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PubMed2002

1: Infections in pregnant women.

Some infections are more serious in pregnant than non-pregnant women because of the potential for vertical transmission to the fetus or infant (eg, varicella, rubella, cytomegalovirus infection, toxoplasmosis and listeriosis). Pre-pregnancy or routine antenatal screening for presence of, or susceptibility to, some of these infections and appropriate management can prevent adverse fetal or perinatal outcomes; screening should include rubella IgG, hepatitis B surface antigen, serological tests for syphilis and HIV antibody. If certain other vertically transmissible infections are suspected because of a positive antenatal test result, confirmatory tests for maternal and, if indicated, fetal infection are essential before intervention is considered (eg, cytomegalovirus infection). For some vertically transmissible infections that are not readily preventable, appropriate management of maternal infection can reduce fetal damage (eg, toxoplasmosis).

Adult↗
PubMed1999

Fifth disease in a small rural community. What are the consequences?

OBJECTIVE: To characterise the implications of an outbreak of human parvovirus in a small community. METHOD: A community survey was conducted over a period of 18 months in a small rural town in Western Australia with a population of approximately 4300 people. Outbreak cases were assessed by the single general practice in the town. Notification of the survey was placed in both the schools and by advertisement in the local paper. Survey questionnaires distributed to community members were returned on a voluntary basis. After 12 months repeat surveys were sent to all adults who had responded to the initial survey. RESULTS: Eighty-eight definite and 14 equivocal cases were identified as part of the outbreak, which occurred between late July 1994 and February 1995. Serological testing which confirmed human parvovirus B19 infection was available for 29% of cases. The highest attack rate was in the 5-9 year age group. One-third of cases were adults and 9% of them developed symptoms lasting longer than 6 months. Transient anaemia almost certainly due to parvovirus infection was identified in one adult women during the course of the outbreak. No pregnant woman suffered any adverse fetal outcome as a result of human parvovirus infection. CONCLUSION: In an outbreak of parvovirus, children will be most commonly affected although adults can develop polyarthralgia/arthritis which may persist for several months and some may suffer transient anaemia. Pregnant women are potentially at risk of the development of fetal hydrops and fetal death, but advice to them can be based on the estimate of a less than 1% risk of adverse fetal outcome due to parvovirus infection.

Adolescent↗
PubMed1999

[Human parvovirus B19-induced aplastic crisis in a patient treated with fibrin sealant].

A 42-year-old woman underwent a myomectomy on March 31, 1998. On the 10th postoperative day, leukopenia and reticulocytopenia were observed. Bone marrow aspiration revealed severe erythroblastopenia with giant proerythroblasts, suggesting a recent parvovirus infection. Both anti-parvovirus B19 IgM antibody and IgG antibody seroconversion was observed, and human parvovirus B19 DNA was detected by polymerase chain reaction (PCR) methods. The hematologic data on the patient rapidly improved thereafter. It was determined that acute-phase serum had inhibited CFU-E and BFU-E derived colony formation. Based on these findings, parvovirus B19-induced aplastic crisis was diagnosed. Fibrin sealant, which is a typical hemostatic agent produced from blood, had been during the operation. Human parvovirus B19 DNA was detected in the fibrin sealant by PCR. Our case report documents the transmission of human parvovirus B19 by fibrin sealant.

Acute Disease↗
PubMedDate not supplied

[Parvovirus B19 infection].

In 1975, during blood screening for hepatitis B, Cossart et al. discovered the human parvovirus B19 (B19). It is a small, single strand DNA virus of the Parvoviridae family. This virus is widespread with 40-80% of adults showing evidence of infection. It is found in the respiratory secretions of viraemic patients and direct contact has been suggested as the most likely mode of transmission. Parenteral transmission is common during treatment with clotting-factor concentrates, but rarely occurs during transfusion with single donor products. Although B19 usually causes a self-limited illness, complications of infection can be severe and at times life threatening. In pregnant women, infection can lead to spontaneous abortions and hydrops fetalis and, in patients with haemolytic anaemias or in immunocompromised individuals, can induce aplastic crisis and chronic anaemias. The diagnosis can be made by indirect (testing for B19 antibodies) or direct methods (detecting B19 viremia). There are no vaccines or specific therapy currently available. Contact isolation is recommended for hospitalized patients.

Erythema Infectiosum↗
PubMed1999

[Hereditary hemoglobin H disease in Japanese siblings diagnosed by human parvovirus B19 infection].

Hereditary hemoglobin H (HbH) disease was diagnosed in 2 Japanese sisters who presented with aplastic crisis following acute human parvovirus B19 (HPV B19) infection. The proband, an 8-year-old girl, developed persistent fever and pallor, and samples of her peripheral blood showed hypochromic microcytic anemia. Other laboratory data were consistent with hemolytic anemia. Fever and signs of hypochromic microcytic anemia also developed in her sister 9 days later. Cation exchange HPLC analysis of their hemoglobin revealed abnormal hemoglobin migrating faster than HbF, a finding consistent with HbH. Although they presented neither arthralgia nor skin rash, we concluded that their aplastic crisis was induced by HPV B19, because HPV B19 DNA was detected in samples of their peripheral blood by PCR analysis, and HPV B19 IgM and IgG antibody titers were elevated. A genetic analysis of the alpha-globin gene in both sisters and their parents disclosed that the father was heterozygous for alpha-Thal-2, the mother, heterozygous for alpha-Thal-1, and the proband and her sister, double heterozygous for alpha-Thal-1 and alpha-Thal-2. alpha-Thal-2 is a 3.7 kb-deletion allele.

Child↗
PubMed1999

Newer pediatric pathogens.

Newer laboratory techniques have allowed the detection of previously unrecognized microbial agents that are now pathogenic in children, as well as newly recognized manifestations of previously known pathogens. Clinical reports of these newer agents or manifestations are reviewed so that pediatricians can become familiar with these emerging infectious diseases. Physicians need to consider these organisms in the differential diagnosis in appropriate clinical illnesses.

Child↗
PubMed2000

Immunoglobulin M and G immunoblots in the diagnosis of parvovirus B19 infection.

BACKGROUND AND PURPOSE: To identify parvovirus B19 infection by means of immunoglobulin (Ig) G and IgM immunoblots among immunocompetent patients who tested negative or had low-titer B19 IgM antibodies in enzyme-linked immunosorbent assays (ELISA). METHODS: Serum samples were obtained from 20 patients with parvovirus B19 infection. Another 130 study subjects presumed to be without B19 infection (40 medical personnel and 90 prisoners) were also included. All sera from the patient and study groups tested positive for IgG or IgM with ELISA and were further evaluated using the immunoblot method. Detection of B19 DNA by nested polymerase chain reaction (PCR) was also performed on IgG and IgM positive sera. RESULTS: IgM immunoblots disclosed one false positive IgM ELISA result in the patient group and three false positive results in the study group. In the patient group, four patients were in the latter stage of antibody response to B19 infection as suggested by the low titer of anti-B19 IgM, incomplete IgM immunoblots, with only a weak viral capsid protein VP-N reaction band, and fading but still strong reaction bands on IgG immunoblots. Strong reaction bands on IgG immunoblots comparable to these four patients were found in three of the 130 study group sera. Furthermore, B19 DNA was detected in three of the four patients and one of the three study subjects by means of nested-PCR. A serum sample from one study subject showed strong IgG but no IgM reactivity to viral capsid protein VP2; nested PCR identified B19 DNA in this serum sample. CONCLUSIONS: Immunoblots and nested PCR should be applied in the diagnosis of B19 infection for patients with low-titer anti-B19 IgM tested by means of ELISA. For diagnosis of B19 infections in certain clinical entities such as chronic arthritis of recent onset and hydrops fetalis, B19 IgM antibodies may have disappeared but B19 infection can still be recognized by the intensity of the reaction bands on IgG immunoblots. The correlation between chronic B19 infection and persistence of antilinear VP2 epitopes requires further study.

Adult↗
PubMed2000

Parvovirus B19 infection in a human immunodeficiency virus-infected patient with anemia.

Anemia is generally attributed to zidovudine therapy in human immunodeficiency virus (HIV)-infected patients, although parvovirus B19 infection has been reported as a rare cause. We report on a 24-year-old homosexual man infected with HIV who presented with anemia. He had received aggressive daily antiretroviral therapy (zidovudine 600 mg, lamivudine 300 mg, and saquinavir 1,800 mg) for 2 years. At the time of admission, his CD4+ count was 10 x 10(6) cells/L. A bone marrow aspirate smear showed a marked decrease in erythropoiesis and immunocytochemical staining for parvovirus B19 was positive. Parvovirus B19 viral DNA was detected in the peripheral blood using a polymerase chain reaction-based assay. Serologic studies were positive for parvovirus B19 immunoglobulin (Ig)M antibodies, but negative for IgG antibodies. The patient was treated with packed red blood cell transfusion. Zidovudine was stopped and replaced with zalcitibine 2.25 mg daily after anemia occurred. He did not receive intravenous Ig therapy because of its cost. After discontinuation of zidovudine for 1 year, anemia persisted and the patient depended on regular blood transfusions to control the anemia. This case emphasizes that, in addition to drug-related causes, parvovirus B19 infection should be included in the differential diagnosis of chronic anemia in HIV-infected individuals.

Adult↗
PubMed2000

[Acute polyarthritis associated with parvovirus B19 infection].

We describe one female with acute polyarthritis and transitory rash. The arthritis of sudden onset, is localized in large and small joints and accompanied by significant stiffness, particularly noted in early morning. The symptoms only improvement a few with nonsteroidal anti-inflammatory drugs and the arthritis resolved within a few days. The diagnosis is based in the presence of anti-B19 IgM. The differential diagnosis of the acute polyarthritis is extensive, serological test should be made when we suspect the presence of a viral arthritis.

Acute Disease↗
PubMed2000

Evaluation of pregnant women exposed to respiratory viruses.

Prenatal patients are often exposed to respiratory viruses at home and at work. Understandably, these patients may be concerned and want immediate answers and advice from their physicians. While most women who are exposed to chickenpox are immune, serologic testing can be performed and susceptible patients can be treated with varicella-zoster immune globulin. If the prenatal patient is infected with the varicella-zoster virus, the risk of fetal manifestations is less than 2 percent. Women who have been exposed to fifth disease can undergo serologic testing to determine the likelihood of infection. If the prenatal patient becomes infected with fifth disease during the first 20 weeks of gestation, the risk of fetal manifestations is about 9 percent and includes nonimmune hydrops and death. Cytomegalovirus, which is the most common congenital infection, is generally asymptomatic in the mother. Infected fetuses have a 25 percent chance of developing early or late neurologic manifestations. The evidence of harm from other common respiratory viruses is inconsistent.

Algorithms↗
PubMed2000

A rash of exanthems. How they affect children and pregnant women.

BACKGROUND: Viral exanthems are a common problem for children, particularly during preschool years. Many of these infections have a dramatic impact on siblings, parents and other contacts. There may also be particular ramifications for pregnant contacts. OBJECTIVE: To discuss some of the most common viral exanthems affecting children, in terms of the epidemiology, clinical features, diagnosis, and the management of both the patient and the contacts. DISCUSSION: Recommendations are made for measles, rubella, parvovirus and varicella regarding immunisations, use of immunoglobulin, serological diagnosis and management of pregnant contacts.

Chickenpox↗