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PubMed1993

Human parvovirus B19-associated arthritis in children.

Human parvovirus B19 (HPV B19) infection has been associated with chronic joint complaints in adult patients. We now report 22 children with joint complaints associated with recent HPV B19 infection. These children had either erythema infectiosum or serologic evidence of recent infection. Twenty children had arthritis; two had arthralgias. Eleven children had associated constitutional symptoms. Laboratory findings were generally normal. The duration of joint symptoms was less than 4 months in 14 children; however, six children have had persistent arthritis for 2 to 13 months, which would fulfill criteria for the diagnosis of juvenile rheumatoid arthritis. Although HPV B19 is usually associated with acute arthritis of brief duration, in some children infection with HPV B19 may be associated with the development of chronic arthritis.

Adolescent↗

PubMed2000

[Parvovirus B19 infection--an incidious chameleon].

Parvovirus B19 is a common source of infection with a seroprevalence of 60-70 per cent in the adult population. The most common manifestation is erythema infectiosum ("fifth disease"), with exanthem, fever and upper airway symptoms in children. The infection can give rise to a multifaceted clinical picture and is probably underdiagnosed, particularly in risk groups (individuals with haemolytic anaemia or immunosuppression, and fetuses). Serological diagnosis can now be complemented with the demonstration of viral DNA using the PCR (polymerase chain reaction) test in various body fluids, or tissue biopsy. Recent years have witnessed manifest increase in clinical knowledge of parvovirus B19-associated complications, and their diagnosis and treatment.

Adolescent↗

PubMed1992

Prokaryotic expression of a VP1 polypeptide antigen for diagnosis by a human parvovirus B19 antibody enzyme immunoassay.

To produce parvovirus B19 antigen for diagnostic purposes, partially overlapping segments covering the genes encoding the viral structural proteins VP1 and VP2 were cloned into expression vectors. The constructs were induced in Escherichia coli, resulting in the expression of beta-galactosidase fusion proteins. In immunoblotting experiments with sera from patients with erythema infectiosum, immunoglobulin G (IgG) and IgM antibodies bound to a single polypeptide of 235 amino acids at the N terminus of VP1. The DNA fragment encoding this polypeptide was amplified by the polymerase chain reaction and cloned into an expression vector. The viral capsid antigen expressed in E. coli was purified by preparative agarose gel electrophoresis and used in IgG and IgM solid-phase enzyme immunoassays. Comparison with reference gamma- and mu-capture radioimmunoassays using whole virus antigen showed that these antibody tests are suitable for the serodiagnosis of human infections caused by parvovirus B19.

Antibodies, Viral↗

PubMed1992

A significant age shift of the human parvovirus B19 antibody prevalence among young adults in Japan observed in a decade.

A seroepidemiological study on human parvovirus (B19) in Japan was undertaken with serum samples randomly collected from healthy Japanese populations (416 in 1973, 675 in 1984 and 508 in 1987/88). All samples were tested for anti-B19 IgG antibody by the indirect antigen-capture ELISA. The antibody prevalence for ages 0-9 years old in 1984 was significantly higher (16%) than that in 1973 (2%), whereas those for ages 20-29 years and 30-39 years were significantly lower in 1984 (20% and 56%) than in 1973 (67% and 80%) (p < 0.005). After the erythema infectiosum (EI) outbreak in 1986/87, the antibody prevalences for ages 5-9, 10-14 and 15-19 years were 40-85% in Fukuoka, 0-10% in Gunma, and 21-41% in Chiba reflecting each EI incidence in these three prefectures, whereas those for ages 20-29 years remained low (< 20%). These data indicate that B19 virus was transmitted mainly among children and no significant incidence of B19 virus infection in adults has occurred since 1973, resulting in a notable shifting of B19 susceptibility toward older ages including child-bearing females.

Adolescent↗

PubMed1996

Parvovirus infection and its treatment.

B19 parvovirus is an important pathogen in man. Acute infection produces fifth disease (erythema infectiosum) in normal individuals, transient aplastic crisis in the patient with haemolysis, and pure red cell aplasia in the immunologically incompetent host. Fetal infection can lead to hydrops fetalis. The target cell of the virus is the marrow erythroid progenitor. The immune response to the virus is largely humoral and directed against limited numbers of epitopes. Persistent infection is due to failure to produce neutralizing antibodies. Because viral infection is prevalent in the population, therapeutic immune globulin preparations are a good source of anti-B19 antibodies. IgG administration can lead to cure of anaemia in the congenitally immunodeficient patient and to its amelioration in AIDS patients with persistent parvovirus infection.

Anemia, Hemolytic↗

PubMedDate not supplied

[Infection with parvovirus B 19 virus in humans].

Human parvovirus B 19 (B 19) causes endemic infections in Germany. Most frequently. B 19 infection is associated in with erythema infectiosum. In patients with underlying chronic-haemolytic anaemia, B 19 infection can result in aplastic crisis. In patients with hereditary or acquired immuno-deficiency syndromes, B 19 virus may persist causing chronic bone marrow aplasia. In pregnancy B 19 infection may cause hydrops fetalis resulting in fetal loss. B 19 infection may cause hydrops fetalis resulting in fetal loss. B 19 infection in sometimes associated with vascular purpura. Infections occur mostly as epidemic outbreaks in families, kindergartens and schools as well as hospital wards. Acute or past B 19 infections are confirmed by detection B 10-specific antibodies (IgM/IgM) by ELISA.

Adolescent↗

PubMedDate not supplied

Neurological manifestations of human parvovirus B19 infection.

Since its discovery, human parvovirus B19 has been linked with a broad spectrum of clinical syndromes. An aetiological role for the virus has been confirmed in erythema infectiosum, transient aplastic crisis, persistent infection manifesting as pure red cell aplasia in immunocompromised persons, non-immune hydrops fetalis and arthritis. Less commonly recognised, but receiving increasing attention recently, are the neurological manifestations, a variety of which have been described in patients with either clinically diagnosed or laboratory confirmed B19 infection. The purpose of this review is to summarise present knowledge of B19, its known and potential pathogenic mechanisms and its association with human diseases, particularly those with neurological manifestations. The outcome of the review supports an aetiological role of the virus in neurological disease. However, the pathogenesis remains unknown and elucidating this is a priority.

Erythema Infectiosum↗

PubMed1999

Genetic heterogeneity of the immunogenic viral capsid protein region of human parvovirus B19 isolates obtained from an outbreak in a pediatric ward.

Whereas human parvovirus B19 commonly infects children and causes erythema infectiosum, it causes more severe diseases when it infects adults. In order to examine whether different clinical outcomes of B19 infection can be ascribed to the viral genetic heterogeneity, we have determined the nucleotide sequence of highly immunogenic portions of the B19 genome obtained from six patients with various clinical manifestations in a single outbreak. Our observations demonstrated that although the B19 sequences showed a significant heterogeneity, it was not correlated with the clinical manifestation. It was thus suggested that the host immune response to B19 infection may be a major determinant of clinical presentations associated with acute B19 infection.

Adult↗

PubMed2003

Systemic lupus erythematosus and parvovirus B-19: casual coincidence or causative culprit?

Systemic lupus erythmatosus (SLE) is a multi-system autoimmune disease characterized by auto-reactive cells and auto-antibodies, which can potentially affect all organ systems. Typical organ systems that are affected include the heart, lungs, skin, kidneys, and central nervous system. Its expression is believed to be dependent on various factors such as genetic predisposition, environmental agents, immune dysregulation, crossreactivity with auto-antigens, alterations in auto-antigens, or most likely, a combination of these. Parvovirus B19, a virus which commonly runs an asymptomatic or benign self-limiting course such as erythema infectiosum, transient aplastic crisis, flu-like symptoms, rash, arthalgia, and arthritis, has recently been associated with a number of rheumatic diseases, more specifically with SLE. Like SLE, it can present with multi- systemic symptoms resembling SLE both clinically and serologically. Similarities have been so striking that patients have been initially misdiagnosed with SLE, having fulfilled 3-5 of the criteria of the American College of Rheumatology, currently used for the diagnosis of SLE, only to discover later that they were infected by parvovirus B19. This paper will discuss parvovirus' link to SLE, its similarities and differences, and whether parvovirus can act as a trigger of, or simply mimic, SLE.

Diagnosis, Differential↗

PubMed2000

Endocapillary proliferative glomerulonephritis in a patient with parvovirus B19 infection.

A 45-year-old woman developed acute nephritic syndrome after erythema infectiosum. Laboratory data on admission showed decreased serum C3, C4, and CH50 levels and the presence of both immunoglobulin (Ig) M and IgG antibodies to human parvovirus B19 (HPV). A renal biopsy showed diffuse endocapillary proliferative glomerulonephritis. Immunofluorescence microscopy indicated 2+ granular staining for IgG, IgM, and C3 over the mesangial area and along glomerular capillary walls. HPV antigen was also detected in glomeruli by immunohistochemistry. Electron microscopy showed electron-dense deposits in the subendothelial space and the paramesangial area. These findings suggest that immune complex-type glomerulonephritis is caused by glomerular deposition of HPV antigen-antibody complexes in some patients with HPV infection.

Antigen-Antibody Complex↗

PubMed2005

Generalized petechial eruption induced by parvovirus B19 infection.

Parvovirus infection classically causes erythema infectiosum. During the past 2 decades, other unusual skin eruptions have been noted in association with parvovirus infection. Papular purpuric gloves and socks syndrome is one form of parvovirus infection described mostly in white, young adult patients. Recently, there have been reports of a few patients with acropetechial syndrome consisting of a papular purpuric gloves and socks syndrome-like presentation with additional involvement of the perioral and chin area, temporally associated with acute parvovirus B19 infection. We report a case of a 7-year-old boy with serologic evidence of acute parvovirus B19 infection who developed a generalized petechial eruption with lesions concentrated on his extremities and face. We also reviewed the literature and summarized the various cutaneous presentations of parvovirus infection.

Child↗

PubMed1992

[24 cases of human parvovirus B19 infection in children].

From January 1, 1987 through December 31, 1990, twenty-four pediatric patients with human parvovirus B19 (HPV B19) infection were seen. In every case the diagnosis was established by a positive capture immunoassay for IgM antibodies against the HPV B19. Four patients had hematologic manifestations, including one case of transient bone marrow aplasia revealing hereditary spherocytosis, one case of autoimmune hemolytic anemia with beta-thalassemia, and two cases of peripheral thrombocytopenia. Eight patients had skin lesions, with a morbilliform rash in six cases, erythema nodosum in one case, and Gianotti-Crosti syndrome in one case. No patients had erythema infectiosum. Seven patients developed joint manifestations: Henoch-Schönlein purpura in two cases, arthralgia in four cases, and polyarticular disease progressing to severe rheumatoid arthritis in a thirteen-year-old girl. Unremarkable symptoms of viral disease were seen in three patients. A five-month-old infant developed severe acute myocarditis. One patient with hepatitis A had acute liver failure. This study confirms the broad spectrum of clinical manifestations of HPV B19 infection. There were a number of unusual findings, including the high rate of joint manifestations (29%) and the severe course of some hematologic and myocardial manifestations. These results raise the question of whether the HPV B19 may be involved in the genesis of chronic juvenile arthritis.

Adolescent↗

PubMed1995

[Parvovirus B19 infection: the general aspects and gestational problems].

Parvovirus B19 is a small, heat-stable, single-strained DNA virus (5.5 kb), with 23 nm icosahedral capsid discovered in 1975. Since its discovery, the virus has been shown to be a causative agent of erythema infectiosum (fifth disease). Under specific circumstances it can cause transient aplastic crisis, chronic anemia, arthritis and fetal death. Laboratory diagnosis of recent or past B19 infection usually relies on the demonstration of virus-specific IgM or IgG antibodies in patient's serum. The aim of this study was to evaluate the prevalence of Parvovirus B19 infection among 87 pregnant patients. Our study on anti-B19 antibody prevalence indicates that about 64% of pregnant women in our country lack specific antibodies and are at risk of B19 infection. One intrauterine death was encountered in a patient with specific IgM antibodies. The authors suggest the detection of IgG and IgM anti-B19 antibodies as a routine screening practice during pregnancy.

Adolescent↗

PubMed1994

[Parvovirus B19 and pediatric pathology].

B 19 parvovirus is a widespread virus with primary infestation generally occurring in childhood through family and community outbreaks. Its most typical manifestation is transient erythroblastopenia with aplastic crisis, often profound, mostly affecting patients with chronic hemolytic anemia, and eventually patients with defective erythropoiesis (chronic hypoplastic anemia, iron deficiency anemia). In normal individuals the primary infestation is usually asymptomatic but may give transient hematological signs for few days: moderate reticulocytopenia, thrombopenia and neutropenia. Clinically two phases of the infection are described: 1.) a first phase of viremia of 2 to 3 days which may be accompanied by fever and myalgias; 2.) a second phase which may last for several weeks with dermatological signs, the most typical being erythema infectiosum, vasculitis, arthralgias or arthritis. In pregnant women, the primary infestation with B 19 parvovirus may lead to fetal anemia and hydrops fetalis with uneven outcomes: fetal death, chronic erythroblastopenia after birth, spontaneous resolution. Although the incidence of fetal infestation in non immunized pregnant women is still unknown, the question is raised of the recognition and protection of non immunized pregnant women at high risk of exposition to infested subjects. Long term persistence of the virus in the organism may be responsible for chronic manifestation, essentially but not exclusively in immunodeficient-patients: prolonged erythroblastopenia and chronic rheumatologic manifestations. It may be also responsible for cases of juvenile arthritis, thrombocytopenic purpura and chronic neutropenia of childhood. The diagnosis of the viral infestation is mainly based upon the detection of specific IgM, then IgG, antibodies by Elisa technique.

Child↗

PubMed1994

Immune-mediated inner ear disease and parvovirus B19.

Human parvovirus B19 (HP-B19), the etiologic agent of the common childhood illness erythema infectiosum, has been implicated in systemic immune disorders. Patients presenting with sensorineural hearing loss and/or dizziness, not readily categorized, were evaluated for immune-mediated inner ear disease. Appropriate serologic studies including parvovirus B19 antibody titers were conducted. Thirty patients with suspected immune-mediated inner ear disease were treated with corticosteroid trial for 5 to 7 days, then reexamined with repeat audiogram and/or vestibular testing. Seventeen patients with clinical response were treated with long-term corticosteroids and cyclophosphamide. Six patients had positive HP-B19 immunoglobulin M (IgM) titers and 8 patients had positive parvovirus immunoglobulin G (IgG) titers. All 14 patients responded to therapy. Parvovirus B19, therefore, is a possible etiology of immune-mediated inner ear disease.

Adrenal Cortex Hormones↗

PubMed2000

Parvovirus-associated arthritis.

Human parvovirus B19 is the cause of several distinct clinical syndromes. The most common is erythema infectiosum (fifth disease), a febrile exanthem occurring primarily in children. Recent studies have shown that parvovirus B19 can cause acute arthritis and occasionally a chronic arthropathy, both in children and adults. Parvovirus B19 DNA has been detected in studies in the synovial tissue of patients with rheumatoid arthritis, but other studies have varied in their findings. Recent studies also indicate a possible connective tissue disease-like syndrome with parvoviral infections. The common features of this syndrome are malar eruption, arthralgias, arthritis, and laboratory abnormalities including antinuclear antibody and rheumatoid factor positivity. However, the data indicate it is unlikely that B19 infection causes rheumatoid arthritis or systemic lupus erythematosus. Continued studies of the pathogenesis of acute and chronic parvoviral B19 infections and arthropathy may provide insights into virus-host interactions and mechanisms of joint disease and connective tissue disease.

Adult↗

PubMed2001

Anti-VP1 and anti-VP2 antibodies detected by immunofluorescence assays in patients with acute human parvovirus B19 infection.

Acute human parvovirus B19 infection is followed by an antibody response to the structural proteins of the viral capsid (VP1 and VP2). We used 80 sera collected from 58 erythema infectiosum and 6 transient aplastic crisis patients to test IgM and IgG antibodies against these two proteins in an immunofluorescence assay (IFA) using Sf9 cells infected with recombinant baculovirus expressing either VP1 or VP2 antigen. Although less sensitive than IgM capture enzyme immunoassay using native antigen (MACEIA), we could detect anti-VP1 or anti-VP2 IgM antibodies by IFA in 49 patients with acute infection (76.6%). Detection of IgG anti-VP1 and anti-VP2 by IFA, however, was as sensitive as IgG detection by indirect enzyme immunoassay. By applying IgG avidity IFA to sera of the 15 IgM IFA negative patients we were able to confirm acute infection in further 12 cases by IFA. Overall, acute infection was confirmed by IFA in 61 (95.3%) of the 64 patients.

Adolescent↗

PubMed2002

Antibody responses in parvovirus B19 infected patients.

Parvovirus B19 is the causative agent of erythema infectiosum. In addition, the infection may be associated with other disease manifestations: anemia and aplastic crisis, thrombo- or granulocytopenies; spontaneous abortion or hydrops fetalis in pregnant women; acute and chronic arthritis in adults and children, myocarditis and hepatitis. Both acute and persistent courses of B19-infections have been reported. All patients develop IgG against the capsid proteins VP1 and VP2, the majority of virus neutralizing antibodies that offer life-long protection against reinfections are directed against the VP1-unique region. IgM is mainly directed against VP2-specific epitopes. These antibodies may be present for only a rather short period of two to ten weeks after acute infection. IgG-antibodies against the nonstructural protein NS1 are preferentially found in patients which are unable to eliminate the virus and develop persisting viremia or virus persistence in distinct organs, e.g. synovial fluid, liver, bone marrow.

Antibodies, Viral↗