B19 IgG Research Articles

Prevalence of Antibody to Human Parvovirus B19 in Pre-School Age/young Adult Individuals in Shiraz, Iran

The present study was conducted to determine the prevalence of antibody against the human parvovirus B19 among 5-25 year old individuals in Shiraz, southern Iran. Serum samples from 908 individuals (505 female and 403 male) were studied. The patients were categorized into seven age groups. The IgG anti-parvovirus B19 was determined by the commercial ELISA kit. Anti-parvovirus B19 IgG was found in 70.09% of the females and 60.04% of the males in this study. In general, 65.63% of the study population had IgG against parvovirus B19. Results from this study have show that the prevalence of parvovirus infection is found to be higher in females than males and in the majority of cases, infection with parvovirus occurs in the pre-school age period. These findings may differ from what is found other countries.

Vasculite leucocytoclasique compliquée d’une atteinte rénale grave au décours d’une primo-infection àParvovirus B19

Leukocytoclastic vasculitis following Parvovirus B19 primary infection has occasionally been reported in children but it occurs rarely in adults. We present an original case report with severe renal complications. A 33-year-old man presented with fever and eruption of the abdomen and members. Papules and vesiculopustules were associated with oral and genital ulcerations. These lesions subsequently became purpuric and necrotic. Histological analysis confirmed the diagnosis of pustulous leukocytoclastic vasculitis with IgA deposits. Laboratory investigations showed elevated sedimentation rate, hepatic cytolysis and renal impairment (hematuria, leucocyturia and proteinuria 1.5 g/24 hours). Anti-parvovirus B19 IgM were positive. Three months after the eruption resolved, IgM were undetectable while anti-parvovirus B19 IgG appeared. Renal injury progressively worsened: elevation of proteinuria (5 g/24 hours) and diminution of creatinine clearance (51 ml/min). Renal biopsy showed glomerulonephritis with mesangial IgA deposits. Major proteinuria persisted one year after the disappearance of dermatological lesions in spite of ACE inhibitor treatment. The role of Parvovirus B19 has been suspected as an aetiological agent in many kinds of vasculitis, e.g. polyarteritis nodosa, Wegener's disease and leucocytoclastic vasculitis. In this case report, the detection of specific IgM and the absence of other factors associated with vasculitis are consistent with a causal role of Parvovirus B19. In previously published cases, the prognosis of parvovirus B19-associated vasculitis does not seem to differ from that of idiopathic vasculitis. To our knowledge, this is the first case exhibiting concomitant and persistent severe renal involvement.

Seroprevalence of parvovirus B19 IgG in children affected by juvenile idiopathic arthritis

Parvovirus (PV) B19 is the causative agent of the childhood disease erythema infectiosum. An association of PV B19 with chronic arthropathies, sometimes resembling rheumatoid arthritis or juvenile idiopathic arthritis (JIA), has repeatedly been described. Other studies, however, have failed to identify any such relationship. In order to study further whether there is a link between PV B19 and JIA, we determined the prevalence of PV B19 specific IgG antibodies in serum samples from children with rheumatoid diseases and compared it with the prevalence in unaffected children We reasoned that if there is an association between PV B19 and JIA, then the prevalence of PV B19 IgG in the children with JIA should be higher than in the control group. PV B19 IgG status was tested in 406 children with JIA and related diseases, and in 146 children constituting a control group. The percentage of PV B19 IgG positive children was not significantly elevated in the disease subgroups compared with age-matched control groups. In conclusion, our findings do not support the hypothesis that human parvovirus B19 is involved in the pathogenesis of JIA.

Current epidemiological aspects of human parvovirus B19 infection during pregnancy and childhood in the western part of Germany

This investigation was undertaken to provide detailed information on the epidemiology of human parvovirus B19 (B19) infection during pregnancy and childhood in the western part of Germany. Between 1997 and 2004, 40,517 sera from pregnant women aged 17-45 years and 6060 sera from children and young adults were tested for B19 IgG and IgM in our laboratory. In pregnant women, both the history of a 'specific' (OR 7.7, 95% CI 5.2-11.4) and a 'non-specific' rash (OR 3.3, 95% CI 1.5-7.1) was predictive for B19 IgM positivity. The B19 IgG prevalence was 69.2% (4097/5924) in a subgroup of asymptomatic pregnant women screened for B19 antibodies. In children, the age-specific IgG-positivity rate increased from 12.2% (66/541) at 2 years of age to 71.9% (396/551) in those older than 10 years. In conclusion, the prevalence of B19 IgG in pregnant women from the western part of Germany is higher then previously reported. Contact with children aged 3-10 years is a major risk factor for exposure to B19. Pregnant women with the history of a 'non-specific' rash should also be evaluated for acute B19 infection.

Acute Human Parvovirus B-19 Infection in Hospitalized Children

The extent and clinical manifestations of acute human parvovirus B19 (B19) infection were assessed in previously healthy hospitalized children admitted with clinical syndromes potentially associated the virus. The study was prospective and was conducted between October 2002 and August 2004 in the pediatric departments of 3 hospitals in Israel. The survey included previously healthy children who were hospitalized with 1 or more of the following acute diseases: acute nonallergic exanthema, fever for >1 week, aplastic anemia or pancytopenia, acute nonbacterial arthropathy, immune thrombocytopenic purpura (ITP), Henoch-Schönlein purpura (HSP) and aseptic meningitis. A control group of children with a proven, non-B19 infection was also studied. Serum samples obtained from each child on admission were tested for B19 DNA by real-time PCR and B19 IgM by ELISA. Acute B19 infection was defined by the following criteria: positive serum B19-DNA and/or B19 IgM, negative serum B19 IgG, and no other proven infection. Overall, 167 children were included in the study. The mean age was 5.5 +/- 4.6 years (range, 0.5-17), males and females equally divided. Acute B19 infection was demonstrated in 12.6% (n = 21) of the children. Both tests were performed in 19 children and were positive in 10 (53%). In 7 and 2 children, only B19-DNA or B19 IgM, respectively, was positive. Acute B19 infection was documented in 27% (10/39) of children who presented with a variety of acute exanthema diseases; 9% (5/57) of children with acute arthropathy (all 5 had transient synovitis); 10% (2/21) of children with fever >1 week, both presented as mononucleosis syndrome; and in 44% (4/9) of children with transient pancytopenia or aplastic anemia. No acute B19 infection was demonstrated in 15 children with ITP, 9 with HSP, and 6 with aseptic meningitis and among 70 children in the control group. By logistic regression analysis, manifestations significantly associated with acute B19 infection were exanthema (OR 2.9; 95% CI = 1.1-7.5), anemia (OR 6.35; 95% CI = 2.2-18.2) and leucopenia (OR 4.14; 95% CI =1.2-14.2). Acute B19 infection was documented among 12.6% of children hospitalized with clinical syndrome potentially associated with the virus. Clinical and laboratory features associated with acute B19 infection were exanthema, anemia and leucopenia. Determination of both serum B19-DNA and serum B19 IgM should be performed for the accurate diagnosis of acute B19 infection.

Prevalência de anticorpos IgG antiparvovírus B19 em gestantes durante o atendimento pré-natal e casos de hidropisia fetal não imune atribuídos ao parvovírus B19, na Cidade do Rio de Janeiro

With the aim of measuring the prevalence of anti-parvovirus B19 IgG antibodies during pregnancy up to 24 weeks of gestation and detecting cases of nonimmune hydrops fetalis, 249 sera from pregnant women attending a reference hospital in Rio de Janeiro city, from June 2003 to November 2004 were collected. They were followed-up until the end of pregnancy, with 17 cases of fetal hydrops detected. Four cases were caused by parvovirus B19 and two of them occurred in pregnant women living in the western zone of the city, during February 2005. Anti-parvovirus B19 IgG antibodies were found in 172 (71.6%) pregnant women (CI 95% 65.5%-77.7%); this antibody prevalence is similar to results found for others Brazilian cities. The only variable associated with previous acquisition of IgG antibodies to parvovirus B19 was number of pregnancies greater than one (p= 0.02, CI 95% 0.36-0.94).

Cardiac troponin I release in non-ischemic reversible myocardial injury from parvovirus B19 myocarditis

Cardiac troponin I is released from myocytes in both reversible and irreversible myocardial injury. The changes in myocyte membrane permeability resulting from the injury could be enough for the release of cardiac troponins from the free cytosolic pool of myocytes without structural damage. We report a case of parvovirus B19 myocarditis in a 26-year-old male who developed regional wall motion abnormalities and severe left ventricular systolic dysfunction with elevated serum levels of cardiac troponin I (peak = 11.7 ng/ml). Diagnosis of parvovirus myocarditis was confirmed by presence of high titers of parvovirus B19 IgG and identification of parvovirus B19 DNA by polymerase chain reaction. Within a few days of supportive treatment, the regional wall motion abnormalities resolved, the cardiac function recovered, and the elevation in serum cardiac troponin I subsided. This case further denotes the possibility of release of cardiac troponin I in non-ischemic, reversible myocardial injury.

Sécurité des produits sanguins labiles et parvovirus B19

More than 25 years after the discovery of the parvovirus B19 (B19), the issue of the safety of blood components and the screening of this virus in blood donations is still debated. Although more often transmitted by respiratory route, B19 may also be transmitted by transfusion of blood components. This risk of exposure has been estimated to a frequency ranging from 1/625 to 1/50,000, according to the sensitivity of the detection methods and to seasonal epidemiologic circumstances. Usually, B19 is responsible for benign pathologies. However, such an infection can have a serious clinical outcome in three categories of susceptible recipients: (i) patients with shortened red cell survival (thalassemia major, sickle cell disease, other hemolytic diseases); (ii) immunocompromised patients (previously exposed to B19 or not) (iii) and pregnant women (not previously exposed the B19), with a risk of hydrops fetalis or of intrauterine death. Selected blood components, not collected during the short but highly viremic pre-seroconversion phase, could be reserved for these three groups of at-risk recipients. The screening of such viremic donations could be performed with nucleic acid testing (NAT), but an alternate strategy could be the selection of B19 immunised donors far from the primo-infection (positive for B19 IgG and negative for B19 IgM, or only positive for IgG at two controls distant of several months). However, the existence of persistently B19-infected individuals carrying B19 DNA despite the presence of specific IgG (estimated at 1% of blood donors) could constitute a potential threat for transfused immunocompromised recipients. The screening of such donors, which could be performed through a very highly sensitive NAT, would be justified only if the infectivity of such blood donations is demonstrated. If not, a screening of blood donors positive for B19 IgG would be a sufficient preventive measure.

Prevalence of anti-human parvovirus B19 IgG antibody among blood donors in Jilin province

To investigate the prevalence of the parvovirus B19 infection among the blood donors in Jilin province to provide the basic data to evaluate the epidemics of B19 virus in China. Indirect ELISA was used to detect IgG antibody against parvovirus B19 in the sera from blood donors. In a total of 184 serum samples, IgG antibody was detected in 55.43% samples, antibody positive rate in female was significantly higher than that in male (P<0.05) and the positive rate peaked at 35-45 years age group. These data illustrate that the prevalence of the B19 antibody in blood donors of Jilin province was high, and it is therefore necessary to detect the B19 DNA to ensure the blood safety.

Parvovirus B19 Infection Contributes to Severe Anemia in Young Children in Papua New Guinea

Severe anemia (hemoglobin level, <50 g/L) is a major cause of death among young children, and it arises from multiple factors, including malaria and iron deficiency. We sought to determine whether infection with parvovirus B19 (B19), which causes the cessation of erythropoiesis for 3-7 days, might precipitate some cases of severe anemia. Archival blood samples collected in the Wosera District of Papua New Guinea, from 169 children 6 months-5 years old with severe anemia and from 169 control subjects matched for age, sex, and time were tested for B19 immunoglobulin M (IgM) by enzyme immunoassay and for B19 DNA by nested polymerase chain reaction (PCR). A total of 168 separate samples from children in the Wosera District were tested for B19 IgG. A strong association between acute B19 infection (positive by both IgM and PCR) and severe anemia was found (adjusted odds ratio, 5.61 [95% confidence interval, 1.93-16.3]). The prevalence of parvovirus B19 IgG reached >90% in 6-year-olds. B19 infections play a significant role in the etiology of severe anemia in this area of malarial endemicity. Given the high levels of morbidity and mortality associated with severe anemia in such regions, the prevention of B19 infection with a vaccine might be a highly effective public health intervention.

The Immune Response to Parvovirus B19 Exposure in Previously Seronegative and Seropositive Individuals

Little information is available on the immune response to parvovirus B19 after the administration of contaminated blood products. In the present study, we found that levels of B19 IgG in B19-seropositive recipients protect against reinfection and, after transfusion with pooled plasma containing B19 DNA (1.6 x 10(8) IU/mL), increase from 19-39 IU/mL to 50-100 IU/mL. We found that, in the presence of 1.6-2.2 x 10(8) IU of B19 DNA/mL in B19-seronegative recipients, a pooled-plasma B19 IgG level of 59.5 IU/mL is insufficient to prevent B19 transmission and subsequent seroconversion. These data should lead to improvements in the assessment of blood-product safety.

Discordant Fetal Infection for Parvovirus B19 in a Dichorionic Twin Pregnancy

There are only a few reports of fetal parvovirus infection in the circumstance of a twin pregnancy. We report a case of differential fetal infection following maternal parvovirus B19 infection in a dichorionic twin pregnancy culminating in a dual live-birth. A 32-year-old woman was diagnosed with parvovirus infection following exposure to her infected child at 19 weeks' gestation in a dichorionic twin gestation. Maternal IgG seroconversion was documented and maternal blood parvovirus B19 DNA was detected by PCR testing. Fetal monitoring with serial ultrasound assessment was instituted. At 25 weeks' gestation Twin I (male) displayed minor ascites, small pericardial effusion, placentomegaly and oligohydramnios. Middle cerebral artery peak systolic velocity (MCA PSV) studies were abnormal. Twin II (female) was sonographically unremarkable. A single fetal intravascular transfusion for Twin I was performed (pretransfusion Hb 80 g/L). Twin I fetal blood parvovirus B19 DNA was detected by polymerase chain reaction (PCR) and serum demonstrated both B19 IgG and IgM. Following fetal transfusion the hydrops resolved, although the placentomegaly persisted. Two live infants were delivered at 37 weeks' gestation. Individual neonatal venepuncture detected B19 DNA by PCR in Twin I but not in Twin II. B19 IgM was present in Twin I but not Twin II. Both neonates had B19 IgG antibodies. Placental histopathology demonstrated mild edema for Twin I but no inclusion cells. The placenta of Twin II was unremarkable. This case demonstrates the ability for differential transplacental infection of this virus and the assistance of fetal MCA flow studies to guide therapy in a multiple pregnancy at risk of parvovirus infection.

Discordant Fetal Infection for Parvovirus B19 in a Dichorionic Twin Pregnancy

AbstractThere are only a few reports of fetal parvovirus infection in the circumstance of a twin pregnancy. We report a case of differential fetal infection following maternal parvovirus B19 infection in a dichorionic twin pregnancy culminating in a dual live-birth. A 32-year-old woman was diagnosed with parvovirus infection following exposure to her infected child at 19 weeks' gestation in a dichorionic twin gestation. Maternal IgG seroconversion was documented and maternal blood parvovirus B19 DNA was detected by PCR testing. Fetal monitoring with serial ultrasound assessment was instituted. At 25 weeks' gestation Twin I (male) displayed minor ascites, small pericardial effusion, placentomegaly and oligohydramnios. Middle cerebral artery peak systolic velocity (MCA PSV) studies were abnormal. Twin II (female) was sonographically unremarkable. A single fetal intravascular transfusion for Twin I was performed (pretransfusion Hb 80 g/L). Twin I fetal blood parvovirus B19 DNA was detected by polymerase chain reaction (PCR) and serum demonstrated both B19 IgG and IgM. Following fetal transfusion the hydrops resolved, although the placentomegaly persisted. Two live infants were delivered at 37 weeks' gestation. Individual neonatal venepuncture detected B19 DNA by PCR in Twin I but not in Twin II. B19 IgM was present in Twin I but not Twin II. Both neonates had B19 IgG antibodies. Placental histopathology demonstrated mild edema for Twin I but no inclusion cells. The placenta of Twin II was unremarkable. This case demonstrates the ability for differential transplacental infection of this virus and the assistance of fetal MCA flow studies to guide therapy in a multiple pregnancy at risk of parvovirus infection.

Increased seroprevalence of parvovirus B 19 IgG in complex regional pain syndrome is not associated with antiendothelial autoimmunity

The etiology of complex regional pain syndrome (CRPS) is unclear yet. Recently autoantibodies and antecedent viral infections have been discussed to be involved in the pathogenesis of CRPS. We investigated sera from 39 CRPS patients and healthy controls for parvovirus B19 IgG and the occurrence of antiendothelial autoantibodies (AECA). CRPS patients showed a higher seroprevalence of parvovirus B19 IgG than controls ( p < 0.01). All CRPS 2 patients were positive. 10.2% of the CRPS patients and 10.0% of the controls had AECA (n.s.) and AECA were not associated with parvovirus B19 seropositivity. Our findings suggest the involvement of parvovirus B19, but not autoantibody-mediated endothelial cell damage, in the pathogenesis of CRPS.

Autoantibody Reaction to Myelin Basic Protein by Plasma Parvovirus B19 IgG in MS Patients

The etiology of multiple sclerosis (MS) remains unclear. To determine if autoantibodies to myelin basic protein (MBP) are produced during parvovirus B19 infection, a competitive ELISA was performed using plasma from MS patients exhibiting high IgG titers for parvovirus. Our results showed the addition of MBP decreased the binding of IgG to B19 antigen in a dose dependent fashion suggesting a possible link between parvovirus B19 and a subset of patients with clinical MS.

Incidence of parvovirus B19 infection among an unselected population of pregnant women in the Netherlands: A prospective study

Objective To evaluate seroprevalence of anti-parvovirus B19 IgG immunoglobulins and the rate of seroconversion in seronegative pregnant women. Design Prospective assessment of anti-parvovirus B19 IgG immunoglobulins in an unselected population of pregnant women booked for antenatal care from 1998 to 2000. Setting Maternity departments of an academic hospital and four affiliated teaching hospitals in the Netherlands. Subjects Two thousand five hundred and sixty seven pregnant women. Main outcome measures Seroprevalence of anti-parvovirus B19 IgG immunoglobulin in the first trimester of pregnancy and subsequent seroconversion in those women who were tested negative for parvovirus B19 antibodies in the first trimester of pregnancy. Results The estimated seroprevalence of anti-parvovirus B19 IgG immunoglobulins among the study population is 70% (95% CI: 68–71) in the first trimester of pregnancy. Seven hundred and seventy nine women tested negative for parvovirus B19 antibodies in the first trimester of pregnancy. Paired testing in these women confirmed 18 seroconversions. Based on these findings the estimated incidence of maternal parvovirus B19 infection in this population among seronegative Dutch women is 2.4% (95% CI: 1.4–3.7). Conclusion Maternal infection with parvovirus B19 is relatively common. However, it is argued that in the Netherlands routine assessment of parvovirus antibodies in pregnant women is not warranted as there is a low risk of adverse fetal outcome and measures to prevent the parvovirus B19 infection and its consequences are very limited.

A Returning Traveler with Fever and Rash

Diagnosis: Papular-purpuric gloves-and-socks syndrome secondary to parvovirus B19 infection. Given the persistent fever, hematologic abnormalities, and new rash, a diagnostic workup for viral illness was performed. Viral serologic tests were performed, including tests for hepatitis B virus, hepatitis C virus, Epstein-Barr virus, cytomegalovirus, and parvovirus B 19. Results of tests for hepatitis B virus surface antigen, hepatitis C virus antibody, and IgM against EpsteinBarr virus viral capsid antigen were negative, as was the result of a mononucleosis spot test. The serologic titer for parvovirus B19 IgG was 5.03 (>1.10 is defined as a positive result), and the titer for parvovirus B19 IgM was 6.79 (>1.10 is a positive result). Serum tested positive for parvovirus B19 by PCR. The patient remained febrile but better tolerated intake of food and liquids. Therefore, the patient was discharged to home. At a follow-up examination 1 week later, he was afebrile and had no rash or lymphadenopathy, and laboratory values were normal.

P06.03: Discordant fetal infection for parvovirus in a dichorionic twin pregnancy

There are only a very few reports of fetal parvovirus infection in the circumstance of a twin pregnancy. We report a case of differential fetal infection following maternal parvovirus infection in a dichorionic twin pregnancy. A 32-year-old woman was diagnosed with parvovirus infection following exposure to her infected child at 19 weeks’ gestation in a dichorionic diamniotic twin gestation. Maternal seroconversion was documented and parvovirus B19 DNA was present on PCR testing. Fetal monitoring with serial ultrasound assessment was instituted and at 25 weeks gestation Twin I (male) displayed mild ascites, pericardial effusion, placentomegaly and oligohydramnios. The MCA PSV was elevated. Twin II (female) was sonographically unremarkable and the MCA PSV was not elevated. A single fetal intravascular transfusion for Twin I was performed (pretransfusion Hb 80 g/L). Twin I fetal blood was positive for parvovirus B19 DNA and serum demonstrated both IgG and IgM. Following the fetal transfusion the sonographic hydrops resolved, although the placentomegaly persisted. Delivery at 37 weeks’ gestation resulted in live male and female fetuses. Both were vigorous at delivery. Individual neonatal venepuncture showed B19 DNA on PCR to be present in Twin I but absent in Twin II. IgM was present for B19 in Twin I but not Twin II. Both neonates had B19 IgG antibodies, passively acquired from the mother. Histopathology of the placentae demonstrated mild edema in that of Twin I but no inclusion cells. The placenta of Twin II was unremarkable. In conclusion, we present a case of discordant fetal infection in a dizygotic dichorionic twin pregnancy for parvovirus, with a dual live birth at term and no adverse perinatal sequelae. This case demonstrates the ability for differential transplacental infection of this virus and the assistance of MCA flow studies to guide therapy in a multiple pregnancy at risk of parvovirus infection.

Non-hydropic intrauterine fetal death more than 5 months after primary parvovirus B19 infection

Clinical follow-up of possible fetal complications associated with maternal parvovirus B19 infection is usually recommended during the 2-3 months after primary infection. A case of late intrauterine fetal death associated with at least 5 months of maternal parvovirus B19 viremia and in the presence of B19 IgG and IgM is described. The time of clinical and laboratory follow-up after maternal parvovirus B19 infection may need to be revised if prolonged viremia is more common than previously described.

Seroprevalence of parvovirus B19 infection in daycare educators

This study was undertaken to provide first-time estimates for the seroprevalence of parvovirus B19 infection among daycare educators in Montréal, Canada, and to identify factors associated with seropositivity. A cross-sectional design was used. Directors and educators from 81 daycare centres (DCCs) were surveyed about DCC and personal characteristics respectively, and serum samples from 477 female educators were tested for parvovirus B19 IgG antibodies. The seroprevalence of parvovirus B19 was 70%. Parvovirus B19 seropositivity was significantly associated with age and with working experience in DCCs, but the latter association was restricted to educators aged less than 40 years. In conclusion, working as a daycare educator appears to be associated with increased risk of acquiring parvovirus B19 infection, but this finding will require further investigation. Because of the large proportion of educators susceptible to acquiring parvovirus B19 infection, our findings also highlight the need for preventive measures.