Impact of Parvovirus B19 Viremia in Liver Transplanted Children on Anemia: A Retrospective Study.

Michael Würdinger,Annelie Plentz,Susanne Modrow

doi:10.3390/v9060149

Abstract

Acute parvovirus B19 (B19V) infection in immunocompromised patients may lead to severe anemia. However, in adult transplant recipients, B19V reactivations without anemia and low-level viremia are common. The impact of B19V in pediatric transplant patients, with high risk of primary infection, is investigated here. In a six-month period, 159 blood samples of 54 pediatric liver transplant recipients were tested for B19V DNA by quantitative real-time PCR. Viremia was correlated with anemia and immunosuppression and compared with rates in adult transplant recipients. B19V DNA was detected in 5/54 patients. Primary B19V infections were observed in four patients prior to and in one patient after transplantation. Rates of viremia were significantly higher in pediatric recipients than in adults. Prolonged virus shedding after primary infection prior to transplantation accounts for most viremic cases. Anemia was significantly more frequent in samples from viremic patients, but remained mild. In 15% of anemic samples, B19V DNA was detected. Therefore, in anemic pediatric transplant recipients, diagnostics for B19V seem reasonable.

Highlights

In immunocompetent individuals, acute parvovirus B19 (B19V) infection is a mild disease associated with transient anemia, rash and arthritis
In immunocompromised patients, cases of persisting B19 viremia with severe life-threatening chronic anemia have been reported [1,2,3]. Those clinical courses occur in acute infections with high B19V DNA levels after solid organ transplantation, whereas B19V reactivations are more likely in adult transplant recipients and lead to low-level DNAemia, which is not associated with notable anemia [4,5]
Children are at higher risk of a primary B19V infection due to the low level of immunoglobulin G (IgG) seroprevalence [6]

Summary

Introduction

Acute parvovirus B19 (B19V) infection is a mild disease associated with transient anemia, rash and arthritis. In immunocompromised patients, cases of persisting B19 viremia with severe life-threatening chronic anemia have been reported [1,2,3]. Those clinical courses occur in acute infections with high B19V DNA levels after solid organ transplantation, whereas B19V reactivations are more likely in adult transplant recipients and lead to low-level DNAemia, which is not associated with notable anemia [4,5]. Children are at higher risk of a primary B19V infection due to the low level of immunoglobulin G (IgG) seroprevalence [6] It is unclear if there is a higher rate of acute B19V infections and severe anemia in pediatric transplant recipients since larger studies are lacking

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Conclusion