Evidence Of Parvovirus B19 Infection Research Articles

Case Report: Susceptibility to viral infections and secondary hemophagocytic lymphohistiocytosis responsive to intravenous immunoglobulin as primary manifestations of adenosine deaminase 2 deficiency

Deficiency of adenosine deaminase 2 (DADA2) is an autosomal recessive disease associated with a highly variable clinical presentation, including systemic vasculitis, immunodeficiency, and cytopenia. We report a case of a 16-year-old girl affected by recurrent viral infections [including cytomegalovirus (CMV)-related hepatitis and measles vaccine virus-associated manifestations] and persistent inflammation, which occurred after Parvovirus infection and complicated by secondary hemophagocytic lymphohistiocytosis (HLH). HLH’s first episode presented at 6 years of age and was preceded by persistent fever and arthralgia with evidence of Parvovirus B19 infection. The episode responded to intravenous steroids but relapsed during steroids tapering. High-dose intravenous immunoglobulin (IVIG) helped manage her clinical symptoms and systemic inflammation. The frequency of IVIG administration and the dosage were progressively reduced. At the age of 9, she experienced varicella zoster virus (VZV) reactivation followed by the recurrence of the inflammatory phenotype complicated by HLH with neurological involvement. Again, high-dose steroids and monthly IVIG resulted in a quick response. Targeted next-generation sequencing (NGS) for autoinflammatory diseases and immunodeficiencies revealed the homozygous Leu183Pro ADA2 mutation, which was confirmed by Sanger analysis. ADA2 enzymatic test showed a complete loss of ADA2 activity. For about 3 years, IVIG alone was completely effective in preventing flares of inflammation and neurological manifestations. Anti-TNF treatment was started at the age of 13 for the appearance of recurrent genital ulcers, with a complete response. This case further expands the clinical spectrum of DADA2 and emphasizes the importance of extensive genetic testing in clinical phenotypes characterized by persistent unspecific inflammatory syndromes. The use of high doses of IVIG might represent a possible effective immune modulator, especially in combination with anti-TNF treatment.

A case report of papular-purpuric gloves and socks syndrome: A manifestation of the parvovirus B19

Introduction: the majority of parvovirus b19 infections are asymptomatic. In childhood, however, they may present as the fifth disease and in adults their manifestations can vary from mild, non-specific, cold-like symptoms to other forms of presentations. Papular-purpuric gloves and socks syndrome (PPGss) is an uncommon form of parvovirus b19 infection, characterized by symmetric, pruriginous and painful erythema and edema of feet and hands. Generally, systemic symptoms are usually mild and dissemination to other body regions occurs in only 50% of the cases. the rash gradually progresses to petechiae and purpura delineating well demarcated “socks” and “gloves” on both feet and hands. the diagnosis is predominantly based on the clinical features. serologic conversion is not considered as evidence of parvovirus b19 infection and histopathological findings from lesional skin are not specific. there are no definite antiviral

Adult Reye-like syndrome associated with serologic evidence of acute parvovirus B19 infection

Reye's syndrome is an infrequently diagnosed medical condition affecting mainly children. The etiology, epidemiology and natural history of Reye's syndrome have been cloudily written in footnotes of medical books and exotic papers since the initial description in early 1950s. We report here a case of adult Reye's syndrome associated with serologic evidence of parvovirus B19 infection.

The investigation of parvovirus B19 infection in patients with haematological disorders by using PCR and ELISA techniques

Parvovirus B19 has a marked tropism for erythroid progenitor cells. This may lead to chronic anemia in predisposed individuals. The purpose of the study was to investigate the frequency of parvovirus B19 infections in patients with diagnosis of haematological disorders. In order to determine the diagnostic use of different markers of parvovirus B19 infection, serum specimens obtained from 79 patients with haematological disorders were tested for specific antibodies and viral DNA through the use of ELISA and PCR techniques. Evidence of parvovirus B19 infection was found in 23/79 (29.1%) patients by demonstrating viral DNA and/or specific IgM antibody. B19 infection was established in 3 of 11 patients with chronic myeloid leukemia, in 3 of 11 acute myeloid leukemia, in 2 of 11 patients with multiple myeloma, in 3 of 8 patients with Hodgkin's lymphoma, in 5 of 10 patients with non-Hodgkin's lymphoma, in 1 of 6 patients with myelodysplastic syndrome, in 4 of 11 patients with chronic lymphocytic leukemia, and in 2 of 11 patients with acute lymphocytic leukemia. In 4 of 23 positive patients, only parvovirus B19 DNA could be detected, while 7 patients were tested positive for both parvovirus B19 DNA and specific IgM. Nine patients were tested positive for both B19 DNA and specific IgG. In the remaining 3 positive patients only specific IgM could be detected. Due to the discrepancies between DNA and IgM results, the diagnostic procedures should include a search for specific DNA by PCR methods if specific IgM has been found to be negative.

Evidence of parvovirus B19 infection in patients of pre‐eclampsia and eclampsia with dyserythropoietic anaemia

Parvovirus B19 (PVB19) infection can induce transient anaemia in patients with increased erythropoiesis. However, the dynamic change within the bone marrow after PVB19 infection is not well understood. Increased erythropoiesis is a physiological phenomenon in puerperital women. Nevertheless, anaemia as a result of PVB19 infection in puerperital women has never been reported. We report one patient with eclampsia and two patients with pre-eclampsia who had transient, severe anaemia during the puerperital period because of PVB19 infection. Viral genomes were detected in the peripheral blood during the anaemic period by polymerase chain reaction and became undetectable after the anaemia was resolved. Viral genomes and protein could also be detected in bone marrow by in situ hybridization and immunohistochemical staining, respectively. Serial aspiration cytology of bone marrow showed severe dysplastic change involving erythroid precursors with a few apoptotic cells at the initial onset of anaemia, markedly increased apoptotic cells that was confirmed by the increased expression of activated caspase 3, around the nadir of anaemia, and a normal marrow picture without features of apoptosis after recovery from anaemia. Our data indicates that PVB19 infection can induce transient, severe dyserythropoietic anaemia in puerperital women with pre-eclampsia/eclampsia and the pathogenetic mechanism may probably involve the induction of apoptosis following PVB19 infection.

Zoonotic and viral infection in fetal loss after 12 weeks.

One hundred and thirty-six women from an urban, rural and farming community were recruited to a study of infectious causes of midtrimester miscarriage (n = 85), stillbirth (n = 32), or termination for developmental (n = 17) or chromosomal (n = 2) abnormalities. No woman had evidence of acute infection with toxoplasma, listeria, leptospira or Chlamydia psittaci (ovine enzootic abortion). One woman had midtrimester miscarriage associated with primary cytomegolovirus infection and five women had evidence of parvovirus B19 infection, although fetal infection was not proven. Zoonoses were not identified as a cause of fetal loss or malformation in this at-risk population, but parvovirus B19 was a significant cause of midtrimester fetal loss.

Parvovirus B19 infection in anemic children with AIDS using a nested polymerase chain reaction (PCR) assay: correlation with slot blot hybridization and antibody status by enzyme linked immunosorbent assay (ELISA)† 911

Parvovirus B19 infection in patients with AIDS tends to be chronic and is associated with anemia and/or bone marrow failure. We looked for evidence of Parvovirus B19 infection in 21 children (mean age 7.24; median 9 years) with AIDS and anemia (mean Hb 9.6 g/dl; range 3.4 - 11.1). The reticulocyte count ranged from 0.6% to 7.1% (mean 2.3%). Absolute CD4 counts ranged from 2 to 1766/cu mm (mean 368.5). Anti Parvovirus IgG and IgM antibody levels were assayed by ELISA and slot blot hybridization was used to detect B19 DNA in the same sera. In addition, nested PCR assay was used to detect B19 DNA in the sera samples. B19 DNA was detected in 3/21 patients (14.3%) by the nested PCR method, but in none by the slot blot method. One patient of 21 (4.7%) was strongly positive for B19 IgM antibody indicative of recent infection; 10/21(47.6%) were anti B19 IgG positive suggesting past infection or recent transfusion. There was no difference in the hemoglobin level and reticulocyte counts in the three patients who were PCR positive compared to the group as a whole or with the patients who were IgG positive. The only patient who was IgM positive (PCR negative) had a hemoglobin level of 11 g/dl, a leukocyte count of 1860/cu mm, and a reticulocyte count of 1.3%. Thus, four patients had clear evidence of B19 infection: viremia in 3 (B19 DNA by PCR), and acute infection in 1 (anti B19 IgM). Of interest, all three patients with viremia had detectable IgG antibodies. Three of 10 (30%) who were IgG positive still had viremia detectable by PCR but not by the relatively less sensitive slot blot method, suggesting failure of the antibody to clear the virus. This study thus underscores the importance of more sensitive assays like nested PCR for detection of B19 Parvovirus infection in children with AIDS where an antibody response may be ineffective in clearing the viremia.

Polymerase chain reaction amplification of archival material for parvovirus B19 in children with transient erythroblastopenia of childhood.

The relationship between transient erythroblastopenia of childhood (TEC) and parvovirus B19 infection remains uncertain. Large series using primarily serologic evaluation have not shown an association, whereas smaller series have reported parvovirus B19 infection in such patients. Further, parvovirus DNA or antigen has been detected in some patients seronegative for the virus at presentation. Polymerase chain reaction (PCR) amplification has never been used to evaluate patients with TEC for parvovirus B19. We used the PCR in an attempt to detect parvovirus B19 in DNA extracted from archived bone marrow coverslips of 16 patients diagnosed with TEC. The patients ranged in age from 3 to 23 months and presented with a mean hemoglobin value of 5.4 g/dL. Sixty-nine percent were neutropenic and none was thrombocytopenic. None of the patients had histologic evidence of parvovirus B19 infection in the bone marrow. DNA amplification for parvovirus B19 was negative in each case. In contrast, parvovirus B19DNA was amplified from DNA isolated from archived bone marrow coverslips of a patient with known parvovirus B19 infection, indicating that the PCR assay was sufficiently sensitive to detect virus from archieved bone marrow coverslips. Review of the literature indicates that the patients with parvovirus-associated TEC are generally older and often present with concomitant thrombocytopenia, whereas patients with parvovirus B19-negative TEC are younger and present without thrombocytopenia, similar to the patients in our study. Our results suggest that parvovirus B19 is not the cause of anemia in the young patient with typical features of TEC. Rather, parvovirus B19 infection of older, previously healthy children may occasionally cause a protracted anemia, often with thrombocytopenia, which may be diagnosed by some as TEC.

Red cell aplasia responsive to immunoglobulin therapy as initial manifestation of human immunodeficiency virus infection

A patient who presented with pure red cell aplasia as the initial manifestation of human immunodeficiency infection is described. The patient had no signs of other autoimmune processes or immunologic or histologic evidence of parvovirus B19 infection, although we detected parvovirus B19 DNA in his serum. This patient had a complete, although temporary, response to a single course of immunoglobulin therapy and is currently responding to a second treatment.