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PubMed1993

Perinatal infections.

Information concerning the most recently discovered infections with perinatal implications is constantly expanding. Hepatitis C virus is responsible for the majority of cases of sporadic and transfusion-related non-A, non-B hepatitis. Its prevalence in the general obstetric population is approximately 2%, but it is much higher in intravenous drug users and recipients of blood transfusions. The risk of vertical transmission is probably small (approximately 4.5%), but mothers coinfected with hepatitis C virus and human immunodeficiency virus type 1 are at higher risk of transmitting infection, possibly as a result of higher levels of viremia. Parvovirus B19 infection can jeopardize the fetus in approximately 9% of cases, leading to profound anemia, followed by hydrops and death. B19 has not been proven to be teratogenic, but survivors have a greater risk of in utero growth retardation. Cytomegalovirus remains the most common cause of congenital infections, and the fetal effects of primary maternal infection during gestation can be devastating. Recurrent infections carry a much lower risk of vertical transmission. Prenatal diagnosis is feasible and reliable. The factors affecting the vertical transmission of human immunodeficiency virus type 1 have been further delineated, and new avenues of research have been opened.

Cytomegalovirus Infections↗
PubMed1993

Has percutaneous umbilical blood sampling improved the outcome of high-risk pregnancies?

PUBS offers distinct advantages to the perinatologist in the management of the high-risk pregnancy. Improvement in outcome has clearly been attained in the severely anemic fetus, for example, whereas fetal blood sampling has also led to great advances in both diagnosis and treatment of many other perinatal abnormalities. The exact role for PUBS in the management of problems such as intrauterine growth retardation and the fetus at risk for thrombocytopenia in ITP remains controversial. It is quite evident, however, that overall PUBS offers tremendous aid to the perinatologist in management of the high-risk pregnancy, with future promise for even greater application.

Blood Transfusion, Intrauterine↗
PubMed1993

[Human parvovirus B19 infection in patients with hematologic disorders on chemotherapy].

We described two cases having erythroid hypoplasia and pancytopenia, respectively, caused by human parvovirus B19 (PVB19) infection on chemotherapy. The first patient was a seven-year-old boy with Non-Hodgkin's lymphoma. He has obtained complete remission with LSA2L2 protocol, but, immediately after this remission, he suddenly developed high fever, erythema on cheeks and severe anemia without reticulocytes. We concluded that the cause of anemia and other symptoms were due to PVB19 infection because PVB19 DNA in his serum was detected by dot blot hybridization and polymerase chain reaction, although specific antibodies to PVB19 remained absent. He received gamma-globulin intravenously (200mg/kg/day for 5 days). The fever and erythema were improved promptly, but viremia and anemia lasted a few weeks and the specific antibodies to PVB19 were negative for about two months thereafter. The second patient was a nine-year-old boy with common ALL in remission. Pancytopenia suddenly occurred under maintenance therapy. Because IgM to PVB19 was detected in his serum, the patient was diagnosed to have temporary pancytopenia due to PVB19 infection. In conclusion, it is important to confirm specific antibodies and PVB19 DNA in serum when anemia or pancytopenia of unknown cause occurs in immunocompromised patients receiving chemotherapy.

Anemia, Aplastic↗
PubMed1993

[Transient pure red cell aplasia in an adult with acute parvovirus B19 infection: observation of PVB19 DNA by polymerase chain reaction, viral antibody and erythroid cells in the bone marrow].

A 35-year-old female was referred to our hospital for fever and anemia. Physical examination was unremarkable. Complete blood count revealed microcytic hypochromic anemia and reticulocytopenia. The bone marrow cellularity was normal. Some giant pronormoblasts were seen but other erythroid cells were absent. No stainable iron was seen. Parvovirus B19 (PVB19) DNA was detectable by polymerase chain reaction. Anti-PVB19 IgM-antibody was also positive in the serum on admission. Antibodies against rubella, measles, mumps, EB virus and HBs were negative and HBs antigen was also negative. Thus the diagnosis of iron deficiency anemia complicated with pure red cell aplasia secondary to PVB19 infection was made. The PVB19 DNA was still positive on days 6 and 11, suggesting that PVB19 virus persists as long as 3 weeks after the onset of PVB19 infection. However, the erythroid cells had recovered by day 6 after admission suggesting that the development of IgM antibody successfully protected the erythroid cells from infection by the residual PVB19. Hence, careful observation for PVB19 DNA and the antibody may be necessary if immunodeficient patients developed anemia of unknown etiology.

Acute Disease↗
PubMed1993

[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↗
PubMed1995

[Cardiac involvement in fetal parvovirus B19 infection].

The review of 15 cases of cardiac involvement demonstrate the cardiac tropism of the human parvovirus B19. Ten of these cases were collected from fetuses during second trimester of maternal-fetal infections. In situ hybridisation detects viral DNA sequences in the nucleus of infected myoblasts. Myocarditis is the most frequent histological damage. Cardiac failure, secondary to myocarditis, may occur in the absence of fetal anaemia. When the fetus is deeply anaemic, like usually in cases of hydrops, damages of the cardiac tissues might hamper the reactional increase of cardiac output; therefore, they might account for the poor prognosis of parvovirus B19 fetal hydrops in the second trimester of pregnancy, despite transfusional therapy attempts in the third trimester.

Erythema Infectiosum↗
PubMed1995

Successful treatment of parvovirus B19 infection and red cell aplasia occurring after an allogeneic bone marrow transplant.

Chronic parvovirus B19 infection in the immunocompromised host may cause severe anaemia secondary to failure of erythropoiesis. This has been previously documented in patients with the Acquired Immune Deficiency Syndrome (AIDS), congenital immunodeficiencies and in children with acute lymphoblastic leukaemia during maintenance chemotherapy. We describe persistent parvovirus infection in a 14-year-old boy after HLA-matched sibling allogeneic bone marrow transplantation for acute lymphoblastic leukaemia in second remission.

Adolescent↗
PubMed1995

[Parvovirus B19 (PV-B19) and the human diseases it causes].

The author reviews the discovery of parvovirus B19, its characteristics, epidemiology, clinical and hematological features of acute and chronic forms of the infection in children and adults, diagnostic techniques, treatment of most severe forms.

Diagnosis, Differential↗
PubMed1995

[The first case in Japan of unstable hemoglobin, Hb Buenos Aires [beta 85 (F1) Phe-->Ser], with parvovirus B19 infection (first case in Japan)].

A 9-year-old girl was admitted to Mie University Hospital June 25, 1992, complaining of fever, skin rash and pallor. Physical examination revealed anemia and hepatosplenomegaly. Laboratory findings showed normocytic normochromic anemia, increased reticulocyte counts and remarkably decreased haptoglobin level. Red blood cells had no morphological abnormality. Bone marrow examination showed erythroid hyperplasia without abnormal cells. Hemoglobin electrophoresis showed an abnormal band. The amino acid structure and sequence of the abnormal hemoglobin was determined to be an unstable hemoglobin, Hb Buenos Aires [beta 85 (F1) Phe-->Ser]. Sequence of genomic DNA and cDNA was compatible to Hb Buenos Aires. Parvovirus B19 infection was thought to have caused severe anemia due to hemolytic crisis in this patient because its IgM antibody was positive on admission. She recovered soon without any treatment and has been followed in the outpatient clinic. Her parents and brother showed no hemoglobin abnormality.

Base Sequence↗
PubMed1995

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↗