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An erythema infectiosum-like illness caused by human parvovirus infection.

In the spring of 1980, an epidemic of an illness that resembled erythema infectiosum occurred in Manitoba, Canada. We initiated prospective epidemiologic, clinical, and microbiologic studies of this illness among elementary-school children and their families. Initial microbiologic studies failed to identify the cause of the exanthem. After a similar illness associated with serologic evidence of human parvovirus infection occurred in London, stored specimens of 12 patients with exanthem were investigated for parvovirus infection. Eleven patients had parvovirus-specific IgM antibody, as did two family contacts and a teacher with nonexanthematous illnesses, and two asymptomatic family members. None of 28 children with measles or rubella had serologic evidence of recent parvovirus infection. Human parvovirus was detected by DNA hybridization and immune electron microscopy in the serum of one patient who later had a rash and in one unaffected family contact. Parvovirus DNA was also detected in the pharyngeal specimen of the teacher who was ill but did not have a rash. We conclude that human parvovirus infection can be asymptomatic or cause a variety of clinical manifestations, including nonexanthematous illness and an illness resembling erythema infectiosum.

Adult↗

Diagnostic of parvovirus B19 infection.

An ELISA for detecting parvovirus B19 specific IgM and IgG was established using B19 viral particles as antigen derived from plasma of donors in the incubation phase of erythema infectiosum. At onset of erythema infectiosum anti-B19 IgM was detected in titers of 10(-4) and was positive up to 19 weeks. Anti-B19 IgG could be detected in clinical specimens one week after onset of erythema infectiosum and persisted in titers up to 10(-6) throughout the convalescent period. Among 3,289 sera of patients tested routinely for acute infection in the virology department in 1987-88, 478 (14.5%) were found anti-B19 IgM-positive. Among all patients with acute B19 infection, erythema infectiosum was the most frequent manifestation (304/63.6%).

Antigens, Viral↗

Persistent erythema infectiosum-like rash as a prodrome of acute lymphocytic leukemia.

A 7-year-old boy had erythema infectiosum with typical manifestations. Over more than 40 days, these lesions showed no sign of regression, and chronic anemia became progressively more severe. Electron microscopic examination performed 20 days after onset showed abnormal Sezary-like lymphocytes. Bone marrow biopsy, which was performed to evaluate the anemia, was consistent with acute lymphocytic leukemia. Persistent parvovirus B19 infection may be connected with immunosuppression. Therefore, early electron microscopic study and bone marrow biopsy may be helpful for early diagnosis of hematologic malignancies.

Anemia↗

Presumed parvovirus B19-associated retinal pigment epitheliopathy.

PURPOSE: To describe a patient with a white dot syndrome associated with acute erythema infectiosum. METHODS: A patient with a clinical history of erythema infectiosum and multifocal punctate white lesions at the level of the retinal pigment epithelium was followed up for an 8-month interval. Serum was tested for immunoglobulin M (IgM) and IgG antibodies to parvovirus B19 at the time of the initial evaluation and during convalescence using an indirect immunofluorescence antibody technique. Serial photographs and fluorescein angiograms were obtained. RESULTS: IgM and IgG antibodies to parvovirus were detected in the serum at the time of initial evaluation; IgM antibodies had disappeared but IgG antibodies persisted in serum obtained at 1-month follow-up. Fundus evaluation revealed clinical disappearance of some lesions, with increased pigmentation of others over the course of follow-up. CONCLUSION: The authors have identified an adult patient who presented with a white dot syndrome associated with acute erythema infectiosum documented by serologically proved parvovirus B19 infection.

Acute Disease↗

Human parvovirus B-19: not just a pediatric problem.

Parvoviruses have long been associated with disabling and even fatal illnesses in animals. The discovery of the human parvovirus B-19 in 1975 (1) and subsequent studies of its effects in humans identified this virus as the causative agent of erythema infectiosum ("fifth disease") in children. (2). Erythema infectiosum (EI) is a common, self-limited infectious disorder in children, easily recognized by the classic "slapped cheek" facial erythema and fine reticular rash. Only in the 1980s have further investigations linked HPV B-19 infection with more significant clinical syndromes, among which is an adult polyarthropathy. This presentation in adults is more common than is currently understood and is easily confused with other symmetric polyarthropathies. Recognition and conservative treatment of this disorder are important for the emergency physician, to whom these patients may present.

Adult↗

Conjunctivitis caused by human parvovirus B19 infection.

A 26-year-old woman with erythema infectiosum is reported. She had small faint erythemas on her extremities and congestion of palpebral and bulbar conjunctiva of both eyes. Human parvovirus B19 (B19) DNA was detected in the specimen of the conjunctiva by the polymerase chain reaction. This result suggests that conjunctivitis in erythema infectiosum may cause the B19 infection.

Adult↗

Infections caused by parvovirus B19.

Parvovirus B19 was discovered in 1974 by Cossart et al; is a single stranded unenveloped DNA virus, which virion is isometric, uniform and has icosagedral symmetry. B19 infection has been found in all countries, it is almost certainly world-wide in distribution. Infections occurs most frequently in late winter, spring and early summer months and are transmitted by respiratory route. Erythema infectiosum is the most common manifestation of human parvovirus B19 infection, is most commonly acquired between 4 and 10 years of age and at least 60% of adults are seropositive. Erythema Infectiosum is characterized by three stages of rash that involves the face and may also involves trunk and extremities. In adult patients, particularly women, arthralgia or arthritis have been associated with up to 80% of Erythema Infectiosum casually starts in the small joints of the hand. Maternal parvovirus B19 infection with or without rash, can affect fetus. Transient aplastic crisis can be caused by HPV B19 in patient who have increased rate of RBC destruction or loss. Others diseases or symptoms complexes may be associated with B19 infection in the coming years as this virus and its infections continues being an interesting field of investigation.

Adolescent↗

Parvovirus infection in children.

Human parvovirus, discovered fortuitously in 1975, is probably most often associated with an asymptomatic or mild nonspecific illness. This small DNA virus, like other members of the Parvoviridae, has a predeliction for rapidly growing cells, especially the erythroid precursor cells of bone marrow. The virus has now clearly been associated with specific clinical syndromes. Epidemiologic and experimental evidence clearly document human parvovirus as the etiologic agent of the acute aplastic crisis associated with various forms of chronic hemolytic anemia. It is also the etiologic agent of erythema infectiosum, the most frequent presentation of acute parvovirus infection in the normal child. The rash of erythema infectiosum is faint and evanescent and may not always be present or recognized, especially in black children. Frequently this infection may occur as a nonspecific viral syndrome in children or adults, accounting for the high incidence of seropositivity among adults despite an infrequent history of erythema infectiosum. The attack rate is highest among 7- to 10-year old contacts. Severe infection in the fetus has been associated with second trimester abortion. Persistent infection in an immunocompromised child has been associated with chronic aplasia of all marrow elements, suggesting the importance of a normal host immune system to contain this infection. The arthritis and arthralgia seen in older patients, especially women, occur after the viremia has ended, suggesting a possible immunologic pathogenesis for this complication. Volunteer studies have delineated the time course of the various manifestations of parvovirus infection. The ability to infect volunteers intranasally and the finding of virus in respiratory secretions suggests that this may be the route of spread to susceptible contacts.

Child↗

[Blood picture findings in children with Parvovirus B19 infections (fifth disease/erythema infectiosum)].

The human parvovirus B19 provokes erythema infectiosum ("e.i."); moreover there is a wide range of diseases due to parvovirus B19 without exanthema/rash. The erythropoietic blast cells of the bone marrow seems to be the main target cells for this virus. Therefore in cases of prenatal infection the consequences are extremely similar to fetal erythroblastosis ("non-immunological" fetal hydrops). In postnatal life the parvovirus B19 infection causes hyporegenerative phases of the erythropoiesis with anaemia after 3-4 weeks. We studied the white blood cell count (WBC), erythrocytes and thrombocytes in children suffering from (serologically well documented) parvovirus B19 infection with exanthem/"e.i." (group 1; n = 23), without exanthem (group 2; n = 46) and with unknown febrile exanthematous rashes (group 3; n = 76). We did not find any characteristic data in the WBC for a diagnosis of parvovirus B19 infection. However we have for the first time documented a significant thrombocytopenia in "e.i." (group 1) not found in group 2. The thrombocytopenia appears earlier than the anaemia, because the lifespan of thrombocytes is considerably shorter than that of erythrocytes. These data suggest that parvovirus B19 attacks not only "erythropoietic" blast cells but also immature bone marrow cells, which are later responsible for the thrombocytopoiesis.

Adolescent↗

Human parvovirus B19 infection in blood donors.

Using an immunodiffusion assay, we tested all of the blood units donated at the Fukuoka Red Cross Blood Center from June 1991 to July 1994 for B19 antigen. Over this 3-year trial period, we detected 16 viremic cases out of approximately 560,000 blood donors. Interestingly, most of the viremic donors (15 out of 16) were detected between February 1992 and January 1993, which coincided with a local erythema infectiosum epidemic in the Fukuoka area (December 1991 to August 1992). In particular, we detected 4 cases of viremia in March 1992, which was the peak of the erythema infectiosum epidemic. The incidence of B19 viremia in this peak period was approximately 1/4,000. The viremic donors ranged in age from 17 to 45 years, and most (11/16) were between 31 and 39 years old. By ELISA, using virus particles purified from viremic donor plasma as antigen, we analyzed the prevalence of B19-specific antibody among blood donors. The antibody-positive rate was approximately 40% in donors 16-30 years old, gradually increased in middle age, and reached a peak of 92% in donors more than 61 years old.

Adolescent↗

Human parvovirus B19 infection associated with acute hepatitis.

BACKGROUND: Human parvovirus (HPV) B19 infection produces a range of clinical manifestations including erythema infectiosum in children. Here we describe seven children who had acute hepatitis with HPV B19 infection. METHODS: Hepatic dysfunction was noted in three children referred to our hospital during the course of erythema infectiosum caused by HPV B19 infection diagnosed by ELISA and PCR. The role of HPV B19 in the pathogenesis of hepatic involvement was investigated retrospectively by PCR assay of stored serum samples from 773 patients admitted to our hospital. FINDINGS: 15 patients admitted to our hospital from January, 1991, to June, 1992, were HPV B19 DNA positive, of whom four had acute hepatitis of unknown origin. These four patients were aged between 7 months and 5 years. Of the seven patients, infection with hepatitis A, B, or C viruses or Epstein-Barr virus was ruled out in six by virological examinations. INTERPRETATION: Epidemiological evidence suggests that HPV B19 can be the cause of acute hepatitis.

Acute Disease↗

Slapped cheek disease. How it affects children and pregnant women.

BACKGROUND: Slapped cheek disease, otherwise known as erythema infectiosum (EI) or 'fifth disease', is a common cause of fever and rash in children. OBJECTIVE: The clinical features in children, and the implications for pregnant contacts will be discussed in this article. DISCUSSION: Erythema infectiosum is usually a mild self limiting illness in children. Patients are unlikely to be infectious after the rash and other symptoms are present, and children do not need to be excluded from school or childcare. Infection in pregnant women under 20 weeks gestation can lead to miscarriage or hydrops, but in 50% of cases the fetus is unaffected. Pregnant women who are IgM positive require appropriate specialist referral and serial ultrasounds.

Child↗

[Human parvovirus B19 infection in a child suffering from chronic arthritis].

The pathogenicity of the human parvovirus B19 has been disclosed in the last two decades. Different syndromes (erythema infectiosum or hydrops fetalis) can be produced by this virus as well as aplastic crisis in patients with haemolytic anaemia. It is a common infection both in adults and in children. The frequency of joint symptoms in erythema infectiosum is about 8% in childhood but tenfold of it in the adults. However, the arthropathy could be the only symptom without constitutional complains or rash. The joint problems used to be solved after some weeks in most cases but occasionally they could keep for some months or years. The disease is thought to be rheumatoid arthritis if the possibility of a parvovirus B19 infection has not been considered. In this paper the authors present a case report of a 14 years old boy with fever of unknown origin, skin eruptions and arthritis. On that connection, they discussed the recent knowledge about the human parvovirus B19 and refer to its importance in differential diagnosis of joint problems.

Adolescent↗

Fifth (human parvovirus) and sixth (herpesvirus 6) diseases.

Fifth (erythema infectiosum) and sixth (roseola infantum) diseases are common rash illnesses of childhood that have long been recognized in clinical medicine. The discovery of the viruses that cause these illnesses has revealed relationships with other syndromes. Primary infection with the agent of erythema infectiosum, human parvovirus B19, is associated with transient aplastic crisis in hemolytic anemia, arthropathy in adults, chronic anemia in immunocompromised patients, and nonimmune fetal hydrops in pregnant women. The only documented illness associated with primary infection with human herpesvirus 6 is roseola or exanthema subitum in young children. However, reactivated infections in adults and immunocompromised patients may be associated with serious illness such as encephalitis/encephalopathy, and bone marrow suppression leading to transplant failure or graft-versus-host disease. Diagnostic studies for both viruses have been limited, although reliable serologic tests for human parvovirus B19 have recently become available. Diagnosis of human herpesvirus 6 remains problematic, because current tests cannot differentiate primary from reactivated disease. This is more of an issue for the putative relationship of these viruses to more chronic conditions, such as rheumatologic disease for human parvovirus B19 and multiple sclerosis for human herpesvirus 6. The relationship between the viruses and these conditions remains controversial, and better diagnostic tests and further information on viral pathogenesis for both viruses are required in order to make a reliable judgment in this regard.

Adolescent↗

[Responsiveness of a new parvovirus B19 antigen produced in baculovirus expression system to B19-specific IgG and IgM antibodies in every epidemic, 1968, 1980, 1987 and 1992 in Japan].

A new recombinant parvovirus B19 antigen was tested whether it was responsive to human serum antibodies in every epidemic year of erythema infectiosum for 25 years, because wild strains of B19 parvovirus were changeable genetically. The antigen was empty particles of both B19-VP1 and VP2 produced in baculovirus expression system. Specimens were 21 sera in 1968, 19 in 1980, 44 in 1987 and 33 in 1992, derived from 67 patients with erythema infectiosum, fever and/or non-specific exanthem and aplastic crisis in persons with hereditary spherocytosis. Each patient had been confirmed of B19 parvovirus infection by other methods as radio immunoassay and/or enzyme-linked immunosolvent assay for B19-IgG and IgM using other antigens and by detection of B19-genome DNA using the polymerase chain reaction. Days of the illness of every serum were confirmed including before infection to 216 days after onset. Sera from 23 patients with measles, Kawasaki disease and rubella were selected for controls, and those patients who had not been infected with B19 parvovirus. Tests were carried out by enzyme immunoassay, indirect method for IgG and IgM capture method. In a total of 103 specimens after onset of symptoms B19-IgG was positive in yearly specimens, and B19-IgM was also positive in all acute phase sera. B19-IgG in most of all sera was kept in peak level up to 216 days after onset. B19-IgM increased rapidly in acute phase and seemed to disappear within one to 5 months after onset. Thirty-seven specimens including 14 obtained at state before infection and 23 controls were completely negative for both B19-IgG and IgM.(ABSTRACT TRUNCATED AT 250 WORDS)

Antibodies, Viral↗

[Serological diagnosis for human parvovirus B19 infection by an enzyme immunoassay kit with recombinant antigens synthesized in a baculovirus expression system].

Propagation of human parvovirus B19 (B19) in cell cultures are not applicable to the source of viral antigens for serological assays at present. Enzyme immunoassay (EIA) kits with recombinant B19 capsids by E. coli or baculovirus expression system have been developed. We tested serum samples from the patients with erythema infectiosum and aplastic crisis by EIA kit with recombinant antigens synthesized in a baculovirus expression system (Denka Seiken Co., Tokyo, Japan). The antigens used in the kit are self-assembled recombinants containing both VP-1 and VP-2 with the same proportion as found in native B19 capsids. B19 IgM is detected by antibody capture methods and IgG by indirect methods. All of the samples were positive for B19 DNA by nested PCR. Thirty-six (97%) of the 37 patients with erythema infectiosum and all (100%) of the 4 patients with aplastic crisis were positive for B19 IgM. The EIA kit with recombinant antigens synthesized in a baculovirus expression system has proved to be reliable and useful for the diagnosis of B19 infection.

Antibodies, Viral↗

Retrospective study on the influence of human parvovirus B19 infection among children with malignant diseases.

Human parvovirus B19 (B19) is a known cause of erythema infectiosum (fifth disease) and aplastic crisis in patients with hemolytic anemias. When patients with malignant diseases are infected by B19 during chemotherapy, erythroid suppression of bone marrow sometimes occurs. We performed a retrospective investigation of B19 infection among 95 children with malignant diseases in our hospital during the past 14 years. By the method of dot blot hybridization, 9 of 95 patients were found to be positive for B19 DNA during chemotherapy. All 9 patients had reticulocytopenia at the time B19 DNA was detected in their serum samples. Neutropenia and thrombocytopenia were not found. Seven of them had only transient reticulocytopenia. Serum samples from 2 other patients were positive for B19 DNA for a longer time. They suffered from persistent anemia for about 2 and 13 month, respectively. The years when B19 DNA was detected from the 9 patients corresponded to the prevalence of erythema infectiosum in Japan.

Child↗

Two family members with a syndrome of headache and rash caused by human parvovirus B19.

Human parvovirus B19 infection can cause erythema infectiosum (EI) and several other clinical presentations. Central nervous system (CNS) involvement is rare, and only a few reports of encephalitis and aseptic meningitis have been published. Here, we describe 2 cases of B19 infection in a family presenting different clinical features. A 30 year old female with a 7-day history of headache, malaise, myalgias, joint pains, and rash was seen. Physical examination revealed a maculopapular rash on the patient's body, and arthritis of the hands. She completely recovered in 1 week. Two days before, her 6 year old son had been admitted to a clinic with a 1-day history of fever, headache, abdominal pain and vomiting. On admission, he was alert, and physical examination revealed neck stiffness, Kerning and Brudzinski signs, and a petechial rash on his trunk and extremities. Cerebrospinal fluid analysis was normal. He completely recovered in 5 days. Acute and convalescent sera of both patients were positive for specific IgM antibody to B19. Human parvovirus B19 should be considered in the differential diagnosis of aseptic meningitis, particularly during outbreaks of erythema infectiosum. The disease may mimic meningococcemia and bacterial meningitis.

Adult↗