Acute Parvovirus B19 Infection Research Articles

Atypical course of parvovirus B19 infection with combined infection (clinical observation)

The article describes a clinical case of atypical severe course of parvovirus B19 infection, similar in its manifestations to meningococcal infection, with combined infection with Meningococcus, Hemophilus bacillus, influenza A virus. A patient hospitalized with acute respiratory disease and toxicoderma had new symptoms within 24 hours: headache, hemorrhagic rash, decrease in blood pressure to 80/50 mm Hg, fever up to 39.8 0C. Based on the symptoms, a preliminary clinical diagnosis was made: “Meningococcal infection, generalized form – meningococcemia, severe course. Infectious-toxic shock of the 2nd degree.” During laboratory examination of clinical samples of the patient by bacteriological, serological and molecular genetic methods, there was no growth of bacterial microflora in liquor, blood and smears from the pharynx and nose. Genetic material (DNA and RNA) of Neisseria meningitides, Haemophilus influenza and influenza A/H3N2 was detected in a smear from the nasal cavity. At the same time, parvovirus B19 DNA was isolated in the patient’s cerebrospinal fluid and blood in a high viral load (Ct 21.1 and Ct 4.9, respectively). The patient was found to have not only IgG, but also IgM antibodies to parvovirus B19, which is a confirmation of acute parvovirus B19 infection. A pronounced allergic reaction was confirmed by a high index of total IgE (1068 units/ml). Thus, we have described an atypical case of laboratoryconfirmed parvovirus B19 infection in the presence of bacterial-viral mixed infection and an allergic reaction in the patient.

163 Lupus like Presentation of Acute Parvovirus B19 Infection With Hypocomplementemia in a Kidney Transplant Recipient

163 Lupus like Presentation of Acute Parvovirus B19 Infection With Hypocomplementemia in a Kidney Transplant Recipient

Treating Parvovirus Triggered Refractory Hemolytic Anemia with Rituximab in Renal Transplant Recipients - A Report of Two Cases.

Parvovirus B19 is a small (26 nm), nonenveloped, single-stranded DNA (5.6-kb) virus. The only known host for parvovirus B19 is humans. Parvovirus B19 is directly cytotoxic to erythroid precursor cells of the colony- and burst-forming units. Human parvovirus B19 is the etiologic agent of erythema infectiosum and chronic pure red cell aplasia in immunocompromised individuals. Acute parvovirus B19 infection should be suspected in immunocompromised patients, who present with reticulocytopenic hemolytic anemia and thrombocytopenia. Intravenous immunoglobulin (IVIg) is the standard treatment for parvovirus-induced cytopenias. We report two cases of postrenal transplant who presented with reticulocytopenic anemia and were found to have parvovirus infection. They did not respond to conventional treatment with intravenous gamma globulin. Both patients were treated with rituximab with which they had improvement in clinical and hematological parameters. There was no previous documentation of using rituximab in the treatment of parvovirus-triggered autoimmune hemolytic anemia postrenal transplant patients. This article illustrates how rituximab will be helpful in this setting, of course, it is a new thought but requires further studies and validation.

Parvovirus Infection Triggering Still's Disease.

We present the case of a 59-year-old man with acute B19 parvovirus infection who developed a systemic inflammatory reaction similar to adult-onset Still’s disease (AOSD). We discuss the clinical challenge due to overlapping symptoms to distinguish between a primary B19 viral infection and the autoimmune disease it can trigger.LEARNING POINTSDistinguishing between primary B19 parvovirus infection and autoimmune diseases can be difficult in view of the significant symptom overlap.In our patient, recurrence of symptoms during follow-up and response to treatment were in favour of adult-onset Still’s disease triggered by B19 parvovirus.

Vitamin A and D Levels Correlate with Outcomes Following Acute Parvovirus B19 Infection in Children with Sickle Cell Disease

Background: Human parvovirus B19, a common childhood infection that typically causes mild disease in healthy individuals, causes life-threatening anemia due to transient red cell aplasia (aplastic crisis) in individuals with sickle cell disease (SCD). This complication often leads to hospitalization and red blood cell transfusions. Limiting the amount of transfusions is imperative to avoid alloimmunization. Strategies to mitigate complications from parvovirus B19 or reduce disease severity in SCD patients are needed. In this prospective observational study, we aim to describe the relationship between vitamin A and D levels and severity of symptoms during parvovirus B19 infection in pediatric patients with SCD.Methods: Twenty pediatric patients with SCD admitted to St. Jude Children's Research Hospital experiencing aplastic crisis and identified as having an active parvovirus B19 infection were under an IRB approved protocol (NCT02261480) and followed prospectively for 120 days post-infection. Acute parvovirus B19 infection was diagnosed by fever and a positive virus-specific IgM ELISA or PCR. Aplastic crisis was defined by worsened anemia without sufficient compensatory reticulocytosis in the setting of an acute parvovirus B19 infection. Virus-specific antibody responses were measured from sera or nasal washes (NW) by ELISA using parvovirus B19 virus-like particles (VLP) as target antigens. Peak serum antibody titers were defined (among measurements from Days 0, 7, 30, and 120). Total erythrocyte transfusion volumes required during the admission were quantified. Hematologic indices and vitamin A and D levels were obtained on Day 0. Vitamin A (retinol) was measured using UPLC and vitamin D (25[OH]D) was measured using a Roche Elecsys Vitamin D ELISA. Statistical analyses were performed with Spearman's rank correlation coefficient or Mann Whitney tests. We scored significance as p<0.05.Results: Twenty patients with different genotypes of SCD requiring hospital admission due to acute parvovirus B19 infection were sequentially enrolled (15 HbSS, 3 HbSC, 1 HbSD, 1 HbSβeta +thalassemia). Thirty-five percent (7/20) of patients were vitamin D deficient (VDD, defined here as <20 ng/mL) while 89% (17/19, one sample was not measured) of patients were marginally or severely vitamin A deficient (defined here as <20 μg/dL) on Day 0. Correlative analyses between vitamin levels and markers of disease severity are shown in figure 1. Lower vitamin D levels trended with lower hemoglobin (r=0.399, p=0.082) and there was a significant inverse correlation between transfused volume and vitamin D levels (r=-0.626, p=0.003, Figure 1B). There was a significant positive correlation of vitamin A levels on Day 0 with hemoglobin concentration (r=0.549, p=0.015, Figure 1D), and an inverse correlation between vitamin A levels and lactate dehydrogenase (r=-0.505, p=0.027, Figure 1F).Children with replete vitamin D levels exhibited significantly better peak virus-specific serum IgG (p=0.037) and IgA (p=0.011) responses (Figure 2A-B). Additionally, vitamin A, which plays an important role in mucosal immunity, correlated positively with virus-specific IgG (r=0.574, p=0.013) and IgA (r=0.480, p=0.044) in nasal passages on Day 30 (Figure 2C-D).Conclusions: In pediatric patients admitted to the hospital for acute parvovirus B19 infection, low vitamin A and D levels were associated with greater disease severity (greater hemolysis, lower hemoglobin concentration, and greater transfusion volumes). Higher vitamin levels were associated with better virus-specific antibody responses. While cause-effect relationships were not discerned in this study, we hypothesize that poor nutritional status contributed to poor outcomes and that efforts to improve nutrition may reduce the severity of parvovirus B19 disease in patients with SCD. [Display omitted] DisclosuresHankins: UpToDate: Consultancy; Vindico Medical Education: Consultancy; Global Blood Therapeutics: Consultancy; Bluebird Bio: Consultancy.

Hemophagocytic lymphohistiocytosis and thrombotic microangiopathy after parvovirus B19 infection and renal transplantation: a case report

BackgroundHemophagocytic lymphohistiocytosis (HLH) is a rare and life-threatening disease characterized by hyperactivation of the immune system that causes hypercytokinemia and potentially multi organ failure. HLH can occur in patients with underlying rheumatic or autoinflammatory disorders. Additionally, HLH can develop in patients during infections or malignancies without a known genetic predisposition.Case presentationWe herein report a patient, who presented with fever, both acute kidney and liver injury, anemia, thrombocytopenia and HSV stomatitis. HLH was diagnosed based on clinical criteria and qPCR revealed an acute parvovirus B19 infection as potential underlying infectious trigger. Treatment was started with both IVIG and dexamethasone. Subsequently, kidney biopsy demonstrated TMA.ConclusionsIn rare cases both HLH and aHUS can occur simultaneously in a patient as a consequence of viral infections. Insights from this unusual case might help physicians understand this complex symptom constellation.

A case of severe multi-system disease in a sickle cell SC patient caused by parvovirus B19 infection

Sickle Cell Disease (SCD) is an inherited hemoglobinopathy, which results in production of abnormal hemoglobin S. HbSC disease is a variant of SCD, which shares a similar clinical complication profile to HbSS disease, but often thought to be a milder condition. In patients with SCD, Hb S in deoxygenated state undergoes polymerization, leading to hemolysis, vaso-occlusive events, and eventually end-organ damage. Among other complications in patients with SCD is increased risk of complications caused by parvovirus B19. We present a case of a 14-year-old female with HbSC disease who presented to the emergency room with complaint of abdominal pain and found to have splenic sequestration. Splenic sequestration progressed rapidly, Hemoglobin (hb) dropped to 4.6 g/dl and acute chest syndrome (ACS) developed. She was treated following the ACS protocol, received 4 units of Packed Red Blood Cells (PRBC) and subsequently underwent a single volume PRBC exchange transfusion. Considering her unusual presentation, with severe ARDS from alveolar hemorrhage requiring mechanical ventilation and multi-organ injury, several autoimmune and infectious conditions with a cytokine storm component including COVID-19 disease, were considered. Results of viral testing revealed parvovirus B19 IgM antibodies signifying an acute infection. She fully recovered with supportive care and was discharged home. Multisystem involvement simulating connective tissue disorders or malignancies with acute parvovirus B19 infection has been reported and is considered extremely rare. To our knowledge, there were no reports of pediatric patients with SC disease presenting with splenic sequestration and ACS in the setting of parvovirus B19 multisystem disease. Keywords: sickle cell disease; acute respiratory distress syndrome; acute chest syndrome; parvovirus B19.

The impact of Parvovirus B19 on hereditary haemolytic anaemias.

The impact of Parvovirus B19 on hereditary haemolytic anaemias.

Woman with Fever and Skin Lesions

Context: Acute febrile Neutrophilic Dermatosis, also known as Sweet’s Syndrome, was first described in 1964 by Dr. Robert Sweet. There have been described four many subtypes: classic type (majority of cases), cases associated with neoplasia, cases associated with inflammatory disease and cases associated with pregnancy. There have been also seen cases associated with drugs. Case Report: We report the case of a 43-year-old woman who presented fever and skin lesions which affected mostly the neck, neckline and upper-back. The biopsy was compatible with Sweet’s Syndrome (SS). Laboratory testing revealed a positive serology for acute Parvovirus B19 infection. Conclusion: After excluding main cases of SS, we hypothesize that in our patient it was related to acute Parvovirus B19 infection.

Prevalence of Parvovirus B19 Infection by Serology and PCR in Pregnant Women Referring to Obstetrics and Gynecology Clinic

ObjectiveInfection by Primate erythroparvovirus 1, generally known Parvovirus B19, is highly prevalent worldwide. Although infection by this virus will not be clinically problematic in most cases, new infections during pregnancy could result in serious repercussions in the fetus. Serologic and PCR-based methods are among the available approaches for diagnosis of Parvovirus B19 infection. In this regard, the present study is aimed to investigate the frequency of Parvovirus B19 infection by these two techniques in pregnant women of Zanjan. Materials and methodsIn this cross sectional-descriptive study, 110 pregnant women referring to Mousavi hospital in Zanjan during one year were evaluated in terms of serologic and Real-Time PCR test results in search for Parvovirus B19 infection. The rate of positive IgG and IgM were determined in women and the Real-Time PCR results were reported. ResultsOverall, 18.2% of participants were above 35 years old and 4.5% of them were younger than 18 years old. 41 (44.1%) and 2 (1.8%) cases had positive anti-Parvovirus B19 IgG and IgM, respectively. Real-Time PCR results were negative in all the studied samples. ConclusionBased on the findings of this study, prevalence of acute Parvovirus B19 infection was 0 and 2% based on Real-Time PCR and IgM tests, respectively. About 40% of pregnant women had experienced infection with this virus before.

Clonal T-Large Granular Lymphocyte Proliferations in Childhood: Friend or Foe?

Background: The pathophysiology of clonal T-large granular lymphocyte (T-LGL) proliferations is not well understood; the distinction between reactive and malignant entities is not very clear given the fact that acquired STAT3 mutations can be seen with clonal T-LGL proliferations in non-malignant Felty syndrome and with frequent use of immunosuppression for the treatment of T-LGL leukemia. Historically, determination of clonality has been often seen as an indicator of T-LGL leukemia. We reviewed our experience on clonal T-LGL proliferations in children.Material and Methods: T-LGLs were identified by CD3 and dim CD5 staining on flow cytometric analysis and observation of lymphocytes with large granular cytoplasm appearance in peripheral blood. Cases with peripheral blood lymphocyte T-LGL population greater than 10% were reviewed in patients whom had flow cytometry studies performed for different indications. Among them, ones with available T cell receptor (TCR) gene rearrangement studies were selected and 16 cases with clonal TCR rearrangement patterns were included in this study. Fifty-seven peripheral blood flow cytometric tests using 15 surface markers were analyzed in those 16 cases. Patients have been followed for up to 7 years.Results: Sixteen cases of clonal T-LGL proliferation associated with different diseases were included in this analysis. Three patients had chronic graft versus host disease, 2 Evans syndrome, and one case each with the following conditions: common variable immunodeficiency disorder, severe combined immunodeficiency who developed CMV infection following umbilical cord blood transplantation (UCBT) and later acute EBV infection, co-existing Langerhans cell histiocytosis and primary hemophagocytic lymphohistiocytosis, autoimmune hemolytic anemia, chronic idiopathic thrombocytopenic thrombocytopenia, Hodgkin lymphoma, X-linked lymphoproliferative disorder, Rosai Dorfman disease (RDD), acute EBV infection, acute parvovirus B19 infection and paroxysmal nocturnal hemoglobinuria with history of treated severe aplastic anemia. Pathophysiological processes involved in these cases included various combinations of inherited immune deficiency in 4, acquired immune deficiency in 5, lymphoproliferation in 6, alloimmune reaction in 3, autoimmune reaction in 5, infection in 4, inflammation in 3 and malignancy in 1. One patient had three different clonal populations at different times due to maternal engraftment, CMV infection following UCBT and during an acute EBV infection after immune suppression withdrawal, respectively. The patient with RDD developed clonal T-LGL expansion when his disease flared. In some cases, clonal T-LGL proliferations disappeared with the resolution of the underlying pathological process. However, the T-LGL clone persisted and was frequently associated with relative increase over time, if the disease process continued to be active and/or progressed, even despite use of therapeutic approaches often including immunosuppression. Four clonal T-LGL proliferations in 2 patients have resolved, remaining 10 were persistent and have not been reevaluated in 4 cases. None of the cases showed a purely monoclonal pattern. The size of the clonal T-LGL population was variable with a median value of 18.6%, as high as 58.7% of the lymphocyte population. T-LGL population has positively correlated with CD3, CD8, CD57 (p<0.001) and inversely with CD19 (p=0.001) expression. There was also an overall positive correlation between the percent of T-LGL cells and absolute T-LGL count (p<0.001).Discussion: Clonal T-LGL proliferations in childhood is a reactive process reflecting the activity of the underlying disease process, including immunodeficiency, autoimmunity, alloimmunity, infection, inflammation, lymphoproliferation and malignancy. Use of immunosuppression has been associated with relative increase in the clone size despite decrease in peripheral blood absolute lymphocyte count along with relative reduction in T and B lymphocyte compartments in patients with active disease. Presence of clonal T-LGL proliferations in a polyclonal background is not an indicator of malignant process. It is very possible that such proliferations are an effort of the immune system to control the most prominently involved immunogenic stressors. DisclosuresNo relevant conflicts of interest to declare.

Seroprevalence of parvovirus B19 in blood donors: the risks and challenges of blood transfusion in Zambia in the era of HIV/AIDS at the Kitwe Central Hospital, blood bank.

Human Parvovirus (B19V) is a small, single-stranded, non-enveloped DNA virus which is pathogenic to humans causing a wide array of clinical complications which include erythema infectiosum, aplastic crisis and hydrops foetalis. It is generally harmless in healthy individuals but may be life threatening in immunocompromised individuals such as patients with sickle cell disease, cancer, HIV and pregnant women. It has been shown to be transmissible by blood transfusion but donor screening for the virus is not yet mandatory in most sub-Saharan African countries including Zambia. This was a cross-sectional study undertaken at the Kitwe Central Hospital, blood bank and Tropical Diseases Research Centre at Ndola Central Hospital. A total of 192 blood samples were screened for Ig M antibodies against parvovirus B19 by ELISA. The general objective of the study was to determine the seroprevalence of parvovirus B19 infections among healthy blood donors at the Kitwe Central Hospital blood bank. Specific Objectives were to detect parvovirus B19 Ig M antibodies in donor blood using serology and to analyse the age and sex distribution of parvovirus among blood donors. The prevalence of parvovirus B19 Ig M in this study was 15.6%. The majority of the positive cases were in the age group 15-22 years (17.8%) but there was no statistical significance between occurrence of parvovirus and age ( p value=0.703). Prevalence in males was higher than in females that is 16.4% and 13.8%, respectively. The relationship between gender and parvovirus B19 occurrence was however not significant either (p value=0.516). This study showed a 15.6% prevalence rate of acute Parvovirus B19 infections in blood donors at the Kitwe Central Hospital, blood bank. Studies with larger sample sizes are needed to validate these results.

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

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.

PARVOVIRUS B19 ASSOCIATED HAEMOPHAGOCYTIC LYMPHOHISTIOCYTISIS IN HEREDITARY SPHEROCYTOSIS PATIENT: A CASE REPORT

Haemophagocytic lymphohistiocytosis (HLH) is a clinico-pathologic entity caused by increased proliferation and activation of benign macrophages with haemophagocytosis throughout the reticulo-endothelial system. Virus-associated HLH is a well-recognised entity. Although majority of parvovirus B19 associated HLH does not require any specific treatment and carries good prognosis, outcome of children is worse than adults. We report here a case of HLH associated with acute parvovirus B19 infection in a young healthy patient with underlying hereditary spherocytosis, with bone marrow findings typical of parvovirus infection. Although this patient had spontaneous recovery of cell counts, he succumbed due to complication from prolonged ventilation. Unexpectedly, his immunoglobulin levels were inappropriately normal despite on-going ventilator associated pneumonia, which reflects inadequate humoral immune response towards infection.

Aseptic arthritis due to parvovirus B19 infection immediately after kidney and pancreas transplantation

Human parvovirus B19 (PVB19) has been frequently identified as a cause of anemia in immunocompromised transplanted patients. Rarely the infection correlates with deterioration of the graft function. Immunomodulatory therapy in PVB19 cases, still not standardised in dose and duration, has been proven to achieve good clinical results. The clinical presentation depends mainly on the immunological status of the patient. Here we report an atypical presentation of an acute PVB19 infection in the immediate postoperative phase after transplantation and aim to raise the recognition of PVB19 as a significant human pathogen in the early post-transplantation period. Additionally, we provide a literature review of clinical presentation and management of recently published cases.

Viral-Associated GN: Hepatitis B and Other Viral Infections.

By definition, viral-associated GN indicates the direct pathogenic relationship between active viral replication and the development of acute GN. This definition is in sharp contrast to the semantic label and pathophysiologic foundation behind postinfectious GN that uniquely develops only during a period of resolved and absent active infection. The primary example of postinfectious GN are the glomerular lesions described after a pharyngeal or cutaneous streptococcal infection and do not represent the clinical or immunologic pattern seen with viral-associated GN. Hepatitis B (HBV) is the most common chronic viral infection in the world affecting >400 million people which is more than double the prevalence of chronic HIV and hepatitis C carriers combined. In addition, 10%-20% of HBV patients may be coinfected with hepatitis C and 5%-10% will have coinfection with HIV. Being able to distinguish the different types of GN seen with each viral infection is essential for the practicing clinician as each virus requires its own specific antiviral therapy. HBV-induced immune complex disease with renal injury lies on one end of the spectrum of disorders that occurs after a prolonged chronic carrier state. On the opposite end of the spectrum are renal diseases that develop from acute or subacute viral infections. One important glomerular lesion in this category is the association of collapsing FSGS with acute active cytomegalovirus, Epstein-Barr virus, and parvovirus B19 infection. The data supporting or disproving this relationship for each of these viruses will be discussed. A second renal manifestation of acute viral infections often occurs with many different sporadic or epidemic infections such as dengue and hantavirus and can lead to a transient proliferative GN that resolves upon viral clearance. The complex interplay of HBV and all viruses with the immune system provides conceptual lessons on the pathophysiology of immune complex GN that can be applied to all infection-related renal disease and plays an integral role in developing an approach to therapeutic intervention.

Agranulocytosis in a patient with acute Parvovirus B19 infection: a case study

The definition of neutropenia is the reduction in the absolute number of neutrophils below 1.5×10&lt;sup&gt;9&lt;/sup&gt;. The chapter about acquired neutropenias affecting the adult population is of particular interest to the internist. PC, 75 years old man, was hospitalized because of fever, asthenia. In anamnesis: recent diagnosis of ulcerative pancolitis treated with mesalazine and corticosteroid therapy. During the hospitalization, to the fever resolution, we witnessed to a gradual reduction in the value of neutrophils leucocytes until the complete agranulocytosis. We set a therapy with granulocytes colony stimulating factors, and antifungal. The osteo-medullar biopsy confirmed a pure aplasia of the granulocyte marrow series without any evidence of cancer. The subsequent clinical development was favorable, with stable apyrexia and recovery of leucocytes count. Few days after, we received the positive response on the research of anti-Parvovirus B19 immunoglobulin M and in qualitative polymerase chain reaction. The patient was discharged with diagnosis &lt;em&gt;agranulocytosis in patient with acute infection of Parvovirus B19&lt;/em&gt;. Neutropenia associated with Parvovirus infection is not frequent and is related to the presence of hematological diseases or condition of immunosuppression. The peculiarity of the case described is the complete agranulocytosis found: in fact in literature, only rare cases are described. Patient gave his informed consent.

Acute Parvovirus B19 Infection in Adults: A Retrospective Study of 49 Cases

ObjectiveOur aim was to describe the epidemiologic, clinical, and laboratory characteristics of acute parvovirus B19 infection in adults. Material and methodsThis study describes all cases of acute parvovirus B19 infection in patients older than 18 years of age who were treated at Hospital Universitario La Paz in Madrid, Spain, in 2012. ResultsForty-nine adults were treated for acute parvovirus B19 infection. Most were young women who were infected in the spring or early summer. In over half the cases skin lesions were key diagnostic signs. We saw the full range of types of rash of purplish exanthems that were fairly generalized; vasculitis was relatively common (in >18%). Mild or moderate abnormalities in blood counts and indicators of liver dysfunction resolved spontaneously in all but 2 immunocompromised patients, who developed chronic anemia. ConclusionsThis is the largest case series of acute parvovirus B19 infection published to date. This infection should be suspected on observing signs of purplish skin rashes, no matter the location or pattern of distribution, or vasculitis, especially if accompanied by fever and joint pain in young women in the spring. Measures to avoid infection should be recommended to individuals at risk.

Acute human parvovirus B19 infection in a 6-year old girl with sickle cell disease: a case report

A 6-year-old girl with Sickle-cell disease was hospitalized because of fever and arthralgia. During hospitalization she developed a splenic sequestration with the need of three successive red packed-cell transfusions. Microbiological investigations revealed positive HPVB19 IgM and IgG and HPVB19 DNA in blood. Given the diagnosis of HPVB19 infection and persistent fever, she received intravenous immunoglobulins (IVIg) with progressive clinical improvement and discharge after 24 days of hospitalization. This is the first case of acute HPVB19 infection in a child with Sickle cell disease and more than 20 days fever, associated with splenic sequestration. IVIg may represent an effective therapy.

Estudio retrospectivo de 49 casos de infección aguda por parvovirus B19 en adultos

ObjectiveOur aim was to describe the epidemiologic, clinical, and laboratory characteristics of acute parvovirus B19 infection in adults. Material and methodsThis study describes all cases of acute parvovirus B19 infection in patients older than 18 years of age who were treated at Hospital Universitario La Paz in Madrid, Spain, in 2012. ResultsForty-nine adults were treated for acute parvovirus B19 infection. Most were young women who were infected in the spring or early summer. In over half the cases skin lesions were key diagnostic signs.We saw the full range of types of rash of purplish exanthems that were fairly generalized; vasculitis was relatively common (in >18%). Mild or moderate abnormalities in blood counts and indicators of liver dysfunction resolved spontaneously in all but 2 immunocompromised patients, who developed chronic anemia. ConclusionsThis is the largest case series of acute parvovirus B19 infection published to date. This infection should be suspected on observing signs of purplish skin rashes, no matter the location or pattern of distribution, or vasculitis, especially if accompanied by fever and joint pain in young women in the spring. Measures to avoid infection should be recommended to individuals at risk.