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ToRCH-screening in pediatric cataract revisited: A North Indian tertiary care centre study
Sushobhan Dasgupta1, Tarannum Shakeel1, Reshmi Chanda Roy1
1Department of Ophthalmology, SGRR-Institute of Medical and Health Sciences, Patel Nagar, Dehradun, Uttarakhand, India.
Insights
ToRCH-serology screening in pediatric cataract cases revealed high seropositivity for TORCH agents, particularly rubella virus. Careful interpretation of results with clinical correlation is crucial to avoid diagnostic errors in pediatric cataract patients.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Pediatrics
Background:
- Pediatric cataract is a significant cause of visual impairment in children.
- ToRCH infections are implicated in the etiology of congenital and developmental cataracts.
- Understanding the seroprevalence of ToRCH agents is vital for diagnosis and management.
Purpose of the Study:
- To analyze the ToRCH-serology screening profile in children with cataracts.
- To determine the prevalence of specific ToRCH infections (Toxoplasma gondii, rubella, cytomegalovirus, herpes simplex virus) in pediatric cataract cases.
Main Methods:
- A prospective analytical study involving 1,026 children.
- Included 46 children with clinically diagnosed congenital or developmental cataracts.
- Sera tested qualitatively and quantitatively for IgG/IgM antibodies against ToRCH agents.
Main Results:
- 91.3% of children showed seropositivity for at least one ToRCH agent.
- Rubella virus was the most common cause of IgM (±IgG) and sero-clinical positivity.
- Congenital rubella syndrome confirmed in 4.3% of cases; 67.4% had CMV IgG positivity.
Conclusions:
- ToRCH screening in pediatric cataract requires cautious interpretation, combining serial assays with clinical correlation.
- Diagnostic errors can be minimized by using both qualitative and quantitative testing.
- Clinicians must be vigilant for sero-clinical positivity in older children due to potential infection spread.
Purpose:
To analyze and report ToRCH-serology screening profile (Toxoplasma gondii [TOX], rubella [RV], cytomegalovirus [CMV], and herpes simplex virus [HSV-I/II]) in pediatric cataract.
Methods:
In this prospective analytical study, 1,026 consecutive children were screened, of which 46 children with clinically diagnosed congenital (n = 26) and developmental cataract (n = 20) were included. Post-traumatic and familial cataracts were excluded. Sera of all children were tested both qualitatively and quantitatively for IgG/IgM-antibodies against ToRCH agents in a sequential manner.
Results:
Overall, IgM/IgG-seropositivity against ≥1 ToRCH agent was reported in 91.3% (42/46) children. IgM (±IgG) positivity against ≥1 ToRCH agent was reported in 26.08% (12/46) children (nine congenital and three developmental cataract; P = 0.18), which included 8.7% (4/46) children reported positive against ≥2 agents. Finally, 13% (6/46) children were reported to be sero-clinical-positive (three were infants and three were> 1 year age, P = 0.55; five congenital and one developmental cataract, P = 0.21). Either alone or combined, RV attributed to the majority (50%; 6/12) of the IgM (±IgG) and sero-clinical-positive (50%; 3/6) children. None of the children were HSV-II IgM-positive. Laboratory-confirmed congenital rubella syndrome was reported in 4.3% (2/46) children. One sero-clinical-positive infant with rare coexisting bilateral persistent fetal vasculature was also reported. IgG-alone positivity was reported highest with CMV in 67.4% (31/46) children, whereas 43.4% (20/46) children were found nonimmune to RV.
Conclusion:
The current study emphasizes the need to interpret ToRCH-screening in pediatric cataract with caution. Interpretation should include both serial qualitative and quantitative assays in tandem with clinical correlation to minimize the diagnostic errors. Clinicians should remain vigilant regarding sero-clinical-positivity in older children too who might pose a threat to the spread of infection.
