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PubMed2001

Renal involvement induced by human parvovirus B19 infection.

In an attempt to clarify the renal involvement induced by human parvovirus B19 (HPB19) infection, we investigated 6 adult patients with transient urinary abnormalities followed by erythema infectiosum. All patients had HPB19-specific IgM antibody and showed mild proteinuria of 0.2-1.2 g/day with or without microscopic hematuria. In 5 patients a decrease of complement was present, and in 2 the circulating immune complex levels were elevated. All patients showed mild or moderate endocapillary proliferation with leukocytic infiltrates in glomeruli and leukocytic infiltrates with edema around interlobular arteries and arterioles. Immunofluorescence microscopy revealed C3c deposits with immunoglobulins along the glomerular capillary walls and in the walls of small arteries and arterioles. Electron microscopic studies showed swelling of the endothelial cells and small electron-dense deposits in mesangium (in all 6 patients) and subendothelium (in 5 of 6 patients). However, HPB19 VP1 and VP2 capsid antigens were not demonstrated in the glomerulus or the vascular wall in any patient. These findings suggest that the renal lesions caused by an immune complex mediated phenomenon would be closely correlated with the HPB19 infection, although the precise mechanism is not entirely clear, and that in adults HPB19 should be thought of as a possible cause of acute postinfectious glomerulonephritis.

Adult↗

PubMed1987

Variation of erythroid and myeloid precursors in the marrow and peripheral blood of volunteer subjects infected with human parvovirus (B19).

Infection of normal individuals with human parvovirus (B19) results in a mild disease (erythema infectiosum) but gives rise to aplastic crises in patients with chronic hemolytic anemias. The effects of this disease on hemopoiesis were investigated following intranasal inoculation of the virus into three volunteers. A typical disease ensued with a viremia peaking at 9 d. Marrow morphology 6 d after inoculation appeared normal but at 10 d there was a severe loss of erythroid precursors followed by a 1-2-g drop in hemoglobin, and an increase in serum immunoreactive erythropoietin. Erythroid burst-forming units (BFU-E) from the peripheral blood were considerably reduced, starting at the time of viremia and persisting for 4-8 d depending on the individual. Granulocyte-macrophage colony-forming units (CFU-GM) were also affected but the loss started 2 d later. Both CFU-GM and BFU-E showed a sharp overshoot at recovery. In the marrow, BFU-E and CFU-E were reduced at 6 and 10 d in the individual having the longest period of peripheral progenitor loss. In contrast, there was an increase in BFU-E and CFU-E in the subject with least change in peripheral progenitors. In the third subject, with an intermediate picture, there was a loss at 6 d but an increase at 10 d of erythroid progenitors. It is suggested that the architecture of the marrow might partially isolate progenitors from high titers of virus in the serum and individual variation in this respect might give the results observed.

Adult↗

PubMed2006

Refractory status epilepticus owing to human parvovirus B19 encephalitis in a child.

Human parvovirus B19 is the agent that causes erythema infectiosum (fifth disease), a disease that is generally benign and self-limiting. This virus also is associated with severe disease in hemolytic or immunocompromised patients. It rarely causes meningoencephalitis in healthy children. Herein we present the case of a 10-year-old healthy girl with refractory status epilepticus possibly owing to human parvovirus B19 encephalitis who was successfully treated with high-dose corticosteroids. To our knowledge, this is the first report of human parvovirus B19 encephalitis complicated by refractory status epilepticus in a child.

Adrenal Cortex Hormones↗

PubMed2002

Mumps-like syndrome owing to parvovirus B19: a brief report.

Major manifestations of acute parvovirus B19 infection are usually erythema infectiosum, transient aplastic crisis and polyarthropathy. We report a case suspected to have mumps-meningo-encephalitis who had IgM and IgG antibodies positive for parvovirus B19.

Acute Disease↗

PubMed1995

Parvovirus infection and generalized edema in adults.

We describe the clinical and laboratory findings of 7 adult patients with serological evidence of recent human parvovirus B19 (HPV) infection who presented with generalized edema. Six of the 7 patients had household contact with children with erythema infectiosum and had flu-like symptoms before visiting hospital. The interval between the flu-like episode and the development of edema ranged from 4 to 13 days (mean 7.0). In all 7 patients, there was serological confirmation of recent HPV infection, and all showed the development of edema following HPV infection without urine abnormalities or anemia. Two patients presented hypocomplementemia, and two patients showed signs of congestive heart failure. HPV may be considered a causative agent of generalized edema not only in the fetus but also in adults and HPV infection should be included in the differential diagnosis of generalized edema formation.

Adult↗

PubMed1997

Primary and secondary infections by human parvovirus B19 following bone marrow transplantation: characterization by PCR and B-cell molecular immunology.

Due to the preparative regimen necessary, bone marrow transplantation (BMT) consistently results in severe immunodeficiency, often associated with anaemia, leukopenia and thrombocytopenia. Parvovirus B19 replicates in red blood cell precursors in the bone marrow and causes erythema infectiosum ('fifth disease'), anaemia, arthritis and foetal death. We assessed the significance of B19 infections as a cause of post-BMT complications. Over 900 serial serum samples from 201 allogeneic bone marrow recipients were studied by polymerase chain reaction (PCR) and by modern serodiagnostic methods. During the first 6 months after transplantation all BMT recipients remained B19 PCR-negative. Antibody screening for B19 infections was performed up to 36 months post-transplantation. Three cases of acute B19 infection were diagnosed during the second year post-BMT. To characterize the adoptively transferred immune system we measured subclasses and avidity of anti-VP1 IgG and epitope-type specificity (ETS) of anti-VP2 IgG, which allowed functional differentiation of primary and secondary B-cell responses long after BMT. The profile of the immune response was that of a primary infection in 1 and of reinfection in 2 of the 3 acute cases. Both types were clinically mild. Infection by human parvovirus B19 is not a frequent cause of post-BMT cytopenias. The findings with the new B19 antibody markers support the concept that the donated marrow determines the type of antiviral B-cell responses.

Adult↗

PubMed1987

Hydrops fetalis caused by intrauterine human parvovirus infection.

During a large outbreak of erythema infectiosum in 1987 in Toyama prefecture, Japan, a 32-year-old woman acquired a mild rash on her arms and legs at 18 weeks of gestation. At 26 weeks and 4 days of gestation, the fetus died by hydrops fetalis and pregnancy was terminated. Histological studies of the fetus revealed degeneration of erythroblastic cells in the liver and bone marrow. Extensive extramedullary hematopoiesis and hemosiderin deposits were observed in the liver. Antibody response to human parvovirus B19 virus was demonstrated in maternal sera by ELISA. Furthermore, dot hybridization with the molecularly cloned DNA probe revealed the presence of human parvovirus DNA sequence in the fetal liver, spleen, lung, kidney and placenta. This report describes the first case in Japan of hydrops fetalis caused by human parvovirus B19 infection.

Adult↗

PubMed2001

[Congenital aplastic anemia caused by parvovirus B19 infection].

Human parvovirus B19 causes the fifth disease (erythema infectiosum) in childhood. Intrauterine infection by parvovirus in immunocompromised fetus can lead to the severe congenital aplastic anemia. Here we report the case of 2.5-year-old girl with congenital infection with parvovirus B19. The girl was born as a pre-term baby with hydrops, congenital aplastic anemia, and low level of immunoglobulins IgG and IgM. She depended on the repeated blood transfusions and she did not respond to erythropoietin therapy. The parvovirus B19 infection in bone marrow was detected by polymerase chain reaction and its therapy started with intravenous administration of immunoglobulins. Hemoglobin reached normal level one year later, but low levels of parvovirus B19 were detectable for another 6 months. Immunoglobulin treatment was finished when the virus could not be detected in the circulation. However, one-month later parvovirus B19 DNA was detected again. The two months course of immunoglobulin treatment was repeated, and the DNA analysis of blood cells for parvovirus B19 has been negative since then. Five months after the final withdrawal of the immunoglobulin therapy the girl is in a good shape and all lab tests, except for the decreased levels of IgM, are within the normal range. The PCR monitoring of the presence of parvovirus B19 DNA in blood and bone marrow cells during and after the treatment of congenital aplastic anemia caused by parvovirus B19 chronic infection becomes the necessity for the rational therapy.

DNA, Viral↗

PubMed2002

Human parvovirus B19 infection among patients with chronic blood disorders.

OBJECTIVE: In a normal host, parvovirus infection can be asymptomatic or can result in erythema infectiosum or arthropathy. Patients with underlying hematologic and immunologic disorders who become infected with this virus are at risk for aplastic anemia. This small study attempts to confirm this relation between the human parvovirus B19 infection as one of the predisposing factor of aplastic crisis in patients with hemolytic disorders. METHODS: The laboratory records of 73 patients' serum samples, which were tested for detection of specific Immunoglobulin M and Immunoglobulin G antibody by means of the recurrently available indirect enzyme linked Immunoassay during the period from March 1998 to March 2001, were reviewed retrospectively at the Armed Forces Hospital, Riyadh, Kingdom of Saudi Arabia. RESULTS: For all patients there were 11 (15%) who were diagnosed as acute infections while 50 (68%) had serological evidence of previous exposure. Eight out of the 11 acute patients had chronic hemolytic disorder as the underlying disease while, the 3 other patients were organ transplant and connective tissue disease patients. CONCLUSION: Seventy-eight percent of our infected patients were known to have an underlying blood disorder, while 22% had immunosuppressed disorders such as organ transplant and connective tissue disorder. Parvovirus B19 can be considered as one of the predisposing factors of hemolytic crisis in patients with chronic hemolytic disease.

Adolescent↗

PubMedDate not supplied

[Familial transient red cell aplasia from parvovirus B-19 infection].

In our Paediatric Clinic we observed a case of transient aplastic crisis caused by Parvovirus B19 in a child and his mother, both affected by spherocytic haemolytic anemia. Anti-Parvovirus IgM antibody titre and viral search by PCR were positive. Anemia was treated with transfusion of concentrated red blood cells. In case of a family onset of hyperacute anemia it is necessary to consider a bone marrow aplastic crisis of the red series, induced by Parvovirus B19, especially if there is notice of an ongoing outbreak of erythema infectiosum.

Adult↗

PubMed2002

Parvovirus B19 infection in pregnancy.

OBJECTIVES: (1) To review the effects of parvovirus B19 on the pregnant woman and fetus, and (2) to discuss the management of women who are exposed to, who are at risk of developing, or who develop parvovirus B19 infection in pregnancy. OUTCOMES: Maternal outcomes of parvovirus B19 including erythema infectiosum, arthropathy, anemia, and myocarditis. Fetal outcomes including spontaneous abortion, congenital anomalies, hydrops fetalis, stillbirth, and long-term effects. EVIDENCE: MEDLINE search from 1966 to January 2002 for articles relating to parvovirus B19 infection, using key words "parvovirus" and "pregnancy," and guidelines of professional organizations including the American College of Obstetricians and Gynecologists. VALUES: The evidence obtained was reviewed and evaluated by both the Maternal Fetal Medicine and Infectious Diseases Committees of the Society of Obstetricians and Gynaecologists of Canada (SOGC) and recommendations were made according to guidelines developed by the Canadian Task Force on the Periodic Health Examination. RECOMMENDATIONS: 1. Pregnant women exposed to, or who develop symptoms of, parvovirus B19 infection should be assessed to determine if they are susceptible to infection (nonimmune) or if they have a current infection, by determining their parvovirus B19 IgG and IgM status. (II-2A) 2. If parvovirus B19 IgG is present and IgM is negative, the woman is immune and can be reassured that she will not develop infection and that the virus will not adversely affect her pregnancy. (II-2A) 3. If both parvovirus B19 IgG and IgM are negative (and the incubation period has passed), the woman is not immune and has not developed the infection. Although she may wish to minimize further exposure, leave from the workplace is controversial and is not routinely recommended. Further studies are needed in this area. (III-B) 4. If a recent parvovirus B19 infection has been diagnosed in the woman, then referral to an obstetrician or a maternal-fetal medicine specialist should be considered (III-B). The woman should be counselled regarding risks of fetal transmission, fetal loss, and hydrops. Serial ultrasounds should be performed up to 8 to 12 weeks after infection to detect the development of hydrops (III-B). If hydrops develops, referral to a maternal-fetal medicine specialist should be made and consideration should be given to fetal blood sampling and intravascular transfusion (II-2B). VALIDATION: These guidelines have been reviewed and approved by the Maternal Fetal Medicine and Infectious Diseases Committees of the SOGC, and the Council of the SOGC.

Decision Trees↗

PubMed2000

Erythrovirus B19 infection in humans.

Erythrovirus B19 (B19) previously called parvovirus B19 is the only human pathogen in the family Parvoviridae. B19 is an autonomously replicating small single stranded non-enveloped DNA of 5.5 Kb with hairpin termini through which it replicates, when the cells are in the S-phase. Virus host interactions are mediated through the capsid protein VP2 attaching to P antigen receptor expressed on certain host cells, which imparts narrow host and tissue tropism. It affects the progenitor red cells, megakaryoblast, endothelial cells and a few organs like the kidney and the heart. VP1 antibodies are neutralizing, non-structural protein NS-1 exert cell cytotoxicity while NS-2 regulates replication. The virus is present world-wide. Most infections are asymptomatic but individuals with red cell defect, immune system defects or immunosuppression manifest disease, which may be persistent. In the immunocompetent host it causes erythema infectiosum in children, arthralgia or chronic polyarthritis especially in females, nonimmune hydrops foetalis, several haematological disorders and recently fulminant hepatitis in children. The virus is transmitted through the upper respiratory tract by droplets, transfusion of blood or its components (factor VIII) and transplacentally. The incubation period is 6-11 days after intranasal inoculation, in human volunteers. Detection of IgM antibodies is most important in serological diagnosis. Viral DNA can be detected by polymerase chain reaction (PCR) or hybridization procedures in patients sera or infected tissues. Intravenous immunoglobulin can be used in the treatment as well as in prophylaxis. In view of its increasing association with a wide variety of clinical diseases, a closer look in its biology, host virus interactions and evaluation of VP1 and VP2 recombinant proteins as B19 vaccines are areas which need the urgent attention of parvovirologists, epidemiologists and clinicians.

DNA, Viral↗

PubMed2005

The seroprevalence of parvovirus B19 infection among to-be-married girls, pregnant women, and their neonates in Shiraz, Iran.

Erythema infectiosum (fifth Disease) is the major clinical manifestation of human parvovirus B19 (HPV B19) infection. HPV B19 is known to be associated with adverse effects on fetuses such as hydrops fetalis, aplastic anemia, intrauterine fetal death, and chronic anemia in immunocompromised individuals. The objective of this study was to assess seroprevalence to HPV B19 in three different groups in Shiraz, Iran. The first group included 91 to-be-married girls. The second group included 184 pregnant women and the third group consisted of 184 neonates, who were born to the women in the second group. Specific IgG and IgM antibodies to HPV B19 were measured using ELISA technique. Results showed that the prevalence for IgG to HPV B19 was 56 (61.5%), 127 (69%), and 127 (69%) for the first, second, and third groups, respectively. Overall, 183 out of the 275 (66.5%) women of childbearing age had IgG to HPV B19. The seroprevalence for IgM to HPV B19 was 2.2% for the second group. There was no detectable IgM in umbilical cord sera or in the first group blood samples. In conclusion, approximately one-third of individuals in the study who were of childbearing age were at risk for primary HPV B19 infection.

Adolescent↗

PubMed1991

Fifth disease and other parvovirus B19 infections.

Parvovirus B19 is the etiologic agent in three diseases with clinically different presentations and implications. The first and most common disease is erythema infectiosum or fifth disease. Symptoms may vary somewhat between affected children and adults. A second type of presentation occurs in infected people who require a greater than normal replacement of red blood cells, and a third infection may affect a developing fetus. Because there is no effective treatment or vaccine, physicians and nurses should conscientiously observe universal precautions to avoid acquisition of B19 infection from patients.

Disease Outbreaks↗

PubMedDate not supplied

[Acute polyarthritis during a parvovirus B19 primary infection].

Parvovirus B19 classically causes erythema infectiosum in children, febrile arthralgia or acute erythroblastopenia in adult. The clinical spectrum of adult primary infection is sometimes misleading. We report an observation of an acute rheumatoid-like arthritis following primary parvovirus B19 infection in a 42-year-old woman.

Adult↗

PubMed2006

Progressive bicytopenia due to persistent parvovirus B19 infection after immunochemotherapy with fludarabine/cyclophosphamide and rituximab for relapsed B cell lymphoma.

Human parvovirus B 19 is known as a virus causing erythema infectiosum, arthropathy, transient aplastic crisis and intrauterine fetal death. Healthy hosts are able to clear the virus within weeks after infection. There are a few reports available in the literature regarding immunocompromised renal transplant recipients with persistent infection without seroconversion. Herein, we describe a 56-year old woman with a relapse of grade II follicular lymphoma who received a combined immunochemotherapy of rituximab, fludarabine and cyclophosphamide and subsequently developed a persistent parvovirus B19 infection. In the absence of serum immunoglobulin antibodies, PCR analysis of peripheral blood and bone marrow aspirate were positive for parvovirus B19. Treatment with IVIG treatment resulted in normalization of peripheral blood counts within 7 weeks.

Anemia↗

PubMed1990

[Prevalence of anti-human parvovirus antibody in pregnant women].

Human parvovirus B19 (B19) has been shown to be associated with erythema infectiosum. Recently, it was reported that when a pregnant woman is infected with B19, the fetus in her uterus sometimes becomes hydropic and results in a stillbirth. But no epidemiologic study of pregnant women in Japan has been performed yet. We have established an in vitro propagation system of B19 virions and an assay system for detecting anti-B19 antibody by indirect immunofluorescence (IF) staining. We examined the positive rate of anti-B19 antibody among 337 normal blood donors, 329 normal pregnant women, 23 early aborted women and 24 non-immune hydrops fetalis cases by IF staining. The positive rate for anti-B19 IgG among normal blood donors increased with age. It was 22% aged 21 to 30, 44% aged 31 to 40, 65% aged 41 to 50, and 76% aged 51 to 60, respectively. Anti-B19 IgG was detected in 33% of 329 of normal pregnant women. The anti-B19 IgG positive rate was 26% in pregnant women in their twenties and 44% in those in their thirties. There was a significant difference between the two generations. The results show that more than half the women in their twenties and thirties risk B19-infection during pregnancy. Nine of twenty-three early aborted women were positive for anti-B19 antibody. Among six pregnant women who were positive for anti-B19 IgM, four delivered normal babies and the others aborted artificially or spontaneously. Anti-B19 IgG and IgM of twenty four non-immune hydrops fetalis (NIHF) were examined and four cases were found to be anti-B19 IgG positive.(ABSTRACT TRUNCATED AT 250 WORDS)

Abortion, Spontaneous↗

PubMed1989

Human parvovirus infection.

Fifth disease (erythema infectiosum) has recently been linked to human parvovirus (HPV) infection. HPV is also capable of causing aplastic anemia, arthritis and perinatal complications, including hydrops fetalis and spontaneous abortion. Clinically suspected cases of HPV infection can now be confirmed serologically. IgM antibodies peak early in the course of infection and are usually undetectable by two months. New procedures, including HPV-specific DNA probes, are being used to confirm in utero infections.

Anemia, Aplastic↗