Acute Parvovirus Infection Research Articles

Parvovirus-induced autoimmune hepatitis: First case in the literature

Parvovirus B19 infection is usually self-limiting in immunocompetent individuals. Twenty-five percent of infected individuals are
 completely asymptomatic during infection, with 50% of them presenting flu-like symptoms and the remaining patients presenting
 erythema infectiosum, arthralgia, or arthritis. More rarely, transient aplastic crisis is seen in individuals with chronic haemolytic
 disorders. Chronic pure red cell aplasia and aplastic anaemia may also be observed in immunocompromised patients. There is
 sufficient evidence in the literature suggesting that B19 infections can also cause a spectrum of liver diseases, ranging from elevated
 transaminase levels to acute hepatitis, fulminant liver failure, and even chronic hepatitis. This case report discusses a patient with
 acute parvovirus infection and newly diagnosed autoimmune hepatitis (AIH) and the role of this viral infection in the disease.

COVID-19, parvovirus and acute HIV infection in the gamut of diagnosis of fever and rash

Coronavirus disease-19 (COVID-19) patients continue to experience different symptoms each day. Many patients were seen with common symptoms such as fever, fatigue, myalgia, respiratory symptoms (e.g., dry cough, dyspnea), smell and taste disorders, gastrointestinal symptoms, and dermatological findings. Although, fever lasting <7 days has been reported in most patients, it has been seen in patients with persistent or recurrent fever patterns in the second week of illness. Although, any symptoms accompanying fever during the pandemic suggest the diagnosis of COVID-19, other etiologies should also be kept in mind. In this case report, we present two patients who were admitted with fever and rash were initially thought to have COVID-19 but were diagnosed with acute parvovirus infection and acute HIV infection finally. These cases are presented to draw attention to the importance of taking a good history and making a rational differential diagnosis.

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.

An unexpected cause of Pseudo-Pelger-HuEt anomaly

Pseudo-Pelger-Huët anomaly (PPHA) is an acquired disorder of neutrophil morphology resembling the inherited condition, Pelger-Huët anomaly. We report a case of PPHA apparently caused by acute parvovirus infection. A 51-year-old woman presented with fevers and cytopenias (mild neutropenia 1.4×109/L, moderate thrombocytopenia 74×109/L). Her history was significant for hypothyroidism treated with thyroxine. Her only other medication was the oral contraceptive pill. Peripheral blood morphology showed many hyposegmented neutrophils with abnormal nuclear chromatin clumping. Red cell and platelet morphology was unremarkable. A blood film from the previous year showed normal neutrophil morphology. Based on a presumptive diagnosis of myelodysplastic syndrome (MDS), a bone marrow examination was performed. It demonstrated a mildly hypocellular marrow with adequate granulopoiesis, frequent Pelger-Huët cells and no increase in blasts. Megakaryocyte number and morphology were normal. Unexpectedly, erythropoiesis was markedly reduced consistent with pure red cell aplasia (PRCA). Concurrent reticulocytopenia was observed. Subsequent testing showed positive IgM and IgG parvovirus serology, consistent with recent parvovirus infection. Our patient’s cytopenias spontaneously resolved within a week. Four months after initial presentation, full blood parameters remain within the reference range, though Pelger-Huët cells persist. PPHA is seen with clonal haematological disorders (MDS, myeloproliferative neoplasms), certain medications1 (tacrolimus, mycophenolate, valproate, ganciclovir, docetaxel and ibuprofen) and infections2 (HIV, tuberculosis and mycoplasma). Our case of PPHA likely resulted from parvovirus infection, which was only incidentally discovered after a bone marrow biopsy showed PRCA. Differentiating benign causes from clonal haematological disorders is essential, and bone marrow examination may assist if no other apparent causes are identified.

PLACENTAL CYTOPATHIC DAMAGE FACTOR DUE TO PARVOVIRUS B19 – AS A HALLMARK OF INTRAUTERINE SYMPTOMATHY OF INFECTED FETUS

Aim of the work. The focus of this study was to analyze the frequency of fetal intrauterine symptomatic realization as a result of B19 parvovirus infection of pregnant women during I and II gestation periods, with the combination of determination the levels of alpha-fetoprotein in maternal serum blood and histopathological investigation of placenta in cases of negative effects for infected fetuses. Materials and methods. A total of 478 pregnant women were at risk of infection and screened for parvovirus B19. The study was based on serological, morphological and virological testing of fetuses from mothers with confirmed parvovirus B19 infection. Infection of pregnant women was detected by serological diagnosis of specific antibodies IgM and IgG to parvovirus B19. Intrauterine fetal infection was confirmed by polymerase chain reaction method. Levels of alpha-fetoprotein in meternal venous blood were detected using an immunochemical test method. An antenatal diagnosis of hydrops fetalis was confirmed by ultrasound scanning. Placenta from the 8 infected fetuses was studied histologically with hematoxylin and eosin staining using electron microscope during gestational periods of 12-22 weeks. Statistical analysis of the obtained data was carried out using nonparametric statistics with the definition of Fisher's criterion. Results and discussion. The average gestational period of symptomatic manifestations of intrauterine fetal infection was 19.9±0.5 weeks of gestation. It was established that in 33 of cases were confirmed the intrauterine infection due to parvovirus B19 by using the morphological placenta tissue analysis. The research found that the levels of maternal serum alpha-fetoprotein was significantly higher (in 2.17 times) in group of fetuses who suffered from fetal hydrops and in cases of intrauterine fetal death before detecting the general echographic sings of fetal failure (p˂0.05). It will be very important to compare this indicator with the Doppler ultrasound measurements of the human fetal middle cerebral artery peak systolic velocity (MCA PSV) and blood flow parameters in the fetal ductus venosus and to predict the possibility of poor perinatal outcomes. It was identified a cytopathic effect in placental cells viral origin and detected in cells of the cytotrophoblast, syncytiotrophoblast, endothelial cells, and blood cells. Conclusions. Parvovirus B19 fractions were visualized in 100 % of cases of miscarriages with fetal hydrops and placental edema during 12-22 weeks of gestation, while acute maternal parvovirus infection (with the detection of IgM against to parvovirus B19) was diagnosed by immunoassay only in 62.5 % of cases. Detection of B19 particles in placental tissue from fetuses with non-immune origin hydrops is an auxiliary method in the diagnosis of vertical transmission of parvovirus during pregnancy. It is more preferable to estimate the levels of alpha-fetoprotein in maternal serum blood in case of parvovirus B19 affected pregnancies as raising rates of this marker may be an early prediction hallmark for adverse fetal outcome.

Detection of Human Parvovirus B19 antibodies in Pregnant Women with Spontaneous Abortion

Background: Viral infection in pregnancy is known to cause many problems such as fetal malformation; growth restriction and even fetal death; the relationship between viral infection and abortions is not well understood. The infection during pregnancy can affect the fetus due to lack of mother’s immunity.Objective: To assess the frequency of human parvovirus B19-specific antibody type IgM and IgG among pregnant women with spontaneous abortion.Patients and Methods: A semi-quantitative enzyme linked immunosorbent assay technique was applied for detection of anti-human parvovirus B19 IgM (Ridascreen-K6031-Germany) and IgG (Ridascreen -K6021- Germany) in sera of 90 pregnant women who have previously experienced abortion were collected from Al-Batool teaching hospital for maternity and children in Baquba-Diyala province, Iraq, during the period from October 2014 till May 2015. The age was ranged from 18-40 years. Statistical analysis was performed by using statistical package of social sciences, version-16, and P-value of < 0.05 as significant difference.Results: Among study group the mean age was 26.57 years, with an age range 18-40 years. Seropositivity rate was 11.11% (10 cases) for an individual occurrence of human parvovirus B19 IgM alone and 13.33% (12 cases) for a similar individual rate of human parvovirus B19 IgG, while 6 cases (6.66%) had both types of antibodies. Multiple variables regarding occurrence of anti-human parvovirus B 19 specific IgM and IgG antibody simultaneously, was evaluated, and none the variables had significant difference.Conclusion: The fact that 31.11% of studied participants had specific Parvovirus B19 antibody revealed a high occurrence of primary acute parvovirus infection and non-immune against parvovirus B19. Considering the potential role of this virus in abortion and fetal death, it emphasizes the importance of Parvovirus infection in pregnant women also this finding is comparable with that in the other countries.

Antibody against Arenaviruses in Humans, Southwestern United States

To The Editor: Woodrats (Neotoma spp.) are natural hosts of Whitewater Arroyo virus (WWAV) and other Tacaribe serocomplex viruses (family Arenaviridae) in the western United States and northern Mexico (1). The results of a previous study (2) suggested that WWAV or Tacaribe serocomplex viruses antigenically closely related to WWAV are etiologic agents of severe febrile illnesses in humans in the United States. We note that Junin virus and other South American Tacaribe serocomplex viruses are etiologic agents of hemorrhagic fever in humans (3). To further our knowledge of the epidemiology of the North American Tacaribe serocomplex viruses, we tested serum samples from hospitalized persons in a study of thrombocytopenic febrile illnesses that mimicked hantavirus pulmonary syndrome for IgG against arenaviruses. The 173 study participants were hospitalized during 1993–2001 in Arizona and New Mexico, United States. The study protocol was approved by the University of New Mexico Human Research Review Committee and the Navajo Nation Institutional Review Board. Ages of the study participants ranged from 9 to 86 years (mean 40 years). Virtually all serum samples were acute-phase specimens, and a specific diagnosis was achieved for only 55 (31.8%) of the 173 study participants. Serum samples were tested for IgG against WWAV, Amapari virus (AMAV), an arenavirus that is antigenically closely related to the Tacaribe serocomplex viruses known to cause hemorrhagic fever (4), and lymphocytic choriomeningitis virus (LCMV), the prototypical arenavirus and member of the Lassa–lymphocytic choriomeningitis serocomplex, by using an ELISA. (5). Briefly, we tested serial 4-fold dilutions (1:80–1:5,120) of each sample and compared results with results for negative control antigens. The adjusted optical density (AOD) of a sample-antigen reaction was the OD associated with the test antigen minus the OD associated with the corresponding control antigen. A sample was considered positive if the AOD at 1:80 was ≥0.250, the AOD at 1:320 was ≥0.250, and the sum of the AOD for the series of 4-fold dilutions was ≥0.750. The criteria for positivity were based on results of ELISA for serum samples from febrile persons who did not participate in this study and were negative for IgG against WWAV, AMAV, and LCMV. The IgG titer against a test antigen in a positive sample was the reciprocal of the highest dilution for which the AOD was ≥0.250. Titers <320 were considered to be 160 in comparisons of titers for WWAV, AMAV, and LCMV in individual samples. The apparent homologous virus in a positive sample was the virus associated with the highest titer if the absolute value of the differences between the highest titer and titers for the 2 other viruses were ≥4-fold. IgG against WWAV was found in acute-phase samples from 8 (4.6%) of the 173 study participants. None of the 173 study participants were positive for IgG against AMAV or LCMV. The IgG titers against WWAV in the positive samples were 320 (n = 1), 1,280 (n = 3), and ≥5,120 (n = 4). WWAV was the apparent homologous virus in the 7 persons with antibody titers ≥1,280. The apparent homologous virus in the person with the titer of 320 could not be determined from ELISA data. The presence of IgG against WWAV in acute-phase serum samples (all collected within 10 days of illness onset) implied past infection with WWAV or an arenavirus antigenically closely related to WWAV. The state of residence (2 from Arizona, 6 from New Mexico), sex ratio (4 male patients:4 female patients), and mean age (36 years, range 16–47 years) of antibody-positive persons reflected the characteristics of the entire study population. The clinical features in each of the antibody-positive persons included fever, headache, myalgia, and thrombocytopenia. The diagnoses given for these persons were acute parvovirus infection (n = 1) by IgM assay, adult respiratory distress syndrome (n = 1) by clinical progression, and not determined (n = 6). The results of this study indicate that a small fraction of the adult population in the southwestern United States has been infected with North American Tacaribe serocomplex virus(es). We note that the dominant epitopes in ELISA for IgG against arenaviruses are associated with the viral nucleocapsid (N) protein, and that amino acid sequence of the N protein of WWAV and amino acid sequences of N proteins of other Tacaribe arenaviruses from Arizona or New Mexico showed differences as high as 15.1% in a previous study (1). It might be the case that human IgG against some Tacaribe serocomplex viruses in the southwestern United States does not react strongly against WWAV in ELISA. If so, the true prevalence of antibody against North American Tacaribe serocomplex viruses in this study might be >4.6%. Accordingly, future work should include development of broadly reactive assays for detection of human IgM and human IgG against North American Tacaribe serocomplex viruses, including those associated with wild rodents in Mexico (6,7).

21: Acute parvovirus infection in pregnancy: are we underestimating the risk?

21: Acute parvovirus infection in pregnancy: are we underestimating the risk?

Clinical Characteristics and Outcomes of 11 Patients with Pure Red Cell Aplasia at a Single Institution Over a 13-Year Period

Pure red cell aplasia (PRCA) is a rare clinical entity characterized by anemia due to severe suppression of erythroid precursors, where the other cell lineages in the bone marrow remain morphologically normal. A standard treatment has not yet been established for PRCA due to the rarity of this condition. Recently, however, the administration of either cyclosporine (CSP) or prednisolone (PSL) has been reported to be an effective treatment for PRCA. To clarify the clinical characteristics of PRCA, 11 PRCA cases were retrospectively analyzed over a 13-year period at our institution. Since acute PRCA was found to be self-limiting, we administered the immunosuppressive treatment of CSP or PSL after providing supportive care for 4 weeks. The causes of PRCA were as follows: idiopathic (3), acute parvovirus infection (1), chronic parvovirus infection (3), thymic tumor (3), and end-stage renal disease with hemodialysis (1). Complete remission (CR) was achieved for 4 of the 5 patients treated with CSP, for 2 of the 3 patients with chronic parvovirus infection treated by immunoglobulin (Ig), and for all 3 patients treated with PSL. During the follow-up periods, 4 of the 11 patients relapsed. Complete remission was achieved a second time in all 4 cases by therapies that were more intensive and had longer administration periods than those provided during initial treatment. Consequently, 9 of the 11 patients were still alive (80%) after 5 years. Depending on the cause of the PRCA, treatment with CSP, PSL, or Ig was found to be effective in most PRCA cases.

T-lineage acute lymphoblastic leukemia and parvovirus infection in a child with neurofibromastosis-1

Neurofibromatosis (NF-1) patients have an increased risk of developing malignancies most commonly rhabdomyosarcomas, optic gliomas, brain tumors and non-lymphocytic leukemias. Acute lymphoblastic leukemia (ALL) has been infrequently reported in association with NF-1. We describe a rare association of NF-1, T-lineage ALL and parvovirus infection in a 12-year-old child. In addition, it is also to emphasize that a high index of suspicion should be kept for parvovirus B19 infection as a cause of bicytopenia/pancytopenia in ALL patients following induction chemotherapy.

Generalized Petechial Rashes in Children During a Parvovirus B19 Outbreak

Human parvovirus B19 infection is associated not only with erythema infectiosum (fifth disease) but also, rarely, with purpuric or petechial rashes. Most reports of these atypical rashes describe sporadic cases with skin lesions that have distinctively focal distributions. During a community outbreak of fifth disease, we investigated a cluster of illnesses in children with generalized petechial rashes to determine whether parvovirus was the causative agent and, if so, to describe more fully the clinical spectrum of petechial rashes that are associated with this virus. Systematic evaluation was conducted by general pediatricians of children with petechial rashes for evidence of acute parvovirus infection. During the outbreak, acute parvovirus infection was confirmed in 13 (76%) of 17 children who were evaluated for petechial rash. Confirmed case patients typically had mild constitutional symptoms, and most (11 [85%] of 13) had fever. Petechiae were typically dense and widely distributed; sometimes accentuated in the distal extremities, axillae, or groin; and usually absent from the head/neck. Most case patients had leukopenia, and several had thrombocytopenia. Parvovirus immunoglobulin M was detected in 8 (73%) of 11 acute-phase serum specimens, and immunoglobulin G was detectable only in convalescent specimens. Parvovirus DNA was detected in all 7 tested serum specimens, including 2 acute-phase specimens that were immunoglobulin M-negative. All case patients had brief, uncomplicated illnesses, but 6 were briefly hospitalized and 1 underwent a bone marrow examination. Two case patients developed erythema infectiosum during convalescence. During an outbreak of fifth disease, parvovirus proved to be a common cause of petechial rash in children, and this rash was typically more generalized than described in case reports. Associated clinical features, hematologic abnormalities, and serologic test results are consistent with a viremia-associated illness that is distinct from and occasionally followed by erythema infectiosum.

Simultaneous acute splenic sequestration and transient aplastic crisis in children with sickle cell disease

Acute splenic sequestration crisis (ASSC) is a hematological emergency in young children with sickle cell disease (SCD), characterized by worsening anemia and splenomegaly, usually with reticulocytosis and thrombocytopenia. Transient aplastic crisis (TAC) due to parvovirus B19 infection occurs in older children with SCD, and typically manifests as worsening anemia with reticulocytopenia and no splenomegaly. Five older children with SCD (4 HbSC, 1 HbSS on hydroxyurea) developed ASSC concurrent with TAC and had a severe clinical course. Our cases suggest that older children with SCD and acute parvovirus infection should be monitored closely for splenomegaly and multi-system dysfunction.

P0712 A CASE OF MORTAL NECROTIZING FASCIITIS IN A DIABETIC PATIENT

Parvovirus B19 is a single-stranded DNA virus. Clinical manifestations associated with acute infection are due to attachment of the virus to the P-antigen receptor on erythroid progenitor cells, and to immune-complex deposition in the skin and joints. Asymptomatic transient reticulocytopenia and a decrease in hemoglobin occur in most patients with B19 infection. We report a case of a 54-year old female patient with scleroderma and chronic low-dose steroid treatment who presented with a fever of unknown origin of 1-months duration. History, physical examination and radiological investigations were non-diagnostic for the source of fever. A decrease in hemoglobin from 12.4 g/dL to 10.3 g/dL was observed, with red cells indicative of a normocytic, normochromic anemia. White blood cell and platelet counts remained intact. Further investigation revealed a mild hemolytic picture with LDH – 945 U/L and haptoglobin – 16 mg/dL with a negative direct Coomb’s antibody test. Peripheral blood and bone marrow examination revealed a borderline lymphocytosis (10) with an abnormally high percentage (38) of these cells having an atypical morphology (large granular lymphocytes). These large granular lymphocytes were CD3and displayed markers for true natural killer cells – CD56+, CD16+, and CD11b. The basis of the patient’s clinical presentation was unclear until serology for acute parvovirus infection (IgM) was confirmed positive. The patient also tested positive for parvovirus B19 DNA on PCR of the bone marrow material. A diagnosis of acute parvovirus B19 infection was rendered. Fever resolved spontaneously within 1 month of its onset. The patient was followed up in an out-patient setting for 6 months with the following observations: – Spontaneous resolution of the anemia and the hemolytic picture. – Seroconversion to IgG for parvovirus B19. – Decrease in number of true NK cells in peripheral blood. In conclusion, parvovirus B19 is a ubiquitous infection that in the majority of affected patients remains asymptomatic. Benign, transient (< 6 months duration) NK lymphocytosis has been described in viral infections and autoimmune disease. Furthermore, isolated case reports exist of autoimmune hemolytic anemia in acute B19 infection. Our report indicates that parvovirus B19 may be associated with a Coomb’s negative hemolytic anemia and a transient appearance of true NK cells in the peripheral blood and bone marrow.

ヒトパルボウイルスＢ１９感染症の様々な病態

Human parvovirus B19 infection causes erythema infectiosum in child, aplastic crisis in patients with chronic hemolytic anemia, chronic pure red cell aplasia in immunocompromised patients and hydrops fetalis. Human parvovirus B19 causes arthritis and acute glomerulonephritis due to immunological mechanism. Other disorders, rheumatoid arthritis, vasculitis and thrombotic microangiopathy, are linked in human parvovirus B19 infection. Parvovirus B19 infection causes choronic rheumatoid-like arthropathy. Autoantibody and low complement were seen in acute human parvovirus infection, and parvovirus B19 infection present clinically lupus like tableau.

Successful treatment of prolonged agranulocytosis caused by acute parvovirus B19 infection with intravenous immunoglobulins

A 21-year-old previously healthy male presented with prolonged fever of 3 weeks duration and profound agranulocytosis that did not respond to treatment with granulocyte-stimulating factors. A bone marrow biopsy demonstrated an absence of myeloid lineage. Acute parvovirus B19 infection was diagnosed by the presence of both IgM and IgG anti-parvovirus antibodies. Two days treatment with intravenous immunoglobulins (IVIg) resulted in complete recovery. The role of treatment with immunoglobulins in acute and persistent parvovirus infection is discussed.

Acquired Pure Red Cell Aplasia Associated with Alemtuzumab, Mycophenolate, and Daclizumab Immunosuppression after Pancreas Transplant.

Acquired pure red cell aplasia (PRCA) is a rare disorder that may be associated with malignancy, infections, connective tissue disorders, pregnancy and drugs. Recently, we observed PRCA in pancreas transplant patients treated with a new immunosuppressive regimen. Since 1966, the University of Minnesota Medical Center (UMMC) has performed 1577 pancreas transplants. Since February 2003, 280 pancreas transplants were treated with a new immunosuppressive protocol involving induction and maintenance with (n=190) or conversion to (n=90) alemtuzumab (humanized anti-CD52) and mycophenolate mofetil (MMF). Daclizumab (humanized anti-CD25, IL-2 receptor) was added when MMF dosing was limited by neutropenia. Between September 2004 and July 2005, 12 patients receiving the triple drug combination were diagnosed with PRCA. All 12 had prolonged exposure to MMF and/or a calcineurin inhibitor (cyclosporine, tacrolimus) prior to induction with [n=8] or conversion to [n=4] the above protocol. Eight subjects had bone marrow biopsies performed and reviewed at UMMC, and 4 additional patients received the diagnosis of PRCA at other institutions. All cases showed similar morphologic features, including dysgranulopoiesis, erythroid aplasia or marked hypoplasia with evidence of maturation, megakaryocytic hyperplasia with normal or low peripheral platelet counts, and atypical lymphoid aggregates in bone marrow trephine sections. Cytogenetic studies showed normal karyotypes. Severe reticulocytopenia was present in all subjects. In one subject, an extramedullary post-transplant lymphoproliferative disorder was diagnosed simultaneously. Another patient developed atypical reactive lymphadenopathy. Acute parvovirus infection was excluded by serology or polymerase chain reaction in 11 cases. Erythropoietin, when used, was started after the diagnosis or maintained through recovery of PRCA. Two patients died, one (post conversion) of PRCA associated with autoimmune hemolytic anemia and one (post induction) of ischemic heart disease. MMF was either discontinued (n=8) or dose reduced (n=2) in the remaining 10 subjects, with improvement in hemoglobin or decreased transfusion requirements in 8 patients. The single patient in whom a follow-up bone marrow biopsy was obtained after clinical recovery showed normal erythropoiesis. Ten patients developed infections with cytomegalovirus (n=7), BK virus (n=3), Zygomyces (n=1), Aspergillus versicolor (n=1), and Mycobacteria Simiae/Interjectum (n= 1). Hypogammaglobulinemia was a common finding. We conclude that reversible PRCA is associated with the immunosuppressive protocol including alemtuzumab, MMF, and daclizumab.

Prevalence of parvovirus B19-specific antibodies and of viral DNA in patients with endogenous uveitis

Parvovirus B19 causes erythema infectiosum (fifth disease) in children. The virus has been associated with several autoimmune diseases and has been found in synovium or serum from patients with long-standing arthritis or other rheumatic diseases. We investigated serum and aqueous fluid samples of patients with endogenous uveitis. Sera of 70 consecutive uveitis patients were investigated for IgG against structural proteins VP1 and VP2 and non-structural protein NS1 by western blot technique. Viral DNA in serum was assessed by quantitative PCR. Simultaneous DNA analysis was also performed on aqueous fluid samples from 11 uveitis patients and 10 patients without uveitis during routine cataract extraction. In 15 (21.4%; healthy population: 16 of 10,000) of the 70 serum samples (mean age 42.69 years, range 9-82 years; 48 women, 22 men), viral DNA was detected. IgG directed against structural protein VP1 or VP2 was found in 60 patients (85.7%; healthy population: 80%) and IgG against non-structural protein NS1 in 33 patients (47.1%; healthy population: 22%). In none of the patients was IgM antibody as a serological marker for acute parvovirus infection found. Patients with posterior uveitis (n=11) had detectable serum DNA in 54.5% (p=0.021). This group displayed the highest rate of deterioration of visual acuity (>2 Snellen lines), at 72.7% (all patients: 58.6%; p=0.219). In 2 of the 11 aqueous fluid samples, viral DNA was detected. Antibodies against parvovirus B19 were found in both samples, whereas viral DNA was absent in the serum. In the control group of 10 healthy cataract patients, 3 had detectable DNA in the aqueous humor; 1 of these 3 also had detectable levels of viral DNA in serum. Prevalence of IgG antibodies against NS1 protein in serum samples and DNA in serum is increased in uveitis patients compared with the normal population, suggesting a persistent infection. The presence of DNA in aqueous humor samples shows, for the first time, persistence of parvovirus B19 in the eye in uveitis and also in healthy patients. The role of parvovirus DNA in the aqueous fluid and of IgG antibodies against NS1 in the pathogenesis of uveitis cannot be defined at present.

Multi-organ Failure Associated with Acute Parvovirus Infection and Exercise in a Patient with Sickle Beta Thalassemia

Multi-organ Failure Associated with Acute Parvovirus Infection and Exercise in a Patient with Sickle Beta Thalassemia

Parvovirus-B19 Infection Preceding Acute Myeloid Leukemia with Orbital Granulocytic Sarcoma

We report here an unusual presentation of acute nonlymphoblastic leukemia with ocular granulocytic sarcoma who was firstly diagnosed iron deficiency anemia and acute parvovirus infection induced erythroid hypoplasia. To our knowledge this is the first paper of acute myeloblastic leukemia (AML) with granulocytic sarcoma, preceded by acute Parvovirus B19 infection.

Aplastic crisis in sickle cell anemia induced by parvovírus B19

PURPOSE: Transient aplastic crisis is reported in an eight-month old child with sickle cell anemia and acute B19 parvovirus infection. This fact is uncommon in this age. PATIENT AND METHODS: The authors review the literature and describe a clinical case of an eight-month old child with sickle cell anemia presented with profound anemia and reticulocytopenia. His peripheral blood was analyzed for parvovirus B19 using the polymerase chain reaction (PCR), and for anti B19 immunoglobulin Ig M, and Ig G by enzyme-linked immunosorbent assay (ELISA). RESULTS: An eight-month old child with sickle cell anemia was admitted to the hospital with fever and profound anemia (HB = 3.8g/ dl) and reticulocytopenia (2%). A diagnosis of aplastic crisis was established. The results indicate that Ig M and PCR were positive and Ig G negative. The patient needed erytrocyte transfusion, and was discharged on hospital day 4. CONCLUSIONS: The clinical and laboratory features indicate that human parvovirus B19 was the etiologic agent of an aplastic crisis in an eight-month old child. According to the international literature this event is uncommon for this age; in addition, this is the first time it appears in the Brazilian literature.