[Aetiological studies on erythema infectiosum].
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Erythema↗
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[An adult case of transverse myelitis with erythema infectiosum].
We reported an adult case of transverse myelitis with erythema infectiosum. A 33-year-old female was admitted to Kyoto University Hospital because of a weakness in the lower extremities and "cloth-wearing" sensation of the trunk and legs. One month before admission, she became febrile and developed a symmetrical erythema on the extremities. At the same time she noticed a slight weakness of the legs and numbness in her fingers and toes, which disappeared next few days. A week later, she again developed a fever, severe weakness of the legs and "cloth-wearing" sensation on the trunk, and erythema appeared on the cheek. Physical examination on admission revealed a weakness and hyperreflexia in the extremities, in particular, knee and ankle jerk, and hypesthesia of the trunk and legs below the level of Th6. Cerebrospinal fluid (CSF) examination revealed 181/mm3 cells (mononuclear cell dominant) and 30 mg/dl protein. Magnetic resonance imaging, CT and electrophysiological studies indicated no abnormalities. IgM antibody against human parvovirus (B19) was detected in the serum and CSF. She was diagnosed as transverse myelitis with parvovirus infection and was medicated with prednisolone 40-60 mg/day, and improved gradually with the residua of a mild weakness of the legs and hypesthesia on the trunk between the level of Th6 and Th10.
Adult↗
Neonatal erythema infectiosum.
A report is presented of a patient with neonatal erythema infectiosum who developed petechiae, transient thrombocytopenia and transient cardiac failure due to transplacental transmission of human parvovirus B19 (HPV B19) infection. It is suggested that the thrombocytopenia was caused by platelet-associated IgG produced by the patient, and that the cardiac failure may have been caused by direct entry of HPV B19 into the cardiac tissue.
Adult↗
Erythema infectiosum in a village primary school: clinical and virological studies.
In a questionnaire response to an outbreak of erythema infectiosum in a village primary school, 55 (46%) of the 121 pupils reported an illness with rash. Three of the 12 members of staff also developed a rash. Onset in most affected children was indicated by the classical ;slapped cheek' appearance of erythema infectiosum with subsequent spread of the rash to the extremities. However, in 17 (35%) of 49 children who provided additional clinical data, the rash spread either in the reverse direction or not at all. Nineteen children (39%) reported recurrence of the rash.Serological studies confirmed that human parvovirus was the cause of the outbreak. Forty-six (44%) of 104 children investigated had significant levels of virus-specific immunoglobulin (lg)M and/or lgG antibodies consistent with recent infection. Most infections occurred in older children. Human parvovirus infection was also confirmed in five of the 12 adults. These studies revealed a substantial number of subclinical episodes - 14 (22%) of 64 subjects who remained well had serological evidence of recent infection with human parovovirus. Significantly, 43 individuals (37% of those investigated) remained seronegative despite frequent exposure to infection within the school. This finding, together with the observed temporary interruption of the outbreak which coincided with school holidays substantiates the view that human parvovirus has a relatively low infectivity and requires close person-to-person contact for its transmission.
Adult↗
[Infection with parvovirus B19: typical course of erythema infectiosum and its complications].
Severe chronic anemia, transitory aplastic crisis (TAC), and lethal hydrops fetalis may be due to an infection with parvovirus B19 i.e. the causative agent of erythema infectiosum. 80% of the patients infected with B19 develop clinical symptoms and typically show the picture of erythema infectiosum--as one of our case reports (daughter) is going to illustrate. Part of the cases, however, take a course without the characteristic slapped-face rash; here we frequently find acute arthritis and arthralgia, as well as fever and rubella-like or purpura-like rashes, predominantly on the smaller joints (mother). In immuno-compromised patients, those with hematologic disorders, as well as in pregnancy, the diseases may take a life-threatening course. In the cases without the characteristic rash, the diagnosis has to be proved by the detection of either antibodies against parvovirus B19 or the virus itself; however, the test kits required are not readily available. Since there is no generally accepted treatment of the infection, as yet, the most important measure on the medical side is the prevention of the infection by means of isolation and other procedures. The problem we face here, however, is the fact that the danger of infection is highest during the viremic phase of the disease, when the patient is still asymptomatic.
Antibodies, Viral↗
Human parvovirus B19 arthropathy in two adults after contact with childhood erythema infectiosum.
An arthropathy has been recently described in association with human parvovirus infection (HPV-B19). Human parvovirus B19 has also been implicated as the etiologic agent in erythema infectiosum, a childhood exanthem that may occur in adults in association with joint manifestations. In this study, two adults are described, in whom an acute arthropathy and rash developed after contact with children with erythema infectiosum.
Adult↗
Erythema infectiosum--the fifth disease: case report.
A case of erythema infectiosum (fifth disease) is discussed. As it is a childhood illness that initially presents with a facial rash, the oral and maxillofacial surgeon will often be the first practitioner to diagnose this interesting, but benign, disease.
Cheek↗
Erythema infectiosum ("slapped cheeks" syndrome): a little-known entity.
Erythema infectiosum is an uncommon, benign, self-limited disease with a distinctive clinical picture, occurring mainly in children. An inquiry showed that most doctors who deal with children are not familiar with it, and the disease is therefore seldom diagnosed. As recognition has connotations which may sometimes be important, the disease is briefly reviewed, and three cases are reported.
Child, Preschool↗
[Scapula alata as a complication of infection with human parvovirus B19 (erythema infectiosum)].
This article reports a case of a 38-year-old woman suffering from erythema infectiosum (slap-cheek disease) complicated by arthritis and severe brachial plexus neuritis resulting in scapula winging.
Adult↗
[Erythema infectiosum].
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Erythema Infectiosum↗
[Erythema infectiosum in pregnancy. A follow-up of children after 2 years].
During an epidemic of erythema infectiosum in Norway 1984-86, infection with human parvovirus B19 was diagnosed in 22 pregnant women by detection of specific IgM antibodies. Information about the outcome of pregnancy was obtained in 19 cases. 17 women delivered live babies. In two cases, spontaneous abortion occurred in week 16 of the pregnancy. In 11 cases, cord blood and serum samples were obtained from the children at an age of between six and 15 months. No specific IgM antibodies were found in cord blood. Clinical information on 16 children at two years of age revealed normal growth and development in 15 cases. One child was hyperactive and showed delayed language development. B19 IgG antibodies were detected in three children with normal growth and development. According to our findings, there was no association between infection with human parvovirus B19 in pregnancy and congenital abnormalities.
Child Development↗
Erythema infectiosum: an epidemic with a probable posterythema phase.
An outbreak of erythema infectiosum occurred in an Ontario school in the spring of 1983. This benign disease ran a 19-day course in the index case and appeared in most of the child's grade 1 classmates. A few adults were also affected. In eight children flu-like symptoms persisted or occurred suddenly and lasted for several days after the rash had vanished. A plan of management that involves communication with parents, teachers and the public health service is outlined for the general practitioner.
Child↗
[The fifth disease--erythema infectiosum. Parvovirus infection in a family group].
The causative agent of Erythema Infectiosum (EI), also known as the fifth disease, has been shown to be Human Parvovirus B19. This virus may also cause foetal damage, resulting in spontaneous abortion, hydrops foetalis or stillbirth. Three cases of Human Parvovirus infection in a family are presented. The child has a classical rash. The father had a rash and joint-symptoms, which is common in adults. The mother had a subclinical infection, which is seen in the majority of EI cases. As the woman was pregnant, ultrasonic tests were carried out frequently to detect possible hydrops foetalis. This pregnancy resulted in a healthy full term infant weighing 3,610 g.
Adult↗
Prolonged parvovirus b19 viremia in spite of neutralizing antibodies after erythema infectiosum in pregnancy.
OBJECTIVE: To check the clearance of parvovirus B19 in the course of the development of neutralizing antibodies after Erythema infectiosum in pregnancy. METHODS: Parvovirus B19 serology (Parvovirus B19 IFA IgG, IgM Antibody Test Kit, Biotrin, Ireland and Immunoblot RIDA Blot Parvovirus B19, R-Biopharm, Germany) and polymerase chain reaction (PCR Parvovirus B19, Roche Diagnostics, Switzerland) were performed in eight predelivery sera, one cord blood sample and one serum 2 months after delivery. RESULTS: Acute parvovirus B19 infection in pregnancy was diagnosed by seroconversion in the IgM and IgG antibody class and detection of viral DNA by PCR. Despite the presence of neutralizing antibodies, PCR gave positive results in all subsequent sera including the cord blood sample and the post-delivery sample 7 months after primary infection. Neonatal examination on the 4th day after delivery was normal and no clinical sign of intrauterine infection was noted. CONCLUSIONS: Prolonged parvovirus B19 viremia infection can be seen in spite of neutralizing IgG antibodies and in IgM negative patients. Therefore, the presence of IgG antibodies in the absence of IgM antibodies should not always be interpreted as a past infection. The infectivity of patients with persistent parvovirus B19 infection requires further studies.
Adult↗
Human parvovirus B19 specific IgG, IgA, and IgM antibodies and DNA in serum specimens from persons with erythema infectiosum.
To determine the diagnostic use of different markers of acute parvovirus B19 infection, serum specimens obtained from 128 persons with erythema infectiosum were tested for specific immunoglobulin G (IgG), IgA, and IgM antibodies by capture enzyme immunoassay (EIA) using Chinese hamster ovary (CHO) cell-expressed B19 antigen, and tested for circulating B19 DNA by polymerase chain reaction (PCR). A significant rise in specific IgG and IgA antibodies was detected in 87% and 77%, respectively, of persons from whom acute- and convalescent-phase serum specimens were available. Specific IgA antibodies were detected in single serum specimens from 90% of cases and were present in 22 (18%) of 120 persons from a control group without a history of recent exposure to B19. Specific IgM antibodies were detected in 97% of cases and one person (1%) from the control group. B19 DNA was detected in 94% of cases and was absent in 20 persons from the control group positive for both IgG and IgA antibodies. Serum specimens obtained between 4 and 6 months after onset of illness from six additional persons were also tested. All had specific IgG antibodies, four (67%) had IgA, five (83%) had IgM, and none had detectable B19 DNA. Our data indicate that 1) specific IgA antibodies are too persistent to be a useful indicator of recent B19 infection; 2) specific IgM antibodies are the most sensitive indicator of acute B19 infection in immunologically normal persons but can persist up to 6 months; and 3) B19 DNA can often be detected up to 2 months after onset of illness even in immunologically normal hosts and might be a useful adjunct test for diagnosis of acute B19 infection.
Adolescent↗
Erythema infectiosum and other parvovirus B19 infections.
The human parvovirus B19 has been identified as the causative agent in several diseases, including the benign childhood condition erythema infectiosum (fifth disease), a polyarthropathy that occurs in adults, aplastic crisis and hydrops fetalis. The virus has also been associated with numerous other hematologic, neurologic and rheumatic conditions. Except for the potential of neonatal death due to fetal hydrops, the prognosis of patients with parvovirus infection is generally good. The diagnosis of B19 infection may be established on clinical grounds but often requires confirmation with serum antibody testing. Treatment strategies may include supportive care, analgesic medications, transfusions with red blood cells or administration of intravenous immunoglobulin, depending on the clinical circumstances.
Animals↗