;(4(1):62-9.
- Chaudhry SA, Gad N, Koren G. Toxoplasmosis and pregnancy. Canadian Family Physician. 2014;60(4):334-6.
- Patel KK, Shrivastava G, Bhatambare G, Bajpai T. Antenatal detection of IgM and IgG antibodies to Toxoplasma gondii in a hospital from central India. International Journal of Health System and Disaster Management. 2014;2(3):133.
- Liesenfeld O, Montoya JG, Kinney S, Press C, Remington JS. Effect of testing for IgG avidity in the diagnosis of Toxoplasma gondii infection in pregnant women: experience in a US reference laboratory. The Journal of Infectious Diseases. 2001;183(8):1248-53.
- Tanyuksel M, Guney C, Araz E, Saracli MA, Doganci L. Performance of the immunoglobulin G avidity and enzyme immunoassay IgG/IgM screening tests for differentiation of the clinical spectrum of toxoplasmosis. Journal of Microbiology. 2004;42(3):211-5.
- Devakumar D, Bamford A, Ferreira MU, Broad J, Rosch RE, Groce N, et al. Infectious causes of microcephaly: epidemiology, pathogenesis, diagnosis, and management. The Lancet infectious diseases. 2018;18(1):e1-e13.
- Gibson CS, MacLennan AH, Goldwater PN, Haan EA, Priest K, Dekker GA. Neurotropic viruses and cerebral palsy: population based case-control study. Bmj. 2006;332(7533):76-80.
- Leung KK, Hon K, Yeung A, Leung AK, Man E. Congenital infections in Hong Kong: an overview of TORCH. Hong Kong medical journal. 2020;26(2):127.
- Berger A, Doerr HW. Preventing vertical virus infections: the role of serologic screening of pregnant women. Medical Microbiology and Immunology. 2018;207(5):249-53.
- Hamkar R, Jalilvand S, Mokhtari-Azad T, Jelyani KN, Dahi-Far H, Soleimanjahi H, et al. Assessment of IgM enzyme immunoassay and IgG avidity assay for distinguishing between primary and secondary immune response to rubella vaccine. Journal of virological methods. 2005;130(1-2):59-65.
- Tastad KJ, Schleiss MR, Lammert SM, Basta NE. Awareness of congenital cytomegalovirus and acceptance of maternal and newborn screening. PloS one. 2019;14(8):e0221725.
- Kagan KO, Hamprecht K. Cytomegalovirus infection in pregnancy. Archives of gynecology and obstetrics. 2017;296(1):15-26.
- Silasi M, Cardenas I, Kwon JY, Racicot K, Aldo P, Mor G. Viral infections during pregnancy. American journal of reproductive immunology. 2015;73(3):199-213.
- Karen E, Johnson M. Overview of TORCH infections https://www.uptodate.com/contents/overview-of-torch-infections2023
- Charles J Lockwood M, MHCMUrania Magriples, MD. Prenatal care: Initial assessment https://www.uptodate.com/contents/prenatal-care-initial-assessment2023
- Doğum Öncesi Bakım Yönetim Rehberi Genelgesi 2010 / 13. https://www.saglik.gov.tr/TR,11145/dogum-oncesi-bakim-yonetim-rehberi-genelgesi-2010--13.html.
- Eskild Petersen, Mandelbrot L. Toxoplasmosis and pregnancy https://www.uptodate.com/contents/toxoplasmosis-and-pregnancy?search=toxoplasmosis%20in%20pregnancy&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H3868472132
- Jones JL, Dargelas V, Roberts J, Press C, Remington JS, Montoya JG. Risk factors for Toxoplasma gondii infection in the United States. Clinical Infectious Diseases. 2009;49(6):878-84.
- Moncada PA, Montoya JG. Toxoplasmosis in the fetus and newborn: an update on prevalence, diagnosis and treatment. Expert review of anti-infective therapy. 2012;10(7):815-28.
- Robert-Gangneux F. It is not only the cat that did it: how to prevent and treat congenital toxoplasmosis. Journal of Infection. 2014;68:S125-S33.
- Nasimi A, Fani M, Salehi M, Ghasemi H, Nezami H, Haghighi FH. Seroprevalence of Toxoplasma gondii, Rubella and Cytomegalovirus Among Women of Reproductive Age in Mashhad, Northeast of Iran. Research Square. 2021;1-14.
- Demiray EKD, Alkan S, Barutcu A, Tahmaz A. Investigating the Toxoplasmosis seroprevalence in pregnant women from Turkey by pool analyses method. Pediatric Practice and Research. 2022;10(1):16-21.
- Yilmaz S, Çetinkaya RA. Seroprevalence of Toxoplasma gondii in Pregnant Women in Turkey: A Meta-Analysis Research. Saudi Journal of Pathology and Microbiology. 2018;335-343.
- World, Health, Organization. Global measles and rubella strategic plan: 2012. 2012.
- Lanzieri T, Redd S, Abernathy E, Icenogle J. Rubella. VPD surveillance Manua Atlanta: Centers for Disease Control and Prevention. 2011:1-12.
- Riley LE. Rubella in pregnancy https://www.uptodate.com/contents/rubella-in-pregnancy?search=rubella%20&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2#H2 [
- Sağlık Bakanlığı Temel Sağlık Hizmetleri Genel Müdürlüğü. Genişletilmiş Bağışıklama Programı. 2006/120 sayılı genelgesi.
- Danovaro-Holliday MC, LeBaron CW, Allensworth C, Raymond R, Borden TG, Murray AB, et al. A large rubella outbreak with spread from the workplace to the community. Jama. 2000;284(21):2733-9.
- Ghazi HO, Telmesani AM, Mahomed MF. TORCH agents in pregnant Saudi women. Medical Principles and Practice. 2002;11(4):180-2.
- Pedranti M, Adamo M, Macedo R, Zapata M. Prevalence of anti-rubella and anti-parvovirus B19 antibodies in pregnant women in the city of Córdoba, and in women of fertile age in the city of Villa Mercedes, province of San Luis. Revista Argentina de Microbiología. 2007;39(1):47-50.
- Sathanandan D, Gupta L, Liu B, Rutherford A, Lane J. Factors associated with low immunity to rubella infection on antenatal screening. Australian and New Zealand journal of obstetrics and gynaecology. 2005;45(5):435-8.
- Çetinkaya RA, Yenilmez E. The seroprevalence of Rubella in pregnant women in Turkey: a meta-analysis research of 90988 Rubella IgM, 84398 Rubella IgG, and 522 avidity results. Turkish journal of obstetrics and gynecology. 2019;16(1):63.
- Sert UY, Ozgu-Erdinc AS, Saygan S, Engin-Ustun Y. The Prevalence of anti-rubella antibodies in pregnant women of Turkey, results of 94508 patients in a tertiary referral center. Zeitschrift für Geburtshilfe und Neonatologie. 2019;223(05):281-4.
- Kul G, Turan G. Comparison of Toxoplasma and Rubella seropositivity rates of Syrian and Turkish pregnant women. Cukurova Medical Journal. 2021;46(3):975-81.
- Leruez-Ville M, Foulon I, Pass R, Ville Y. Cytomegalovirus infection during pregnancy: state of the science. American journal of obstetrics and gynecology. 2020;223(3):330-49.
- Zuhair M, Smit GSA, Wallis G, Jabbar F, Smith C, Devleesschauwer B, et al. Estimation of the worldwide seroprevalence of cytomegalovirus: a systematic review and meta‐analysis. Reviews in medical virology. 2019;29(3):e2034.
- Çetinkaya RA. Gebelerde sitomegalovirüs seroprevalansı ve Türkiye’nin dünyadaki seroepidemiyolojik durumu; bir meta-analiz araştırması. Flora. 2019;24(2):119-30.
Seroprevalence of Toxoplasma gondii, Rubella and Cytomegalovirus in Pregnant Women: A Countrywide Multicenter Study
Öz
Objective: Objective: While TORCH infections caused by Toxoplasma gondii (T. gondii), Rubella and Cytomegalovirus (CMV) agents are asymptomatic in healthy adults, vertical transmission during pregnancy may result in fetal morbidity and mortality. Currently, there is no clear consensus on routine screening for these infectious agents during pregnancy. In our study, it was aimed to determine the seroprevalence status of toxoplasma gondii, rubella and cytomegalovirus infections throughout the country during pregnancy and to compare them with the data of other countries.
Material and Method: The study was planned as a multicenter, retrospective, descriptive cross-sectional study. The number of pregnant women who applied to the secondary level state hospital, tertiary education research hospital and university hospitals that year between 2011-19, the number of pregnant women who were tested for toxoplasma, rubella and cytomegalovirus that year, IgM and IgG results, and toxoplasma and cytomegalovirus if available. avidity test results were recorded. Ages of patients who were Rubella IgG negative were included.
Results: In this study, in which a total of 15 centers from secondary and tertiary health institutions in ten different provinces of Turkey participated, as a result of the data obtained from a total of 354526 people who applied to these centers and had pregnancy; anti toxoplasma IgG seropositivity was 21%, anti rubella IgG seropositivity was 96.5%, anti CMV IgG seropositivity was 56.2%. In our study, the ages of anti rubella Ig G negative pregnant women were evaluated. The mean age of 2024 Rubella IgG negative pregnant women was 30.6 years (18-54). When examined according to age ranges, it was seen that seronegativity was mostly in the 30-39 age range.
Conclusion: Having information about the frequency and prevalence of toxoplasma, rubella and cytomegalovirus infections in pregnant women plays a critical role in determining the burden of disease, planning screening programs and active use of primary health care services. It is important to detect seronegative individuals and vaccinate before pregnancy for rubella infection, in which immunity can be achieved by vaccination.
Anahtar Kelimeler
Kaynakça
- Toxoplasma gondii. In: Topçu Ayşe Willke SG, Doğanay Mehmet, editor. Enfeksiyon Hastalıkları ve Mikrobiyolojisi: Nobel Tıp Kitabevleri; 2015. p. 1883-97.
- Kızılkaya Beji N. (Ed). Women’s Health and Diseases. Nobel Medical Bookstores, İstanbul 2015.
- Adgoy ET, Elfatih M, Elhadi B, Zerizgie H, Said SM, Tekle F, et al. Seroprevalence of TORCH in women with spontaneous abortion and stillbirth, in Asmara, Eritrea. Population Medicine. 2020;2:1-5.
- Kourí V, Correa CB, Verdasquera D, Martínez PA, Alvarez A, Alemán Y, et al. Diagnosis and screening for cytomegalovirus infection in pregnant women in Cuba as prognostic markers of congenital infection in newborns: 2007–2008. The Pediatric infectious disease journal. 2010;29(12):1105-10.
- Montoya JG, Boothroyd JC, Kovacs JA. Toxoplasma gondii. Mandell, Douglas, and Bennett’s principles and practice of infectious diseases: Elsevier; 2015. p. 3122-53. e7.
- Yıldız Ç, Akkar ÖB, Karakuş S, Cetin A. Congenital toxoplasmosis. Basic and Clinical Sciences. 2015;(4(1):62-9.
- Chaudhry SA, Gad N, Koren G. Toxoplasmosis and pregnancy. Canadian Family Physician. 2014;60(4):334-6.
- Patel KK, Shrivastava G, Bhatambare G, Bajpai T. Antenatal detection of IgM and IgG antibodies to Toxoplasma gondii in a hospital from central India. International Journal of Health System and Disaster Management. 2014;2(3):133.
- Liesenfeld O, Montoya JG, Kinney S, Press C, Remington JS. Effect of testing for IgG avidity in the diagnosis of Toxoplasma gondii infection in pregnant women: experience in a US reference laboratory. The Journal of Infectious Diseases. 2001;183(8):1248-53.
- Tanyuksel M, Guney C, Araz E, Saracli MA, Doganci L. Performance of the immunoglobulin G avidity and enzyme immunoassay IgG/IgM screening tests for differentiation of the clinical spectrum of toxoplasmosis. Journal of Microbiology. 2004;42(3):211-5.
- Devakumar D, Bamford A, Ferreira MU, Broad J, Rosch RE, Groce N, et al. Infectious causes of microcephaly: epidemiology, pathogenesis, diagnosis, and management. The Lancet infectious diseases. 2018;18(1):e1-e13.
- Gibson CS, MacLennan AH, Goldwater PN, Haan EA, Priest K, Dekker GA. Neurotropic viruses and cerebral palsy: population based case-control study. Bmj. 2006;332(7533):76-80.
- Leung KK, Hon K, Yeung A, Leung AK, Man E. Congenital infections in Hong Kong: an overview of TORCH. Hong Kong medical journal. 2020;26(2):127.
- Berger A, Doerr HW. Preventing vertical virus infections: the role of serologic screening of pregnant women. Medical Microbiology and Immunology. 2018;207(5):249-53.
- Hamkar R, Jalilvand S, Mokhtari-Azad T, Jelyani KN, Dahi-Far H, Soleimanjahi H, et al. Assessment of IgM enzyme immunoassay and IgG avidity assay for distinguishing between primary and secondary immune response to rubella vaccine. Journal of virological methods. 2005;130(1-2):59-65.
- Tastad KJ, Schleiss MR, Lammert SM, Basta NE. Awareness of congenital cytomegalovirus and acceptance of maternal and newborn screening. PloS one. 2019;14(8):e0221725.
- Kagan KO, Hamprecht K. Cytomegalovirus infection in pregnancy. Archives of gynecology and obstetrics. 2017;296(1):15-26.
- Silasi M, Cardenas I, Kwon JY, Racicot K, Aldo P, Mor G. Viral infections during pregnancy. American journal of reproductive immunology. 2015;73(3):199-213.
- Karen E, Johnson M. Overview of TORCH infections https://www.uptodate.com/contents/overview-of-torch-infections2023
- Charles J Lockwood M, MHCMUrania Magriples, MD. Prenatal care: Initial assessment https://www.uptodate.com/contents/prenatal-care-initial-assessment2023
- Doğum Öncesi Bakım Yönetim Rehberi Genelgesi 2010 / 13. https://www.saglik.gov.tr/TR,11145/dogum-oncesi-bakim-yonetim-rehberi-genelgesi-2010--13.html.
- Eskild Petersen, Mandelbrot L. Toxoplasmosis and pregnancy https://www.uptodate.com/contents/toxoplasmosis-and-pregnancy?search=toxoplasmosis%20in%20pregnancy&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H3868472132
- Jones JL, Dargelas V, Roberts J, Press C, Remington JS, Montoya JG. Risk factors for Toxoplasma gondii infection in the United States. Clinical Infectious Diseases. 2009;49(6):878-84.
- Moncada PA, Montoya JG. Toxoplasmosis in the fetus and newborn: an update on prevalence, diagnosis and treatment. Expert review of anti-infective therapy. 2012;10(7):815-28.
- Robert-Gangneux F. It is not only the cat that did it: how to prevent and treat congenital toxoplasmosis. Journal of Infection. 2014;68:S125-S33.
- Nasimi A, Fani M, Salehi M, Ghasemi H, Nezami H, Haghighi FH. Seroprevalence of Toxoplasma gondii, Rubella and Cytomegalovirus Among Women of Reproductive Age in Mashhad, Northeast of Iran. Research Square. 2021;1-14.
- Demiray EKD, Alkan S, Barutcu A, Tahmaz A. Investigating the Toxoplasmosis seroprevalence in pregnant women from Turkey by pool analyses method. Pediatric Practice and Research. 2022;10(1):16-21.
- Yilmaz S, Çetinkaya RA. Seroprevalence of Toxoplasma gondii in Pregnant Women in Turkey: A Meta-Analysis Research. Saudi Journal of Pathology and Microbiology. 2018;335-343.
- World, Health, Organization. Global measles and rubella strategic plan: 2012. 2012.
- Lanzieri T, Redd S, Abernathy E, Icenogle J. Rubella. VPD surveillance Manua Atlanta: Centers for Disease Control and Prevention. 2011:1-12.
- Riley LE. Rubella in pregnancy https://www.uptodate.com/contents/rubella-in-pregnancy?search=rubella%20&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2#H2 [
- Sağlık Bakanlığı Temel Sağlık Hizmetleri Genel Müdürlüğü. Genişletilmiş Bağışıklama Programı. 2006/120 sayılı genelgesi.
- Danovaro-Holliday MC, LeBaron CW, Allensworth C, Raymond R, Borden TG, Murray AB, et al. A large rubella outbreak with spread from the workplace to the community. Jama. 2000;284(21):2733-9.
- Ghazi HO, Telmesani AM, Mahomed MF. TORCH agents in pregnant Saudi women. Medical Principles and Practice. 2002;11(4):180-2.
- Pedranti M, Adamo M, Macedo R, Zapata M. Prevalence of anti-rubella and anti-parvovirus B19 antibodies in pregnant women in the city of Córdoba, and in women of fertile age in the city of Villa Mercedes, province of San Luis. Revista Argentina de Microbiología. 2007;39(1):47-50.
- Sathanandan D, Gupta L, Liu B, Rutherford A, Lane J. Factors associated with low immunity to rubella infection on antenatal screening. Australian and New Zealand journal of obstetrics and gynaecology. 2005;45(5):435-8.
- Çetinkaya RA, Yenilmez E. The seroprevalence of Rubella in pregnant women in Turkey: a meta-analysis research of 90988 Rubella IgM, 84398 Rubella IgG, and 522 avidity results. Turkish journal of obstetrics and gynecology. 2019;16(1):63.
- Sert UY, Ozgu-Erdinc AS, Saygan S, Engin-Ustun Y. The Prevalence of anti-rubella antibodies in pregnant women of Turkey, results of 94508 patients in a tertiary referral center. Zeitschrift für Geburtshilfe und Neonatologie. 2019;223(05):281-4.
- Kul G, Turan G. Comparison of Toxoplasma and Rubella seropositivity rates of Syrian and Turkish pregnant women. Cukurova Medical Journal. 2021;46(3):975-81.
- Leruez-Ville M, Foulon I, Pass R, Ville Y. Cytomegalovirus infection during pregnancy: state of the science. American journal of obstetrics and gynecology. 2020;223(3):330-49.
- Zuhair M, Smit GSA, Wallis G, Jabbar F, Smith C, Devleesschauwer B, et al. Estimation of the worldwide seroprevalence of cytomegalovirus: a systematic review and meta‐analysis. Reviews in medical virology. 2019;29(3):e2034.
- Çetinkaya RA. Gebelerde sitomegalovirüs seroprevalansı ve Türkiye’nin dünyadaki seroepidemiyolojik durumu; bir meta-analiz araştırması. Flora. 2019;24(2):119-30.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Bulaşıcı Hastalıklar |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Erken Görünüm Tarihi | 24 Ekim 2023 |
| Yayımlanma Tarihi | 1 Kasım 2023 |
| Gönderilme Tarihi | 4 Mayıs 2023 |
| Kabul Tarihi | 25 Eylül 2023 |
| Yayımlandığı Sayı | Yıl 2023 Cilt: 5 Sayı: 3 |
Kaynak Göster
Anka Tıp Dergisi Creative Commons Atıf 4.0 Uluslararası Lisansı ile lisanslanmıştır.
Anka Tıp Dergisi Budapeşte Açık Erişim Deklarasyonu’nu imzalamıştır.