A Virological Investigation of Transient Synovitis. 354

Abstract

It is believed that Transient Synovitis may be caused or preceded by a viral infection. OBJECTIVE: This study's objective is to evaluate children with Transient Synovitis (TS) for serological evidence of Parvovirus B-19(PVB) and Human Herpesvirus 6 (HHV6) infection. DESIGN/SETTING: Prospective patient series in an urban children's hospital emergency department. PATIENTS: 20 children ages 15 months to 6 years (12 boys) diagnosed with TS. INTERVENTIONS: Clinical data were collected and acute PVB and HHV6 IgG and IgM titers were performed on all patients. Ten patients returned 4-6 weeks later for convalescent titers. RESULTS: Mean age was 4.1 years. Prodromal symptoms within a week of presentation were noted in 50% of patients, most commonly fever (25%) and upper respiratory infection (20%). Mean sedimentation rate was 11 mm/hr (range 2-22), and mean white blood count was 11,000/ul (range 5-22). Parvovirus results: no patients had an elevation of acute or convalescent IgM titers, and none of the 10 returning for convalescent titers had a significant rise of IgG. For HHV6: no patients had elevated acute or convalescent IgM titers. A majority (80%) had elevated acute HHV6 IgG reflecting immunity from previous infection. No patients demonstrated a significant rise in convalescent IgG titers. CONCLUSION: Although many patients with Transient Synovitis have a history suggestive of a recent viral illness, there is no serological evidence in this series for recent Parvovirus B-19 or Human Herpesvirus-6 infection.