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PubMed2002

Confirmation of an outbreak of parvovirus B19 in a primary school using IgM ELISA and PCR on thumb prick blood samples.

BACKGROUND: Although parvovirus infections are usually benign and self-limiting, it is important to confirm the diagnosis in a public health setting which might involve pregnant women and in which an outbreak could lead to medical consequences. In these situations, microbiological confirmation by thumb prick is a relatively low-invasive method that is simple to carry out. OBJECTIVE AND STUDY DESIGN: Because relatively small blood volumes are obtained in thumb prick blood samples, we compared the results of two different techniques during an outbreak of erythema infectiosum: the usual serological detection of IgM antibodies (ELISA) versus PCR-based detection of viral DNA. RESULTS: In a school-based outbreak, 39 cases (33 schoolchildren, three parents, three pre-schoolers) were registered over a period of 11 weeks. Sera were obtained from 23 of the school cases and two of the three parent cases. Of all thumb prick serum samples, 65% (15/23) tested positive or borderline positive for parvovirus IgM with ELISA, while 70% (16/23) tested positive or borderline positive with PCR. Although the overlap between the two tests was large (11 samples tested positive or borderline positive in both), a substantial number of samples showed contradictory results (nine samples). CONCLUSION: The overall picture of 37 clinical cases of erythema infectiosum and two adult cases with arthritis, linked to a primary school, fits in well with positive diagnostic results by either technique for parvovirus B19, convincingly demonstrating an outbreak of fifth disease. The considerable number of discrepancies in sample results demonstrates that maximum sensitivity of parvovirus testing would require both tests to be performed.

Antibodies, Viral↗
PubMed2002

[Parvovirus B19 outbreak in a rural community in Alicante].

BACKGROUND: Parvovirus B19 (PVB19) has been identified as the cause of erythema infectiosum. The epidemiology of PVB19 has not been extensively studied in Spain or in the autonomic community of Valencia. The aim of this work is to describe an outbreak of PVB19 infection occurring in the area of Monforte del Cid, Alicante. METHODS: A probable case was defined as: all subjects living in Monforte who presented a rash (mainly facial) and/or arthralgia starting from November 1999. A confirmed case was defined as: a probable case confirmed by laboratory analysis or a case having an epidemiological link. Laboratory confirmation included specific IgG or IgM antibodies to PVB19. Cases were mainly detected through the Monforte del Cid Primary Health Care Center. RESULTS: The outbreak occurred from November 1999 to August 2000. A total of 118 cases were detected, giving an overall attack rate (AR) of 23.2 cases per 1,000 inhabitants. The highest rates were in the age groups of 0-4 years old (AR 5 114.5 per 1,000) and 5-9 years old (AR 5 180.3 per 1,000). By gender, the AR per 1,000 inhabitants was 26.9 in men and 16.7 in women. Two of the cases were pregnant women and one of them had a miscarriage. CONCLUSIONS: The outbreak of erythema infectiosum lasted 10 months and mainly affected children under 14 years old. Active surveillance was focussed on women in the first three months of pregnancy.

Abortion, Spontaneous↗
PubMedDate not supplied

Human parvovirus B19: historical and clinical review.

Human parvovirus B19 has been associated with disease only for the past few years. First isolated from sera obtained for studies on hepatitis B in 1975, it was not until 1981 that infection with this small, single-stranded DNA virus was related to aplastic crisis associated with hemolytic anemia. A nonspecific viral prodrome, the occurrence in family members, and epidemics of aplastic crisis suggested the infectious etiology. Human parvovirus infection has since been associated with arthritis, erythema infectiosum (fifth disease), fetal death, and hydrops fetalis. Through the use of recently developed serologic tests, epidemics of erythema infectiosum and parvoviral infection have been related not only to aplastic crisis but also to intrauterine infection and hydrops; DNA hybridization studies have allowed the detection of viral DNA in serum and tissue extracts. Studies have been hampered by the lack of an ability to culture the virus, but this is now possible utilizing bone marrow culture and erythropoietin. This article is a historical and clinical review of human parvovirus infection and disease and considers potential questions regarding their consequences.

Anemia, Hemolytic↗
PubMed1990

Risk of infection following exposures to human parvovirus B19.

In response to concern about the effect of human parvovirus B19 infection of the fetus, we have developed estimates of the risk of adults becoming infected following B19 exposures at home, in schools or day-care centers, and in hospitals. These estimates can then be used with other data to estimate the risk to the fetus of a B19 exposure during pregnancy. The risk to the fetus equals the rate of maternal susceptibility to infection times the rate of maternal infection following the specific type of exposure times the rate of fetal death following maternal infection. Data from studies of outbreaks of B19 associated erythema infectiosum and aplastic crisis suggest that the risk of infection among susceptible adults following household exposure to a B19 infected person is approximately 50% and following school exposures during outbreaks of erythema infectiosum is 20% to 30%. All susceptible school staff members, not just teachers, appear to be at risk for infection during outbreaks. Additional study is needed to determine the risk of infection following exposure to B19 infected patients in the hospital. Based on these and other data we can estimate that pregnant women whose serologic status is unknown have less than 2.5% chance of suffering fetal loss after household exposure and less than 1.5% chance after school exposure.

Adolescent↗
PubMed2002

Human fetal infection with parvovirus B19: maternal infection time in gestation, viral persistence and fetal prognosis.

OBJECTIVE: To clarify the relation between the time of parvovirus B19 (B19) infection in pregnancy and fetal outcome, including the viral persistence in the fetus. METHODS: Among 57 pairs showing serologic and/or virologic evidence of maternal and fetal B19 infection between 1986 and 1999 in Japan, 13 maternal-fetal pairs with the time of maternal B19 infection documented were retrospectively evaluated for fetal outcome and viral persistence. RESULTS: Nonimmune hydrops occurred at 23, 21 and 26 gestational weeks (gw) in three fetuses as a result of their mothers' symptomatic infection (erythema infectiosum) at 3, 16 and 19 gw, respectively. Spontaneous abortion without hydrops and intrauterine growth retardation resulting in small-for-gestational age (SGA) classification occurred in two fetuses whose mothers had developed erythema infectiosum at 5 and 16 gw, respectively. Eight fetuses were asymptomatic as a result of their mothers' infection at 6, 9, 12, 15, 18, 23, 23 and 33 gw, respectively. B19 DNA was detected in neonatal serum in all nine cases tested. CONCLUSION: Maternal B19 infection throughout gestation including the early stage after fertilization caused fetal infection that persisted until intrauterine fetal death with or without nonimmune hydrops or until the neonatal period after birth.

Adult↗
PubMed1988

Parvovirus infections. From benign to life-threatening.

Erythema infectiosum, aplastic crisis, intrauterine fetal demise, and an acute polyarthralgia syndrome can all be caused by human parvovirus B19. The major pathophysiologic effect of infection seems to be cessation of erythropoiesis as a result of cytolytic infection of red cell precursors. Erythema infectiosum is a benign disease that usually occurs in childhood. The acute polyarthralgia syndrome is likewise benign, and patients in whom parvovirus infection has been confirmed by serologic testing can be reassured that their joint symptoms are likely to be self-limited. Parvovirus-induced aplastic crisis in a patient with chronic hemolytic anemia is life-threatening but can be reversed with blood transfusions if recognized promptly. Parvovirus infection during pregnancy clearly increases the risk of fetal demise, and parental anxiety is understandably high. An organized approach using a combination of tests to monitor mother and fetus can provide optimal care in these cases.

Adolescent↗
PubMed1999

Serologic study of human parvovirus B19 infection in pregnancy in Japan.

OBJECTIVES: To clarify the relationship between hydrops fetalis and parvovirus outbreaks in the community, seroprevalence of B19 antibody among women of childbearing age, and adverse effects of intrauterine B19 infection. METHODS: Sera were collected from 168 cases of hydrops fetalis which were diagnosed between 1987 and 1997 in Miyagi prefecture, Japan, from 232 healthy pregnant women in 1987 and 277 healthy pregnant women in 1997 in Miyagi, and from 48 women infected with B19 during pregnancy. The sera were examined for B19 IgG and IgM antibodies by enzyme-linked immunosorbent assay and for B19 DNA by polymerase chain reaction. The number of cases of erythema infectiosum in Miyagi had been monitored each month. RESULTS: Thirteen of the 168 cases of hydrops fetalis were found to be caused by intrauterine B19 infection and 12 of the 13 cases clustered in two periods of outbreaks of erythema infectiosum in the community. The positive rates of B19 IgG antibody between 1987 and 1997 were significantly different: 33% in 1987 and 46% in 1997. Nine of the 48 women infected during pregnancy showed adverse effects of the fetus: eight hydrops fetalis and one early abortion with positive B19 DNA. The fetal death rate (>12 weeks of gestation) among them was 15% (7/48), far higher than the calculated 1% among the general population. The nine mothers with adverse fetal outcomes had contact with the infectious source at the 16 weeks of gestation or earlier. CONCLUSIONS: These data clearly showed a relationship between hydrops fetalis and parvovirus outbreaks in the community, and it may be important to follow the seroprevalence for an extrapolated period time to predict occurrence of hydrops fetalis caused by B19. Also the data indicated that the gestational week infection occurred is the most important determinant of an adverse effect to the fetus as described previously.

Adolescent↗
PubMed1996

[Parvovirus B 19 in pregnancy].

The human parvovirus B 19 was discovered in 1975 by Cossart but its etiological association with erythema infectiosum and hydrops of the foetus was proved only in 1984-1985. The objective of the submitted prospective study was to assemble basic findings on the herd immunity of the female population and the risk of infection with this agent during pregnancy. Seropositivity of women of fertile age before the epidemic of parvovirus B 19 in 1993 and 1994 was cca 50%, after the epidemic 70%. Erythema infectiosum is a childhood disease (96% of the cases are children under 14 years of age), but seroprevalence of parvovirus IgG in these age groups is only 11%. Thus the infection in adults is frequent but not diagnosed. A parvovirus etiology of possible loss of the foetus on the basis of serological examination is encountered only exceptionally. The Czech commercial preparation gammaglobulin can be used for prevention and treatment of a non-immune foetal hydrops.

Adult↗
PubMed1995

An epidemic of aplastic crisis caused by human parvovirus B19.

Human parvovirus B19 has been associated with several diseases. Aplastic crisis in patients with chronic hemolytic anemia, erythema infectiosum, hydrops fetalis and arthritis are among the common diseases caused by this virus infection. In the period between July, 1991, and March, 1992, 48 patients with aplastic crises were hospitalized at Saudi Aramco-Dhahran Health Center, Dhahran, Saudi Arabia. Forty-six patients had homozygous sickle cell disease, one had hemoglobin H disease and one had hereditary elliptocytosis. Evidence of recent human parvovirus infection was present in 91% of the cases. Leukopenia was present in 21%, neutropenia in 27% and thrombocytopenia in 42%. This differs from previous reports in which red blood cell aplasia causing anemia was the only hematologic finding reported in most patients. There were no cases of erythema infectiosum in either the patients or the community during the epidemic and the reason for this phenomenon is not obvious. The almost limited occurrence of aplastic crisis in patients with sickle cell disease in a population with a high incidence of other types of chronic hemolytic anemias is of interest.

Adolescent↗
PubMedDate not supplied

Parvovirus B19 infection in children with acute illness and rash.

Parvovirus B19 is responsible for a variety of cutaneous diseases, including erythema infectiosum and papular purpuric gloves-and-socks syndrome. It is also associated with other dermatologic diseases, such as systemic lupus erythematosus. To study the prevalence of parvovirus B19 infection in children with acute illness and rash, we did a prospective study of 110 children at the Chiang Mai University teaching hospital from January 2001 to November 2003. Sera from these patients were analyzed for immunoglobulin M and immunoglobulin G antibodies against human parvovirus B19 using enzyme-linked immunosorbent assay techniques. From a total of 110 patients with acute illness and rash, there were paired serum samples for 90 patients and single serum sample for 20 patients. For those with paired serum samples, there were three patients with recent parvovirus B19 infection that presented with erythema infectiosum, urticaria, and lupus erythematosus, respectively. Immunoglobulin G antibodies were tested in serum samples of 103 children; 28.2% were positive. These data indicate that parvovirus B19 is not a common cause of acute illness and rash in children.

Acute Disease↗
PubMed1989

Human parvovirus B19 infection among hospital staff members after contact with infected patients.

In the spring and summer of 1988, two separate outbreaks of an illness with a rash resembling erythema infectiosum occurred among members of the nursing staff of the Children's Hospital of Philadelphia. The sources were two adolescent patients with sickle cell disease and aplastic crisis who had unsuspected parvovirus infection. Tests for IgM and IgG antibodies to parvovirus B19 were positive in both patients, and electron microscopical examination showed parvovirus-like particles in the early serum samples. Of 40 health care workers exposed to infected patients, 12 (30 percent) were infected, 2 (5 percent) were possibly infected, 8 (20 percent) had evidence of a past infection with B19, and 18 (45 percent) remained seronegative. Attack rates among the susceptible contacts were 36 percent in the first outbreak and at least 38 percent in the second. Clinical symptoms began a mean of 12.6 days after exposure and included malaise, rash, and joint pain. We conclude that hospital workers are at risk of contracting nosocomial erythema infectiosum from patients with parvovirus-associated aplastic crisis. We recommend that all patients with hereditary hemolytic anemias who are admitted with a febrile illness be evaluated for aplasia and promptly placed in respiratory and contact isolation if aplastic crisis is suspected.

Adolescent↗
PubMed2000

[Leukocytopenia and thrombocytopenia preceded by human parvovirus B19 infection: report of three adult cases].

In Saiki City, Oita, Japan, erythema infectiosum in children has been prevalent from June, 1999 to the time of writing (January, 2000). We present three adult cases of parvovirus B19-associated leukocytopenia and thrombocytopenia that developed during this epidemic. Between June and November, 1999, a 32-year-old woman, a 38-year-old woman, and a 63-year-old man were referred to our hospital for treatment of leukocytopenia and thrombocytopenia. All complained of common cold-like symptoms. Their WBC counts (percentage of neutrophils) were 1,000/microliter (70%), 1,900/microliter (40%) and 1,680/microliter (40%), their hemoglobin levels 9.4 g/dl, 9.8 g/dl and 14.9 g/dl, and their platelet counts 10.8 x 10(4)/microliter, 6.9 x 10(4)/microliter and 4.5 x 10(4)/microliter, respectively. The diagnosis of parvovirus B19 infection was documented by the presence of B19-specific IgM antibodies or serum positivity for viral DNA. In two cases, the leukocytopenia and thrombocytopenia resolved gradually. In the other case, leukocytopenia, thrombocytopenia and B19 infection persisted for more than two months. These cases suggest that parvovirus B19 may be a common cause of leukocytopenia and thrombocytopenia even in adult patients without hematological disorders (erythropoietic stress), and that testing for parvovirus infection is justified in such patients, even if anemia is slight, especially when erythema infectiosum is prevalent.

Adult↗
PubMed1995

Spectrum of parvovirus B19 infection: analysis of an outbreak of 43 cases in Cadiz, Spain.

In the spring of 1993, an epidemic of infection with human parvovirus B19 occurred in Cadiz, Spain. Evaluation of the 43 patients in whom this diagnosis was confirmed revealed four groups of predominant manifestations: (1) hematologic manifestations in six cases (13.9%), including four of aplastic crisis and two of pancytopenia; (2) dermatologic manifestations in 23 cases (53.4%), including 10 of erythema infectiosum and one of erythema multiforme ampullosum; (3) arthralgias/arthritis in nine cases (20.9%), including two with a chronic course; and (4) infection during pregnancy in three cases (7.0%), including two that ended in abortion. Of the 43 patients, 37.2% presented with fever and adenopathies, and these were the only manifestations in two cases. The appearance of clinical disease correlated with modifications in isotype and serum level of specific antibodies to parvovirus B19; the disappearance of IgM antibodies coincided with the resolution of clinical manifestations. Although their presence did not correlate with the course of the disease, the detection of circulating immune complexes in 81.6% of cases supports the possibility that some manifestations were immune mediated.

Adolescent↗
PubMed2002

Parvovirus B19: a review.

Infection with parvovirus B19 may result in a wide range of dermatologic manifestations. The specific skin findings include erythema infectiosum and papular purpuric "gloves-and-socks" syndrome. The nonspecific findings include reticular erythema, maculopapular eruptions, and petechiae and purpura, as well as other less frequently described findings. Associations with other dermatologic diseases, such as erythema multiforme and erythema nodosum, also have been described. A role in the pathogenesis of various collagen vascular disorders has been suggested and is under investigation. The diagnosis of infection rests on the typical clinical findings. Whenever parvovirus B19 infection is diagnosed, the physician must ensure that neither the patient nor his or her contacts is a member of certain vulnerable populations. In these populations, infection with parvovirus B19 may result in devastating complications. The vulnerable populations include those with hematologic disease, immunosuppressed patients, and pregnant women. Treatment of infection in the healthy immunocompetent individual is asymptomatic, and the acute infections typically resolve without complications.

Erythema Infectiosum↗
PubMed2006

[A 28-year-old patient with exanthema on hands and feet].

We report on a case of papular-purpuric gloves and socks syndrome (PPGSS). Our 28-year-old female patient showed a typical exanthema on hands and feet followed by high fever, cervical swelling of lymph nodes and general symptoms. Clinical and paraclinical tests led to a diagnosis of PPGSS. This is, in most cases, caused by viral infections, in particular by the parvovirus B19. After recovering, the daughter of our patient suffered from erythema infectiosum, a typical infection caused by parvovirus B19.

Adult↗
PubMed2002

A clinical study of adult human parvovirus B19 infection.

OBJECTIVE: We investigated the clinical aspects of adult human parvovirus (HPV) B19 infection. PATIENTS AND METHODS: We retrospectively reviewed the charts of 21 consecutive patients [4 males, aged 32 to 43 years (average 38.0 years), and 17 females, aged 15 to 43 (average 34.2)] with adult HPV B19 infection who visited our outpatient department between July 1997 and June 1998. All diagnoses of adult HPV B19 infection were based on positive anti-HPV B19 IgM antibody in serum and/or positive HPV B19 DNA in peripheral blood. RESULTS: The predominant signs and symptoms of the patients were: fever (81.0%), arthralgia/myalgia (61.9%), skin rash (47.6%), general fatigue (42.9%), lymph node swelling (38.1%) and edema (38.1%). Six patients had the following underlying diseases or complications: pregnancy, myoma uteri, cervical cancer of the uterus, lupus diathesis/ endometriosis, hereditary spherocytosis, and multiple sclerosis. The following abnormal laboratory findings (more or less than normal limits) were observed: anemia (81.0%), leukopenia (33.3%), elevated transaminases (28.6%), and elevated lactate dehydrogenase (LDH) (57.1%). Six patients were considered to have persistent infection. CONCLUSION: HPV B19 can infect healthy adults and causes more predominant signs and symptoms (arthralgia, myalgia and fever) than in children, and adult HPV B19 infection can be suspected from the familial history and clinical findings. Accordingly, more attention must be paid to adult HPV B19 infection, particularly when erythema infectiosum is prevalent in children.

Acute Disease↗
PubMed1996

[Dermatologic symptoms of parvovirus B19 infections].

Infections with parvovirus B19 are often characterized by the well-known erythema infectiosum, usually accompanied by fever and arthralgia. Furthermore the virus may cause a lethal hydrops fetalis during the pregnancy or a severe aplastic crisis in patients suffer from chronic hemolytic anemia. We present three patients infected by parvovirus B19. Whose skin lesions included a non-specific exanthem, erythema multiforme, and purpura. The virus infection was confirmed both by serology and PCR identification. In conclusion the diagnosis of acute exanthems should include the search for virus infections.

Adult↗