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[Acute vasculitis and arthritis caused by Parvovirus B 19 infection].

A 35-year old woman was admitted with fever, polyarthritis and severe vasculitis. The symptoms resolved spontaneously within a week. Two weeks later, her seven year old son developed erythema on arms and legs and the typical "slapped cheek syndrome" characteristic of erythema infectiosum. Both cases were due to acute infection with Parvovirus B 19 as demonstrated by the presence of IgM-antibodies to Parvovirus B 19. The cases are described in order to draw attention to the possibility of Parvovirus B 19 infection as the etiological agent for acute vasculitis in adults.

Acute Disease↗

Parvovirus B19 infection presenting as pre-B-cell acute lymphoblastic leukemia: a transient and progressive course in two children.

Parvovirus B19 is the causative agent of various forms of hematologic diseases such as aplastic crisis in patients with hemolytic anemia, aplastic anemia, hypoplastic anemia, and idiopathic thrombocytopenic purpura. In addition, parvovirus B19 infection may precede or be associated with acute lymphoblastic leukemia (ALL). The authors present two cases of parvovirus B19 infection and bone marrow infiltration with pre-B-cell lymphoblasts; one patients was diagnosed as having ALL, and the other patient, with neurologic findings, showed total resolution of the blastic morphology and phenotype.

Antibodies, Viral↗

[Parvovirus B19 infection--dangerous for the fetus].

BACKGROUND: Human parvovirus B19 infection is a common and usually benign disease in children, but may cause severe complications in pregnancy. We determined the proportion of the pregnant population at risk of infection and present a recent cluster of cases with fetal complications, hoping to raise the general awareness. MATERIAL AND METHODS: Five cases of fetal parvovirus B19 infection during 2001--2 illustrate the delay in diagnosis, treatment and outcome. During the same period, the number of positive and negative serological tests was noted for the catchment area and the entire country. Additionally, 206 consecutive pregnant women were tested to determine susceptibility. RESULTS: Out of the five cases of fetal complications, all had cardiac involvement, three had anaemia, and two fetuses died. Lag-time to fetal diagnosis was six, eight, and 13 weeks for those with known maternal disease. In Norway, seroconversion is similar to that found in other Nordic countries; 36 % (74/206) of the pregnant population is seronegative. In Norway, parvovirus B19 infection is more frequently reported in the January-June period. A third of the pregnant population is susceptible to infection. Early testing in cases of exposure or suspected infection in pregnancy is recommended in order to ensure appropriate follow-up and treatment.

Disease Susceptibility↗

[Rheumatologic manifestations of parvovirus B19 infection].

Rheumatologic manifestations of parvovirus B19 infection is a recent individualization. They are rather frequent and varied and meet at the young adult's. Generally, it is responsible for acute, bilateral and symmetrical arthritis, usually involving distal joints and sometimes associated to signs caused by viral infections. Prolonged articular forms were discribed but are rare being able to sometimes feign a nocive rheumatoid arthritis because of their clinical aspect and of a seropositivity. Axial manifestations were also reported. The diagnosis of the recent infection by the parvovirus B19 can be confirmed by ELISA identification of specific IgM antibodies. The mechanism of the articular manifestations is still unknown and the link between parvovirus B19 and systemic vasculitis is questioned.

Adolescent↗

[Parvovirus B9 infection in a renal transplant recipient. Diagnosis by detection of viral genome in peripheral blood].

Parvovirus B19 can produce a picture known as pure red blood aplasia in recipients of solid organ. Occasionally the viruses cause decrease of the other blood cells, and various extra-hematologic manifestations. Common diagnosis is realised by bone marrow examination. The diagnostic value of the viral genome in the blood stream is not well defined. We reported the case of a male of 17 years of age, whose diagnosis was done by repeated determinations of the viral parvovirus B19 genome in peripheral blood. It was confirmed by a biopsy of the iliac crest. The patient was treated with unspecific IgG immunoglobulins, with complete recovery from the symptoms and signs. It did not have any recurrence of the disease. This case suggests that the realisation of PCR of Parvovirus B19 in renal transplant patients with pure red cell aplasia could be of greater interest in the diagnosis and monitoring of the disease. The detection of the viral genome could avoid the administration of unnecessary blood transfusions, and possibly the realization of bone marrow biopsy.

Adolescent↗

[Lung cancer with polyarthropathy due to parvovirus B19: report of a case].

We reported a case of lung cancer with polyarthropathy induced by human parvovirus B19. A 60-year-old female with lung cancer was admitted to our hospital with polyarthropathy similar to rheumatoid arthritis. Although the abnormal accumulation of 99mTc-MDP in the bone scan film and rheumatoid factor positive were detected before operation, we diagnosed polyarthropathy induced by parvovirus B19 through the detection of parvovirus B19 IgM and B19 DNA. The joint pain gradually improved after surgical treatment for lung cancer.

Arthritis↗

Parvovirus b19 infection in HIV patient with pure red cell aplasia.

Anemia in HIV-infected patients is a common clinical manifestation. We report on a 31-year-old Thai male, who had been HIV positive for 6 years, did not harbor any opportunistic infection, and had been receiving Highly Active Anti Retroviral Therapy (HAART) for one month, and who developed severe anemia. Investigation revealed pure red cell aplasia, suspected secondary to parvovirus B19 infection. This diagnosis was confirmed by the detection of parvovirus B19 DNA in his serum. He received blood transfusions for supportive treatment and continued on HAART to improve his immune status and to resolve the anemia. This case suggests that parvovirus B19 infection should be considered as a possible cause of anemia in HIV-infected individuals.

AIDS-Related Opportunistic Infections↗

Gloves and socks syndrome associated with parvovirus B19 infection.

The spectrum of disease caused by parvovirus B19 infection ranges from asymptomatic to a serious disease. Parvovirus B19 plays a role in the pathomechanism of gloves and socks syndrome, erythema infectiosum, acute polyarthralgia, aplastic crisis in persons with hemolytic anemia, and birth defects. Gloves and socks syndrome has an acute febrile course. Painful edema of hands and feet, and numerous small confluent petechiae in the same localization are the most characteristic signs. Blisters and erosions may occur in oral mucosa. General discomfort and arthralgia accompany skin lesions. The disease tends to be self-limiting. A typical case of gloves and socks syndrome in a 36-year-old woman is reported. Serological tests disclosed the parvovirus B19 infection, confirming the causal relationship between the syndrome and this infection.

Adult↗

Hydrops fetalis caused by parvovirus B19 infection: case report and literature review.

An intrauterine parvovirus B19 infection can result in severe fetal anemia and hydrops fetalis, which can lead to death. A case of fetal hydrops, diagnosed at 31 weeks gestation, is reported Cordocentesis revealed fetal hemoglobin of 5 g/dL. Due to fetal distress 18 hours later, the baby was delivered by emergency cesarean section and died two days later. Characteristic intra-nuclear inclusions in nucleated red blood cells were found in histopathological examinations of the liver and placenta, which supported the diagnosis of parvovirus B19 infection. Literatures about parvovirus B19 infection, especially intrauterine infection, its effects on the fetus, methods of diagnosis and management, were reviewed.

Adult↗

Cerebellar hypoplasia in three sibling cats after intrauterine or early postnatal parvovirus infection.

The present report describes the case of an intrauterine or early postnatal parvovirus infection with subsequent cerebellar hypoplasia in three kittens from the same litter. Clinical examination of affected cats revealed neurologic signs indicative of cerebellar ataxia. Due to poor prognosis, animals were euthanised and submitted for necropsy. Post mortem examination demonstrated variable degrees of cerebellar hypoplasia. Histologically, brain lesions were characterised by segmental loss of the external and internal granular layer and decreased numbers of Purkinje cells. Reactive proliferation of astrocytes in the central nervous system was verified by the detection of GFAP-expressing glial cells in affected areas using immunohistochemistry. Furthermore, parvovirus antigen was detected immunohistochemically in neuronal cells of the cerebellum, but not in other parts of the brain and spinal cord or non-neuronal tissues. The present report demonstrates the usefulness of post mortem examination and detection of viral antigen by immunohistochemistry for the discrimination of neurologic disorders in feline species. Neurologic deficiencies due to cerebellar hypoplasia caused by in utero or perinatal feline parvovirus infection should be taken into consideration as differential diagnoses for ataxia in neonatal and juvenile cats.

Animals↗

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↗

[Obstructive respiratory tract diseases in children and Parvovirus B19 infections].

Acute respiratory diseases (ARD) due to parvovirus B 19 infection can be observed relative frequently in children. In 21 children (infants, toddlers and school children) we have seen acute or prolonged obstructive bronchitis/bronchiolitis (15 infants), acute subglottic laryngitis (3 toddlers) and acute asthmatic attacks (3 children of school age) in connection with parvovirus B 19 infection. Other respiratory viruses (adeno-, influenza, parainfluenza and RS-virus) could be excluded as agents causing the ARD. We suggest that parvovirus B 19 can provoke ARD with obstructive ventilatory disturbances of the upper or lower airways in children with a specific endogenous predisposition (small or unstable bronchial walls, or bronchial or tracheal mucosal hyperreactivity).

Airway Obstruction↗

[Parvovirus B19 infection as the cause of hepatitis and neutrophil granulocytosis in a 20-year old woman].

A case of Parvovirus B19 infection (erythema infectiosum) in a 20 year old woman is presented. The patient presented with fever, arthritis in one knee, neutrophil granulocytosis and biochemical evidence of hepatitis. Serological evidence of Parvovirus B19 infection was found as the only explanation of the clinical picture. Hepatitis was due to Parvovirus B19 infection as there was no serological evidence of EBV or CMV reactivation. Neutrophil granulocytosis and thrombocytosis were found and were probably due to an active bone marrow in the recovery phase of bone marrow aplasia.

Adult↗

[Cutaneous parvovirus infections: "gloves and socks" syndrome].

INTRODUCTION: Among the viral purpuric cutaneous manifestations, papular-purpuric "gloves and socks" eruptions have been lately described. The responsibility of parvovirus B19 infection has been suspected. OBSERVATION: We report two pediatric cases of papular-purpuric eruption of the extremities with a seroconversion for the parvovirus B19. One patient, a twelve-year old girl, also had cellulitic plaques. DISCUSSION: Parvovirus B19 is known for causing various cutaneous manifestations, among which erythema infectiosum as the most classical. A papular-purpuric "gloves and socks" syndrome may be individualised. Previously described in adults, this type of eruption may be prevalent in childhood.

Child↗

Human B19 parvovirus infection in an obstetric population. A prospective study determining fetal outcome.

In a prospective study of 1,967 pregnant women who were routinely screened for recent human B19 parvovirus infection, 64 (3.3%) were identified as being IgM positive. No adverse effects were documented by ultrasound in any of the fetuses. The outcome of pregnancy was favorable in 95.1% of these women, with no evidence of hydrops fetalis or any congenital abnormalities. Two neonates (3.4%) were small for gestational age, and there was one abortion. Samples of blood obtained from 20 neonates born to women with evidence of recent infection were B19 parvovirus IgM negative. Recent infection with human B19 parvovirus in pregnancy constitutes a low risk for the development of adverse fetal effects; hence, routine antenatal screening is not warranted.

Antibodies, Viral↗

B19 parvovirus-induced anemia in a normal child. Initial bone marrow erythroid hyperplasia and response to intravenous immunoglobulin.

PURPOSE: Human B19 parvovirus infection may cause severe erythroid hypoplasia in patients with an underlying hemolytic anemia. We report a case of severe parvovirus-induced anemia with initial marrow erythroid hyperplasia in a child with no underlying hematologic disorder. CONCLUSIONS: The patient's rapid hemoglobin recovery after treatment with i.v. immunoglobulin further supports this form of therapy for children with parvovirus-induced anemia.

Anemia↗

[Human parvovirus B19-induced aplastic crisis in an elderly man with intestinal hemorrhage].

An elderly man with an intestinal hemorrhage from bowel diverticulosis developed human parvovirus B19-induced aplastic crisis. A 71-year-old man noticed occasional tarry stools and at the same time showed fever, arthralgia and severe anemia. Blood counts revealed Hgb 5.3g/dl, reticulocytes 0%, and WBC 1,900/microliters. Bone marrow examination showed hypocellular marrow with rare erythroid precursors (4.8%). A few giant proerythroblasts were found in the bone marrow smears. A diagnosis of parvovirus B19 infection was made because of detection of B19-specific IgM and IgG antibodies. Parvovirus B19 infection should be carefully checked for in patients with hemorrhage as well as those with hemolysis.

Acute Disease↗

Use of digoxigenin-labelled probes for the detection of B19 parvovirus DNA in batches of blood products.

Being thermostable and non lipid-enveloped, the B19 parvovirus cannot be destroyed by the chemical and physical treatments presently used to inactivate lipid-enveloped viruses such as HIV, hepatitis C and B viruses in plasma derivatives. A polymerase chain reaction assay was used to detect B19 parvovirus DNA. Amplified products were detected through a non-radioactive technology based on the use of a digoxigenin-labelled probe. B19 parvovirus DNA was detected in 20% of the studied batches of factor coagulation concentrates and in none of the albumin batches.

Blood↗