Parvovirus B19 Immunoglobulin Research Articles

Parvovirus Infection Causing Aplastic Anaemia in an Immunocompetent Patient Diagnosed by Bone Marrow Aspiration Cytology

Human Parvovirus infection is associated with transient aplastic crisis as a most common complication in chronic haemolytic anaemia patients. Very few case reports are available regarding aplastic crisis in immunocompetent patients. Here the authors are reporting a case of 17-year-old immunocompetent male that presented with fever, headache for three days. Complete blood count showed pancytopenia. Bone marrow aspiration and trephine biopsy revealed hypocellularity. Giant pro-erythroblasts with multiple cytoplasmic projections (dog ear appearance) and prominent intranuclear inclusions were seen in marrow aspirated cytology. Classical cytological findings in bone marrow aspiration raised the suspicion of human parvovirus infection. Findings were confirmed by positive Deoxyribonucleic Acid Polymerase Chain Reaction (DNA PCR) for parvovirus B19 and parvovirus Immunoglobulin M (IgM) antibody using Enzyme Linked Immunosorbent Assay (ELISA) test. Patient was managed with antibiotic therapy and was trasfused three units of blood. Complete blood count became normal after two months. This emphasises the role of keeping high index of suspicious for Parvovirus B19 infection as a cause of aplastic anaemia even in individual without underlying diseases. Secondly characteristic morphological changes in the erythroid precursors in the bone marrow aspiration is highly suggestive of Parvovirus B19 infection.

Epidemiology of parvovirus B19 and anemia among kidney transplant recipients: A meta-analysis.

Background:Persistent anemia has been described in kidney transplant (KTx) recipients with parvovirus B19 virus infection. However, the epidemiology of parvovirus B19 and parvovirus B19-related anemia after KTx remains unclear. We conducted this systematic review (1) to investigate the incidence of parvovirus B19 infection after KTx and (2) to assess the incidence of parvovirus B19 among KTx patients with anemia.Materials and Methods:A systematic review was conducted in EMBASE, MEDLINE, and Cochrane databases from inception to March 2019 to identify studies that reported the incidence rate of parvovirus B19 infection and/or seroprevalence of parvovirus B19 in KTx recipients. Effect estimates from the individual studies were extracted and combined using random-effects, generic inverse variance method of DerSimonian and Laird. The protocol for this systematic review is registered with PROSPERO (no. CRD42019125716).Results:Nineteen observational studies with a total of 2108 KTx patients were enrolled. Overall, the pooled estimated seroprevalence of parvovirus B19 immunoglobulin G was 62.2% (95% confidence interval [CI]: 45.8%–76.1%). The pooled estimated incidence rate of positive parvovirus B19 DNA in the 1st year after KTx was 10.3% (95% CI: 5.5%–18.4%). After sensitivity analysis excluded a study that solely included KTx patients with anemia, the pooled estimated incidence rate of positive parvovirus B19 DNA after KTx was 7.6% (95% CI: 3.7%–15.0%). Among KTx with anemia, the pooled estimated incidence rate of positive parvovirus B19 DNA was 27.4% (95% CI: 16.6%–41.7%). Meta-regression analysis demonstrated no significant correlations between the year of study and the incidence rate of positive parvovirus B19 DNA (P = 0.33). Egger's regression asymmetry test was performed and demonstrated no publication bias in all analyses.Conclusion:The overall estimated incidence of positive parvovirus B19 DNA after KTX is 10.3%. Among KTx with anemia, the incidence rate of positive parvovirus B19 DNA is 27.4%. The incidence of positive parvovirus B19 DNA does not seem to decrease overtime.

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.

Seroprevalence of human parvovirus B19 immunoglobulin G in children with hematological disorders and healthy children

Objective The aim of this study was to determine the serum levels of anti-parvovirus B19 immunoglobulin-G (IgG) and its prevalence in children with hematological disorders and in apparently healthy children in Menoufia University Hospitals. Background Parvovirus B19 infections can suppress erythropoiesis and induce acute erythroblastopenia, which is often referred to as transient aplastic crisis in patients with chronic hemolytic anemia such as sickle cell anemia, thalassemia, and hereditary spherocytosis. Patients and methods The study was conducted on 60 children with chronic hemolytic anemia (40 children with chronic hemolytic anemia without a history of aplastic crisis and 20 children with chronic hemolytic anemia with a history of aplastic crisis) and 20 age-matched and sex-matched apparently healthy children. All patients were subjected to full history taking, clinical examination, and laboratory investigations. Serum anti-parvovirus B19 IgG levels were measured using anti-parvovirus B19 ELISA kits. Results The prevalence of anti-parvovirus B19 IgG antibodies in the sera of chronic hemolytic anemia children with and without a history of aplastic crisis was 62.5 and 100%, respectively. Seropositivity of anti-parvovirus B19 IgG antibodies was 20% in apparently healthy children. Seropositivity of anti-parvovirus B19 IgG antibodies in children with β-thalassemia major and sickle cell anemia was 78 and 100%, respectively. Significant positive correlations were detected between age of the children, frequency of blood transfusion, and the level of anti-parvovirus B19 IgG. Conclusion The prevalence of anti-parvovirus B19 IgG antibodies was higher in all chronic hemolytic anemia children, particularly in those with a history of aplastic crisis. Furthermore, all children with β-thalassemia major and sickle cell anemia with a history of aplastic crisis had anti-parvovirus B19 IgG antibodies.

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.

Parvovirus B19 infection in pregnancy.

This guideline reviews the evidence relating to the effects of parvovirus B19 on the pregnant woman and fetus, and discusses the management of women who are exposed to, who are at risk of developing, or who develop parvovirus B19 infection in pregnancy. The outcomes evaluated were maternal outcomes including erythema infectiosum, arthropathy, anemia, and myocarditis, and fetal outcomes including spontaneous abortion, congenital anomalies, hydrops fetalis, stillbirth, and long-term effects. Published literature was retrieved through searches of PubMed and The Cochrane Library on July 8, 2013, using appropriate controlled vocabulary (MeSH terms "parvovirus" and "pregnancy") and key words (parvovirus, infection, pregnancy, hydrops). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. There were no date restrictions but results were limited to English or French language materials. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, and national and international medical specialty. The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table 1). Recommendations 1. Investigation for parvovirus B19 infection is recommended apart of the standard workup for fetal hydrops or intrauterine fetal death. (II-2A) 2. Routine screening for parvovirus immunity in low-risk pregnancies is not recommended. (II-2E) 3. Pregnant women who are exposed to, or who develop symptoms of, parvovirus B19 infection should be assessed to determine whether they are susceptible to infection (non-immune) or have a current infection by determining their parvovirus B19 immunoglobulin G and immunoglobulin M status. (II-2A) 4. If parvovirus B19 immunoglobulin G is present and immunoglobulin M is negative, the woman is immune and should be reassured that she will not develop infection and that the virus will not adversely affect her pregnancy. (II-2A) 5. If both parvovirus B19 immunoglobulin G and immunoglobulin M are negative (and the incubation period has passed), the woman is not immune and has not developed the infection. She should be advised to minimize exposure at work and at home. Absence from work should be considered on a case-by-case basis. (II-2C) Further studies are recommended to address ways to lessen exposure including the risk of occupational exposure. (III-A) 6. If a recent parvovirus B19 infection has been diagnosed in the woman, referral to an obstetrician or a maternal-fetal medicine specialist should be considered. (III-B) The woman should be counselled regarding risks of fetal transmission, fetal loss, and hydrops and serial ultrasounds should be performed every 1 to 2 weeks, up to 12 weeks after infection, to detect the development of anemia (using Doppler measurement of the middle cerebral artery peak systolic velocity) and hydrops. (III-B) If hydrops or evidence of fetal anemia develops, referral should be made to a specialist capable of fetal blood sampling and intravascular transfusion. (II-2B).

Anterior ischemic optic neuropathy in patient with hereditary spherocytosis and coexisting angioid streaks.

Purpose. To describe a rare case of hereditary spherocytosis (HE) with angioid streaks that developed anterior ischemic optic neuropathy (AION). Method. Case report. Results. A 53-year-old woman with HE had a 3-day history of blurred vision in the lower hemifield in the left eye. At presentation, her visual acuity was 20/20 OD and 20/200 OS. Perimetric testing showed a relative scotoma in the superior parafoveal region in the right eye and an inferior altitudinal field defect in the left eye. Fundus examination demonstrated angioid streaks in both eyes with swelling of the optic disc in the left eye. Both parvovirus B19 immunoglobulin M and immunoglobulin G were identified in her serum. Conclusions. This is the first report of AION in HE and coexisting angioid streaks. The infection by parvovirus itself might be involved in the development of AION.

Parvovirus B19 Infection in the First Trimester of Pregnancy and Risk of Fetal Loss: A Population-based Case-Control Study

Because parvovirus B19 infection during pregnancy has been associated with increased risk of fetal loss in small or selected study populations, the authors evaluated the risk in a population-based study. A nested case-control study was conducted by using a population-based screening for syphilis in 3 regions in Denmark from 1992 to 1994. Cases of women with fetal loss were identified in the National Patient Register (n = 2,918), and control women with live-born children were identified in the Medical Birth Register (n = 8,429) by matching on age and sampling week. First-trimester serum samples were tested for parvovirus B19 immunoglobulin M positivity. Parvovirus B19 immunoglobulin M positivity was associated with a 71% increased risk of fetal loss (odds ratio = 1.71, 95% confidence interval: 1.02, 2.86). Adjustment for number of children or stratifying for gestational age at loss did not change the risk estimate. Assuming causality, only 0.1% of fetal losses were attributable to parvovirus B19 positivity, a proportion which could increase to approximately 1% during epidemic periods. In conclusion, acute parvovirus B19 infection during the first trimester of pregnancy was associated with an increased risk of fetal loss. However, the impact on the overall burden of fetal losses appeared small even during epidemics.

Seroepidemiology of parvovirus B19 in the Frankfurt am Main area, Germany: evaluation of risk factors

Parvovirus B 19 is a virus that is distributed by respiratory droplets. It is known to be an initiator of erythema infectiosum (children's fifth disease), with erythroblasts being the target cells of infection. In case of vertically transmission, hydrops fetalis has been documented. Parvovirus B19 seroprevalence was investigated in serum samples routinely collected from patients who had been admitted to the University Hospital in Frankfurt a. M., Germany. Patients were classified in different groups in order to analyze parovirus B19 seroprevalences in terms of risk factors. Between June 2007 and March 2010, a total of 2,197 serum samples were analyzed for parvovirus B19-immunoglobulin G using an enzyme-linked immunosorbent assay. The study population included six groups of patients, namely, patients suffering from haemophilia, malignant disease, immunodeficiency diseases, common gynecological ailments, pregnant women and children with malignant diseases. Of the 2,197 serum samples, 1,383 contained antibodies to parvovirus B19 (62.9%). The overall seroprevalence in adults (20 to ≥60years of age) was 71%. Gradually rising prevalences were recorded in children/adolescents with increasing age. We found a positive serostatus in 54.9% of adult patients with malignant disease, in 64.2% of patients with haemophilia (1 to ≥60years), in 66.7% of patients under immunosuppression with various drugs (1 to ≥60years) and in 41.7% of oncological patients aged 1-19years. Of the pregnant women (aged 15-49years), 71.1% were seropositive. The seroprevalence of parvovirus B19 in patients admitted to the University Hospital in Frankfurt a.M. was, on average, lower than that among the general population in Germany. Infection among patients in specific risk groups did not spread more than that in age-matched non-selected patients, with the exception of the group of immunocompromised patients.

Parvovirus B19 Infection in Pediatric Oncology Patients

Oncology patients are at particular risk for parvovirus B19 infection, which may cause severe, persistent, usually nonspecific illness in this group. This study was designed to assess the prevalence and impact of parvovirus B19 in pediatric oncology patients receiving chemotherapy, and to define the optimal diagnostic tests in such patients. Fifty-nine children under chemotherapy (39 with acute lymphocytic leukemia and 20 with solid tumors) with mean age of 4.96+/-1.94 years, in addition to 30 healthy children of matched age and sex, were enrolled in this study. Clinical and laboratory data were collected by examination and from patients' records. Specific parvovirus B19 immunoglobulin (Ig) M and IgG antibodies were assessed by enzyme-linked immunosorbent assay, and parvovirus DNA was detected by nested polymerase chain reaction (PCR) for all patients and controls. Parvovirus DNA was detected in 16 (27.1%), IgM in 3 (5.1%), and IgG in 36 (61%) patients. IgM had sensitivity, specificity, and accuracy of 18.75%, 100%, and 77.9%, respectively, whereas those of IgG were 81.25%, 53.4%, and 61%, respectively. PCR-positive patients had significantly higher frequency of unexplained anemia, red blood cell transfusions, and longer hospital stay than PCR-negative patients (P<0.001). Multiple linear regression analysis showed that unexplained anemia and multiple red blood cell transfusions were the most important variables that can predict PCR positivity. Parvovirus B19 is not an uncommon problem in pediatric oncology patients who exhibited weak antibody response and nonspecific clinical features. Screening of these patients with PCR rather than serology is recommended when infection is suspected.

Acute Parvovirus B19 Infection Frequently Causes False-Positive Results in Epstein-Barr Virus- and Herpes Simplex Virus-Specific Immunoglobulin M Determinations Done on the Liaison Platform

During an outbreak of parvovirus B19 we collected serum samples from 68 nonpregnant patients in the region of Antwerp (Belgium). Fifty-seven (84%) of the parvovirus B19 immunoglobulin M (IgM)-positive sera had a positive result for Epstein-Barr virus (EBV) IgM by Liaison testing, 61 (90%) had a positive result for herpes simplex virus (HSV) IgM, 20 (29%) samples were positive for cytomegalovirus IgM, and 15 (22%) had a positive result for Borrelia burgdorferi sensu lato IgM. As assay interference was suspected, sera were further investigated by using additional infectious-disease serology tests and by performing various interference elimination procedures. We could show that the EBV IgM and HSV IgM results were false positives due to aspecific IgM reactions with the solid phase. All samples were also analyzed by a modified Liaison EBV IgM assay, based on the addition of polyvinylpyrrolidone and polyvinyl alcohol to the dilution buffer, which partially eliminated this type of assay interference. Although the Liaison is a very convenient, automated immunoassay platform, this study demonstrates the potential for improvement of mainly the EBV IgM and HSV IgM tests.

Parvovirus B19-Antibody Serosurvey in 500 Developmentally Disabled Subjects

Sera of 500 residents were screened for parvovirus B19 immunoglobulin M (IgM) and immunoglobulin G (IgG) by enzyme-linked immunosorbent assay. Positive IgM and equivocal IgG or IgM results were confirmed by immunofluorescent antibody and Western blot. IgM was detected in 13 sera (2.6%), and IgG was detected in 285 (57%). Records of IgM-positive residents contained no evidence of erythema infectiosum or polyarthropathy.

Parvovirus B19-Antibody Serosurvey in 500 Developmentally Disabled Subjects

Sera of 500 residents were screened for parvovirus B19 immunoglobulin M (IgM) and immunoglobulin G (IgG) by enzyme-linked immunosorbent assay. Positive IgM and equivocal IgG or IgM results were confirmed by immunofluorescent antibody and Western blot. IgM was detected in 13 sera (2.6%), and IgG was detected in 285 (57%). Records of IgM-positive residents contained no evidence of erythema infectiosum or polyarthropathy.

Evaluation of serological assays for identification of parvovirus B19 immunoglobulin M

Three different enzyme immunoassays (EIAs) (Parvoscan-B19, IBL parvovirus B19, and IDEIA parvovirus B19) and one immunofluorescence assay (Biotrin Parvo B19 IFA) were evaluated for detection of parvovirus B19 immunoglobulin M (IgM) antibodies in 203 clinical serum samples. An IgM antibody capture radioimmunoassay was used as a reference test. Serum specimens obtained from patients with clinical symptoms suggestive of parvovirus B19 infections were used to evaluate the sensitivities of the assays, which were shown to be comparable for the Biotrin IFA and IDEIA (97%) and lower for the other two EIAs (90%). In order to test the specificity of the assays, clinical serum samples with IgM antibodies against other viruses were examined, as well as sera with rheumatoid factor activity and sera from healthy pregnant women. The specificities of B19 IgM antibody detection were 96% for the Biotrin IFA, 96% for IDEIA, 90% for Parvoscan, and 88% for the IBL assay. These results show that all four assays can be recommended for diagnostic purposes, although false-positive results may be seen with other acute viral infections, healthy pregnant women, and rheumatoid factor-positive samples.