Erythema Infectiosum Research Articles

Investigation of Parvovirus B19 IgM and IgG Positivity Rates in Pediatric Hematology Patients

AbstractHuman parvovirus B19 is a frequent etiologic agent causing erythema infectiosum in children. It has recently been suggested that parvovirus B19 may be latent after infection and cause reactive infections especially in immunosuppressed patients with hematological problems. In this study, we aimed to investigate the parvovirus B19 immunoglobulin M (IgM) and immunoglobulin G (IgG) seropositivity rates of patients evaluated in a pediatric hematology clinic. We retrospectively screened the laboratory results of parvovirus B19 IgM and IgG antibody assays of children less than 18 years, who consulted pediatric in-and-outpatient clinics between 2013 and 2016. Parvovirus B19 IgM and IgG antibodies were investigated in serum samples by using enzyme-linked immunosorbent assay method in the Medical Microbiology Laboratory. Parvovirus B19 IgM antibodies were detected in 109 of 602 patients attending pediatric hematology clinics (18.1%). Parvovirus B19 IgG antibody was detected in 244 of 952 patients attending pediatric hematology clinics (25.6%). Parvovirus B19 IgM and IgG positivity in samples from pediatric in-and-outpatient clinics other than pediatric hematology were 2.8% and 35.7%, respectively. Parvovirus IgM and IgG positivity in serum samples sent from the pediatric hematology clinic and outpatients was statistically significant compared with those sent from pediatric clinics other than pediatric hematology (p = 0.0001 and p = 0.0008, respectively). The higher detection rate of serum parvovirus B19 IgM positivity in patients under the follow-up of pediatric hematology clinics suggests that immune suppression-related viral reinfection or persistence may occur in these patients.

Short Term Prediction of Infectious Diseases Patients from Prescription Surveillance

In Japan, the incidence of almost all common pediatric infectious diseases has been monitored, with 7 - 10 day delays, at medical institutions through the National Official Sentinel Surveillance of Infectious Diseases (NOSSID). On the other hand, based on prescriptions filled at external pharmacies, Prescription Surveillance (PS) collects information and provides estimated numbers of influenza, varicella, and gastroenteritis infectious (GI) patients to the public the following morning. For precise, and real-time estimation of incidences of common pediatric infectious diseases, we evaluated predictive power of PS for diseases other than influenza, varicella, and GI. Results demonstrated that PS information has sufficient predictive power for pharyngoconjunctival fever, group A streptococcal pharyngitis, exanthem subitum, and mumps, some predictive power for RS virus infection, erythema infectiosum and herpangina, but insufficient predictive power for hand, foot and mouth disease.

Fifth Disease: A Review

Erythema infectiosum which is also popularly called as is a contagious caused by Parvovirus B19, its endemic in parts of Europe and children are vulnerable to contract this illness; however the treatment is symptomatic but once recovered individual gains life time immunity. The name Fifth disease comes from its place on the standard list of rash-causing childhood diseases, which also includes measles (first), scarlet fever (second), rubella (third), Dukes ’disease (fourth, but is no longer widely accepted as distinct) and roseola (sixth). is viral illness that most kids recover from quickly and without complications. Also called erythema infectiosum, it's caused by parvovirus B191.

Detection of parvovirus B19 in selected high-risk patient groups & their phylogenetic & selection analysis.

Background & objectives:Human parvovirus B19V (B19V) is known to be associated with erythema infectiosum commonly in children, aplastic crisis, especially in persons with underlying haemolytic disorders, hydrops fetalis in pregnancies and arthritis. This cross-sectional study was aimed to determine the presence of B19V infection in childhood febrile illnesses, association of B19V with arthropathies and in adult patients with end-stage renal disease (ESRD) on dialysis. The genetic diversity among the sequences was also analysed.Methods:A nested polymerase chain reaction (nPCR) assay was used for B19V DNA targeting VP1/VP2 region and used for testing 618 patients and 100 healthy controls. Phylogenetic analysis on nucleotide and amino acid sequences was carried out to compare our sequences with other Indian strains and global strains.Results:Among 618 samples tested, seven (1.13%) were found positive. The phylogenetic analysis revealed that all the seven sequences belonged to genotype 1 and showed low genetic diversity. The clustering pattern of seven sequences was similar both by nucleotide and by predicted amino acid sequences. The fixed effects likelihood analysis showed no positive or negatively selected sites.Interpretation & conclusions:Seven samples (4 from non-traumatic arthropathies, 2 from patients with ESRD and 1 from febrile illness patient) were found positive by nPCR. When our seven sequences were compared with global strains, the closest neighbour was other Indian strains followed by the Tunisian strains.

Common childhood illnesses: slapped cheek syndrome

Slapped cheek syndrome is a common childhood illness that around 50–60% of the population have had at some point in their lifetime. While the symptoms are usually mild and do not require medical intervention, the illness can be dangerous to pregnant women, the immunocompromised and children with hereditary anaemia.

Recognising the signs of slapped cheek syndrome

There have been recent outbreaks of slapped cheek syndrome or fifth disease in the UK. Dorothy Lepkowska looks at some of the signs and what parents should know.

Investigating the Role of the Human Parvovirus B19's Main Viral Protein, NS1, in Viral Replication and Interactions with Host DNA

Human Parvovirus B19 (B19V) is a ubiquitous virus that infects the majority of the human population. B19V is a non‐enveloped, single stranded DNA virus with a viral genome composed of 5594 nucleotides. Infection with B19V has been associated with a multitude of diseases, such as hydrops fetalis, arthropathy, hepatitis, cardiomyopathy, erythema infectiosum (Fifth disease), and possible onset of a variety of autoimmune diseases. The viral genome of B19V encodes for five known, possible six, protein products: VP1 and VP2 that compose the capsid, NS1, the main viral protein, and two to three smaller protein products of indistinct function. The main replicative protein, NS1, is a multiple domain protein with a nuclease domain, helicase domain, and a C‐terminal domain. Through its multi‐functional capabilities, NS1 has been hypothesized to play several roles in the triggering autoimmune disease via formation of covalent DNA‐NS1 adducts and/or host gene transactivation. In order to understand the mechanism behind NS1's ability to bind viral and host genomic DNA, biochemical experiments were carried out to build a model for NS1's role in viral genome replications and host gene transactivation capabilities.Support or Funding InformationSupported by: the National Science Foundation under Grant MCB1410355, and National Institutes of Health via Grant S10OD013237

Molecular diversity of human parvovirus B19 during two outbreaks of erythema infectiosum in Brazil

This study was conducted to provide information on the genetic diversity of human parvovirus B19 (B19V) circulating in the municipality of Niterói, Rio de Janeiro, Southeast Brazil during 1996–2006, a period with two distinct outbreaks of B19V infection: 1999–2000 and 2004–2005. A total of 27 sera from patients with erythema infectiosum and five sera from HIV-infected patients that tested positive for B19V DNA during the study period were analyzed. To genotype B19V strains, a semi-nested PCR for partial amplification of the capsid gene was performed and sequence analysis revealed that 31 sequences belonged to subgenotype 1a (G1a) of the main genotype 1 and one sequence was characterized as subgenotype 3b (G3b). The phylogenetic tree supported the division of the G1a into two well-defined clades with 1.3% of divergence. The low diversity of the G1a strains may be explained by the fact that all patients had acute B19V infection and 30/32 sera were collected during two distinct outbreaks. The G3b strain was from an HIV-infected patient who seroconverted to anti-B19 IgG antibodies in September/2005. This is the first report of G3b in the state of Rio de Janeiro.

DNA Binding and Cleavage by the Human Parvovirus B19 NS1 Nuclease Domain

Infection with human parvovirus B19 (B19V) has been associated with a myriad of illnesses, including erythema infectiosum (Fifth disease), hydrops fetalis, arthropathy, hepatitis, and cardiomyopathy, and also possibly the triggering of any number of different autoimmune diseases. B19V NS1 is a multidomain protein that plays a critical role in viral replication, with predicted nuclease, helicase, and gene transactivation activities. Herein, we investigate the biochemical activities of the nuclease domain (residues 2-176) of B19V NS1 (NS1-nuc) in sequence-specific DNA binding of the viral origin of replication sequences, as well as those of promoter sequences, including the viral p6 and the human p21, TNFα, and IL-6 promoters previously identified in NS1-dependent transcriptional transactivation. NS1-nuc was found to bind with high cooperativity and with multiple (five to seven) copies to the NS1 binding elements (NSBE) found in the viral origin of replication and the overlapping viral p6 promoter DNA sequence. NS1-nuc was also found to bind cooperatively with at least three copies to the GC-rich Sp1 binding sites of the human p21 gene promoter. Only weak or nonspecific binding of NS1-nuc to the segments of the TNFα and IL-6 promoters was found. Cleavage of DNA by NS1-nuc occurred at the expected viral sequence (the terminal resolution site), but only in single-stranded DNA, and NS1-nuc was found to covalently attach to the 5' end of the DNA at the cleavage site. Off-target cleavage by NS1-nuc was also identified.

The VP1u Receptor Restricts Parvovirus B19 Uptake to Permissive Erythroid Cells.

Parvovirus B19 (B19V) is a small non-enveloped virus and known as the causative agent for the mild childhood disease erythema infectiosum. B19V has an extraordinary narrow tissue tropism, showing only productive infection in erythroid precursor cells in the bone marrow. We recently found that the viral protein 1 unique region (VP1u) contains an N-terminal receptor-binding domain (RBD), which mediates the uptake of the virus into cells of the erythroid lineage. To further investigate the role of the RBD in connection with a B19V-unrelated capsid, we chemically coupled the VP1u of B19V to the bacteriophage MS2 capsid and tested the internalization capacity of the bioconjugate on permissive cells. In comparison, we studied the cellular uptake and infection of B19V along the erythroid differentiation. The results showed that the MS2-VP1u bioconjugate mimicked the specific internalization of the native B19V into erythroid precursor cells, which further coincides with the restricted infection profile. The successful mimicry of B19V uptake demonstrates that the RBD in the VP1u is sufficient for the endocytosis of the viral capsid. Furthermore, the recombinant VP1u competed with B19V uptake into permissive cells, thus excluding a significant alternative uptake mechanism by other receptors. Strikingly, the VP1u receptor appeared to be expressed only on erythropoietin-dependent erythroid differentiation stages that also provide the necessary intracellular factors for a productive infection. Taken together, these findings suggest that the VP1u binds to a yet-unknown erythroid-specific cellular receptor and thus restricts the virus entry to permissive cells.

Erythema Infectiosum: clinical case

Human Parvovirus B19 has been recognized as the causative agent of a wide range of diseases. The cellular receptorfor parvovirus B19 is P antigen located on the trophoblast cells, bone marrow, liver, kidney, synovium, etc. has been associated with many clinical situations, erythema infectiosum and erythroblastopenia crisis. In the absence of P-antigen, revealed no susceptibility to parvovirus infection. Infection in pregnant women under 20 weeks gestation can lead to miscarriage or non-immune hydrops, fetal death. 1-5% of women are susceptible to parvovirus infection during pregnancy. Viral infection may be responsible for aplastic anaemia in immuno-compromised patients. Diagnosis ofparvovirus infection B19 is based on the results of general blood analysis; biochemical analysis of blood; serological methods, PCR detection of IgM, immunoblot IgM/IgG. The most common clinicalform of parvovirus B19 infection in children is erythema infectiosum. It is also called “fifth disease”. Erythema infectiosum is characterized by a viral prodrome followed by the “slapped cheek’ facial rash and macula papular lace or mesh rash on the skin of the trunk and extensor surfaces.

Seroprevalence of human parvovirus B19 in children with fever and rash in the North of Tunisia

The aim of the study is to evaluate the prevalence of specific antibodies anti-human parvovirus B19 (PVB19) immunoglobulin M (IgM) and IgG in children with fever and rash. This study involved 257 children aged from 7 months to 15 years with febrile rash unrelated to measles and rubella (seronegative for IgM). The sera were examined by immunoenzymatic assay. Detection of antibodies of PVB19 was done by enzyme-linked immunosorbent assay (Elisa). In our study, prevalence of immunoglobulin G (IgG) and IgM were 44 and 11.3%, respectively. Clinically, children with positive IgM serology had submitted an erythema infectiosum (13/29 cases), myocarditis (1 case), encephalitis (1 case), severe sickle cell anemia (7 cases), and immunocompromised (7 cases). The incidence rate of viral infection was 11.3%; most of the cases of PVB19 infection occurred between the months of May and August. Incidence was higher in the 10-15 years age group (21%). The prevalence of IgG antibody varied and increased with age, it rises from 38.2% in preschool children (19 months-4 years) to 53.5% in those aged between 4.5 and 15 years, reaching 58% in the 10-15 years age group. The four risk factors of PVB19 infection are: (1) those aged between 4.5 and 9 years, which is the most affected age group (P = 0.0018); (2) female gender in children aged between 19 months and 4 years (P = 0.037); (3) transfusion and (4) immune deficiency (P = 0.022 and P = 0.001, respectively). The study of the prevalence of PVB19 infection shows that viral infection is acquired early in childhood, increases with age; viral transmission is favored by the community life. Because of the widespread vaccination program against measles and rubella, the systematic search of PVB19 in front of eruptive fevers becomes important.

Atypical Papular Purpuric Eruption Induced by Parvovirus B19 Infection

Parvovirus B19 infection’s most common dermatological manifestation is erythema infectiosum as also known the fifth disease. Rare clinical presentations of parvovirus B 19 like papulopurpuric gloves and socks syndrome and acropetechial syndrome has also been described recently. This study presents report of a case with atypical feature and distribution of rash due to parvovirus B19 infection. We want to emphasize that pediatricians should consider parvovirus B19 infection of any patient who has leukopenia presenting with petechial/purpuric eruption of an unclear origin. Key words: Parvovirus B 19, papulopurpuric eruption, childhood

The Receptor-Binding Domain in the VP1u Region of Parvovirus B19.

Parvovirus B19 (B19V) is known as the human pathogen causing the mild childhood disease erythema infectiosum. B19V shows an extraordinary narrow tissue tropism for erythroid progenitor cells in the bone marrow, which is determined by a highly restricted uptake. We have previously shown that the specific internalization is mediated by the interaction of the viral protein 1 unique region (VP1u) with a yet unknown cellular receptor. To locate the receptor-binding domain (RBD) within the VP1u, we analyzed the effect of truncations and mutations on the internalization capacity of the recombinant protein into UT7/Epo cells. Here we report that the N-terminal amino acids 5–80 of the VP1u are necessary and sufficient for cellular binding and internalization; thus, this N-terminal region represents the RBD required for B19V uptake. Using site-directed mutagenesis, we further identified a cluster of important amino acids playing a critical role in VP1u internalization. In silico predictions and experimental results suggest that the RBD is structured as a rigid fold of three α-helices. Finally, we found that dimerization of the VP1u leads to a considerably enhanced cellular binding and internalization. Taken together, we identified the RBD that mediates B19V uptake and mapped functional and structural motifs within this sequence. The findings reveal insights into the uptake process of B19V, which contribute to understand the pathogenesis of the infection and the neutralization of the virus by the immune system.

Seroprevalence of erythrovirus B19 in Saudi pregnant women.

Background:Erythrovirus B19 infection is associated with clinical symptoms that range from mild to severe. The common clinical presentation of B19 virus (B19V) infection is erythema infectiosum, arthropathy, aplastic crisis, and fetal infection. Infection in seronegative pregnant women can lead to fetal hydrops.Objectives:To determine the seroprevalence of immunoglobulin G (IgG) to erythrovirus B19 in Saudi pregnant women in the cities of Makkah and Jeddah in Saudi Arabia.Materials and Methods:A total of 364 blood (serum) samples were tested for erythrovirus B19-specific-IgG antibody in Saudi pregnant women in the cities of Makkah and Jeddah in Saudi Arabia.Results:Erythrovirus B19-specific-IgG antibodies were detected in 182/364 (50%) of Saudi pregnant women of different age groups.Conclusion:This study indicated that B19V is clearly circulating in the community in a way that is similar to what is found in most nontemperate countries.

Atypical rashes in adult human Parvovirus B19 infection; atypical is typical

The childhood illness erythema infectiosum (EI) is caused by Parvovirus (PV) B19 with a slapped cheek-like rash and sometimes a lace-like rash on the extremities but cutaneous manifestions in infection in the adult can be atypical. A healthy 38-year-old male office worker and a 32-year-old non-pregnant female kindergarten teacher presented with fever (former; 37.2 °C for 3 days, latter 38.1 °C for 4 days) following a skin rash persisting several days at different times. Both had a non-pruritic rash (Fig. 1, Fig. 2) on the extremities and a painful postauricular lymphadenopathy. PV B19 infection was confirmed in both by a positive enzyme-linked immunosorbent assay (ELISA) result for serum PV B19-specific IgM. Neither had a typical facial rash nor painful joints. Although the man had no history of exposure to PV B19 infection, the woman was exposed to kindergarteners who with PV B19 infection.

Primate Erythroparvovirus 1 (Parvovirus B19): An Etiologic Agent of Ataxia and Cerebellar Disease?

Ataxia, a gross lack of motor control, is symptomatic of broader neurological disorder, typically of the cerebellum. A few case reports have documented the association of primate erythroparvovirus 1 [more commonly known as human parvovirus B19 (B19)] with ataxia. Parvoviruses are small DNA viruses that infect many different species. B19 is a well-known cause of erythema infectiosum, a common rash disease of childhood. B19 is also a cause of hydrops fetalis, a severe anemia of the fetus. Is it possible that the human parvovirus B19 is a cause of ataxia

How Do Viruses Really Cause Neuropathology?: Is There More to the Story

Our work has focused over the years on Primate Erythroparvovirus 1 [more commonly known as parvovirus B19 (B19)]. B19 is a human pathogen that is the causative agent of erythema infectiosum, the common rash disease of childhood. In addition to several other human diseases, B19 has also been associated with multiple brain diseases. Those brain diseases include, but are not limited to, encephalitis, encephalopathy, meningitis, meningoencephalitis, ataxia, seizures, and stroke. To date, the association has grown, but causation has not been determined. Several possible mechanisms of pathogenesis including direct infection, indirect/epigenetic, reactivation, and autoimmune/ inflammatory cytotoxicity, as well as effects due to infection of other organs have been suggested. We will also offer other hypotheses.

A case report: cerebellar ataxia associated to parvovirus b19

Human parvovirus B19 (PVB19) is well known to cause erythema infectiosum and has other pathological manifestations such as central nervous system (CNS) diseases, aplastic crisis, thrombocytopenia, purpura, myocarditis, and arthritis. Meningitis and encephalitis have been reported in association with this viral infection, but acute cerebellar ataxia has rare previously been documented. We report a 2 year old boy admitted acute cerebellar ataxia in association with erythematous skin lesion. He was diagnosed as human parvovirus B19 after serological tests. İn his physical examination we remarked ataxic gait, nystagmus and erytematous lesions on body. İn the 3rd day, ıdiopathic thrombocytopenic purpura was developed. All laboratuary findings were normal except thrombocytopenia. He had normal cranial MR imaging. Serology was positive for antibodies to IgM and IgG antibodies against PVB19 in blood and cerebrospinal fluid. Ataxia and nystagmus disappeared in a week without any spesific treatment. Acute cerebellar ataxia occurs in association with various viral and non-viral infections and vaccines. It has been assumed that most acute cerebellar ataxia cases result from postinfectious allergic autoimmune reactions. Antineuronal antibodies were detected in patients following ınfections . Our case was thought to be acute cerebellar ataxia caused by PVB19 infection. To the best of our knowledge, case reports of acute cerebellar ataxia associated with PVB19 infection are rare. Further attempts are required to clarify the role of this virus in the development of acute cerebellar ataxia as about 30% of PVB19 infections in children. Keywords: acute cerebellar ataxia; erythema infectiosum;human parvovirus B19

Proposition of real-time precise prediction model of infectious disease patients from Prescription Surveillance using the National Database of Electronic Medical Claims.

The incidence of common pediatric infectious diseases has been monitored officially at sentinel medical institutions in Japan. However, the numbers of affected patients are not provided. Prescription Surveillance (PS), which infers the number of patients with influenza, varicella, and gastrointestinal infections from data related to prescriptions at external pharmacies, provides estimates to the public the following morning. This study assessed the prediction ability of the incidence of common pediatric infectious diseases from PS information using the National Database of Electronic Medical Claims (NDBEMC): the number of patients prescribed neuraminidase inhibitors, anti-herpes virus drugs, antibiotic drugs, antipyretic analgesics, and multi-ingredient cold medications. The diseases include RS virus infection, pharyngoconjunctival fever, hand, foot and mouth disease, erythema infectiosum, exanthem subitum, pertussis, herpangina, influenza, varicella, and gastrointestinal infection. For comparison, we used the estimated number of patients who were prescribed neuraminidase inhibitor in PS, which had been confirmed already for precision, and provided estimates to the general public via the internet. The discrepancy rates of all considered diseases between the reported number in NDBEMC and the predicted numbers of patients from PS were less than the value in NI counts and the coefficients of determination in the estimation were from .8109 to .9825. These predictions were sufficiently precise to provide to the general public.