Parvovirus B19 Infection In Children Research Articles

Role of clinical, molecular, and serological features in the diagnosis of parvovirus B19 infection in children

Parvovirus B19(B19) is a DNA virus. The most common B19 disease is erythema infectiosum (fifth-disease). PCR and ELISA are sensitive for detecting of acute disease. However, it is not clear which test better and the relationship between laboratory tests and clinical findings. To discuss the clinical and laboratory characteristics of pediatric patients infected with B19. 236 children were examined. Children with at least one positive molecular or serological test were included. Positive serum B19-DNA and/or B19-IgM was considered an acute B19 infection. B19DNA was detected in 80.8 % of acute cases. Serological tests were less positive. Acute B19 infection was observed in 24 patients. Only 17 patients were positive for B19 DNA, 3 for IgM and 4 for both. The sensitivity of B19 DNA is 87.5 %. However, this rate is 29.2 % for B19 IgM. B19-DNA and IgM together provide a better, highly accurate diagnosis.

The Spectrum of Clinical Manifestations of Serious Human Parvovirus B19 Infection in Children without any Underlying DiseasesA Case Series

Human Parvovirus B19 causes mild to life-threatening illnesses, especially in immunosuppressed individuals. In the immunocompetent individuals, the severe spectrum of clinical manifestations of the virus infection is not widely known. This case series presents the spectrum of clinical manifestations of serious Parvovirus B19 infection in children without any chronic haematological or immunodeficiency disease. This series is about a total of 12 children who were positive for Parvovirus Immunoglobulin M (IgM) antibody and the age range was between 1-12 years. Fever, fatigue, and arthritis were the most common manifestations. Pure red cell aplasia, the specific manifestation of Parvovirus infection, was seen only in one-third of patients. All the children were treated with Intravenous Immunoglobulin (IVIG) along with supportive therapy. All except one had a successful recovery.

Vitamin A and D Levels Correlate with Outcomes Following Acute Parvovirus B19 Infection in Children with Sickle Cell Disease

Background: Human parvovirus B19, a common childhood infection that typically causes mild disease in healthy individuals, causes life-threatening anemia due to transient red cell aplasia (aplastic crisis) in individuals with sickle cell disease (SCD). This complication often leads to hospitalization and red blood cell transfusions. Limiting the amount of transfusions is imperative to avoid alloimmunization. Strategies to mitigate complications from parvovirus B19 or reduce disease severity in SCD patients are needed. In this prospective observational study, we aim to describe the relationship between vitamin A and D levels and severity of symptoms during parvovirus B19 infection in pediatric patients with SCD.Methods: Twenty pediatric patients with SCD admitted to St. Jude Children's Research Hospital experiencing aplastic crisis and identified as having an active parvovirus B19 infection were under an IRB approved protocol (NCT02261480) and followed prospectively for 120 days post-infection. Acute parvovirus B19 infection was diagnosed by fever and a positive virus-specific IgM ELISA or PCR. Aplastic crisis was defined by worsened anemia without sufficient compensatory reticulocytosis in the setting of an acute parvovirus B19 infection. Virus-specific antibody responses were measured from sera or nasal washes (NW) by ELISA using parvovirus B19 virus-like particles (VLP) as target antigens. Peak serum antibody titers were defined (among measurements from Days 0, 7, 30, and 120). Total erythrocyte transfusion volumes required during the admission were quantified. Hematologic indices and vitamin A and D levels were obtained on Day 0. Vitamin A (retinol) was measured using UPLC and vitamin D (25[OH]D) was measured using a Roche Elecsys Vitamin D ELISA. Statistical analyses were performed with Spearman's rank correlation coefficient or Mann Whitney tests. We scored significance as p<0.05.Results: Twenty patients with different genotypes of SCD requiring hospital admission due to acute parvovirus B19 infection were sequentially enrolled (15 HbSS, 3 HbSC, 1 HbSD, 1 HbSβeta +thalassemia). Thirty-five percent (7/20) of patients were vitamin D deficient (VDD, defined here as <20 ng/mL) while 89% (17/19, one sample was not measured) of patients were marginally or severely vitamin A deficient (defined here as <20 μg/dL) on Day 0. Correlative analyses between vitamin levels and markers of disease severity are shown in figure 1. Lower vitamin D levels trended with lower hemoglobin (r=0.399, p=0.082) and there was a significant inverse correlation between transfused volume and vitamin D levels (r=-0.626, p=0.003, Figure 1B). There was a significant positive correlation of vitamin A levels on Day 0 with hemoglobin concentration (r=0.549, p=0.015, Figure 1D), and an inverse correlation between vitamin A levels and lactate dehydrogenase (r=-0.505, p=0.027, Figure 1F).Children with replete vitamin D levels exhibited significantly better peak virus-specific serum IgG (p=0.037) and IgA (p=0.011) responses (Figure 2A-B). Additionally, vitamin A, which plays an important role in mucosal immunity, correlated positively with virus-specific IgG (r=0.574, p=0.013) and IgA (r=0.480, p=0.044) in nasal passages on Day 30 (Figure 2C-D).Conclusions: In pediatric patients admitted to the hospital for acute parvovirus B19 infection, low vitamin A and D levels were associated with greater disease severity (greater hemolysis, lower hemoglobin concentration, and greater transfusion volumes). Higher vitamin levels were associated with better virus-specific antibody responses. While cause-effect relationships were not discerned in this study, we hypothesize that poor nutritional status contributed to poor outcomes and that efforts to improve nutrition may reduce the severity of parvovirus B19 disease in patients with SCD. [Display omitted] DisclosuresHankins: UpToDate: Consultancy; Vindico Medical Education: Consultancy; Global Blood Therapeutics: Consultancy; Bluebird Bio: Consultancy.

Detection of Human Parvovirus B19 Infection in Children with Chronic Haemolytic Anaemia in Benha University Hospitals

Background: Due to the tropism of human parvovirus B19 to erythroid progenitor cells, infection in patients with an underlying hemolytic disorder such as thalassemia, hereditary spherocytosis, sickle cell disease and Glucose-6-phosphate dehydrogenase deficiency leads to suppression of erythrocyte formation, referred to as transient aplasia crisis (TAC), which may be life-threatening. Objectives: Detection of parvovirus B19 DNA and its IgG antibodies in the serum of children with chronic hemolytic anemia and in apparently healthy children in Benha University Hospitals. Methodology: The study was conducted on 80 children. Forty of them with chronic hemolytic anemia, they were subdivided into 2 groups, Group (1a) included 20 patients without history of aplastic crisis, Group (Ib) included 20 patients with a history of aplastic crisis and 40 age and sex-matched apparently healthy children representing control (Group II). All patients were subjected to full history taking, clinical examination and laboratory investigations. Parvovirus B19 IgG was measured using anti-parvovirus B19 ELISA kits (SUNRED), and parvovirus B19 DNA was detected by using nestedpolymerase chain reaction. Results: The seroprevalence of parvovirus B19 IgG was significantly higher (P value =0.016) in Group Ia (50%) (10 out of 20) and Group Ib (45%) (9 out of 20) than the control group (Group II) (17.5%) (7 out of 40). There was a significant positive correlation between anti-parvovirus B19 IgG and age of all patients, frequency of blood transfusion. The prevalence of parvovirus B19 DNA was 10% (2 out of 20) in group Ia and 30% (6 out of 20) in group Ib and no viral DNA was detected in the controls (P value=0.001). Although 42.3% (11 out of 26) of children with β thalassemia major had a detectable level of antiparvovirus B19 virus IgG antibodies, only (23.1%) (6 out of 26) of them had B19 DNA. Anti-parvovirus B19 IgG antibodies were detected in 4 children out of 5 children of sickle cell anemia (80%) but the the prevalence of Parvovirus B19 DNA was 20% among them. Conclusion: Measures to keep away from iatrogenic and nosocomial infection transmission should be implemented including screening of donated blood for parvovirus B19 especially blood given to patients with blood disorders. Recommendation: Data from this study support the need for introduction of an approved vaccine that mainly protects children with chronic hemolytic anemia against that infection.

Clinical Characteristics of Human Parvovirus B19 Infection in Children

목적: 인간 파르보바이러스 B19 감염은 무증상에서 생명을 위협하는 합병증에 이르기까지 광범위하고 다양한 증상을 나타낸다. 우리는 파르보바이러스 B19 감염의 지역사회 내 집단발생 시기 동안, 파르보바이러스 B19 감염의 다양한 임상 양상에 대해 조사하였다. 방법: 2017년 12월부터 2019년 4월까지 부산대학교 어린이병원에서 파르보바이러스 B19 면역 글로불린 M (IgM) 또는 중합효소 연쇄 반응(polymerase chain reaction, PCR)에 의해 검출된 파르보바이러스 B19 DNA를 가진 소아의 임상적 특징을 후향적 차트 분석을 통해 알아보았다. 결과: 24명의 어린이가 파르보바이러스 B19 감염으로 진단되었다. 24명의 환자 중 12명(50%)은 레이스 형태 발진이 있었고, 24명의 환자 중 4명(16.7%)은 점상출혈 발진, 24명의 환자 중 2명(8.3%)은 무병소 발열로 진단되었다. 24명 중 6명의 환자(25%)는 골수무형성위기가 발생하였고, 이 중 3명은 이전에 유전 구형적혈구증, 3명은 이전에 급성 림프모구 백혈병으로 진단되었던 환자이다. 결론: 감염홍반 외에도 파르보바이러스 B19 감염의 임상적 특징은 다양한 종류의 발진과 무병소 발열으로 나타날 수 있다. 또한, 혈액학적 증상으로 중성구 감소증, 골수무형성 위기와 같이 발생할 수 있다.

Molecular Study of Parvovirus B19 Infection in Children with Acute Myeloid Leukemia

Background:Parvovirus B19 is a common viral infection in children. Nearby evidences are present about its association with acute leukemia, especially acute lymphoblast leukemia. Nevertheless, scanty reports have discussed any role in acute myeloid leukemia (AML).Purpose:To evaluate the frequency of virological markers of B19 infection including its DNA along with specific immunoglobulins G (IgG) and M (IgM) among children with newly diagnosed AML. Besides, describing the clinical importance of Parvovirus B19 infection in those patients.Patients and methods:A case-control retrospective study was conducted on 48 children recently diagnosed with AML before and during chemotherapy induction and 60 healthy control. Specific serum IgM and IgG levels were determined by enzyme linked immunosorbant assay (ELISA) and DNA detection by polymerase chain reaction (PCR).Results:Parvovirus DNA was detected in 20 patients with AML. IgM was found in sera of four patients and one case had positive DNA and IgG (5%). Patients with recent parvovirus B19 infection had a significantly reduced hemoglobin levels, RBCs counts, platelet counts, neutrophil counts and absolute lymphocytosis (p=0.01, p=0.0001, p=0.01, p=0.02, p=0.0003, respectively). There were no clinical findings with statistically significant association to recent infection. Half of the patients with AML had positive PCR and/or IgM for parvovirus B19. Among children with AML under chemotherapy, there were reduced hemoglobin levels (P=0.03), reduced platelet counts (P=0.0001) and absolute neutropenia (mean±SD, 1.200 ±1.00) in those with parvovirus B19 infection. More than half of patients with parvovirus B19 (72.2%) had positive PCR and/or IgM and 36.4% of them had positive IgG.Conclusion:This study highlights that parvovirus B19 is common in children with AML either at diagnosis or under chemotherapy. There are no clinical manifestations that can be used as markers for its presence, but hematological laboratory findings can provide evidence for infection in the presence of anemia and neutropenia. Detection of parvovirus B19 by combined molecular and serological markers is required in such patients for accurate diagnosis.

B cell response to parvovirus B19 despite abnormal splenic architecture and cytokine/chemokine profiles in patients and animal models with sickle cell disease (SCD)

Abstract Sickle cell disease (SCD) is caused by a mutant β-globin gene and affects more than 100,000 individuals in the USA alone. Sickled RBCs and ischemic events cause tissue damage, altered splenic architecture, and inflammation. When children are infected with parvovirus B19, they can develop life-threatening aplastic crisis. Previous reports have described immune defects among patients with SCD, and their potential correlations with splenic dysfunction or inflammation. In a multi-center study involving St. Jude, NIH, Novartis, and GlaxoSmithKline, we examined (i) inflammatory cytokines/chemokines in patients with SCD, treated or untreated with hydroxyurea (HU); (ii) immune responses toward parvovirus B19 infections in children with SCD; and (iii) immune responses in a mouse model for SCD against a candidate Saccharomyces cerevisiae-derived parvovirus B19 VLP vaccine. Results showed that HU treatment reduced serum cytokines/chemokines in patients with SCD (e.g. TGFα, TNFα, and sVCAM-1). Both HU-treated and untreated children, regardless of their cytokine/chemokine profile, responded to parvovirus B19. Binding antibodies were apparent in the nasal cavity (a common point-of entry for the pathogen) and sera by day 7 post-infection, and virus-specific neutralizing antibodies were induced. In transgenic mice with SCD (expressing human α, βS, and γ globin genes), we observed normal antibody activities toward the VLP vaccine. Together, data show that parvovirus B19 -specific B cells withstand the aberrant SCD environment better than their previously-described Streptococcus pneumonia-specific B cell counterparts. Data encourage rapid development of the VLP vaccine to prevent aplastic crises in children with SCD.

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 parvovirus B19 infection in patients with beta thalassemia major in Fayoum University Hospital

Background and objectivesPatients with beta thalassemia major are at higher risk of acquiring reticulocytopenia, and cessation of erythropoiesis after exposure to parvovirus B19. The aim of the study was to detect the seroprevalence of parvovirus B19 infection in children with transfusion dependent beta-thalassemia major through the detection of its specific IgM and IgG in their sera by Enzyme-linked Immunosorbent Assay (ELISA) in the Pediatric Department of Fayoum University Hospital. Materials and methodsA cross sectional descriptive study was carried out from July to September 2013, in the Pediatric Department of Fayoum University Hospital in Egypt. A total of fifty-five children with beta-thalassemia major aged from 2 to 16years were enrolled in the study. All patients were subjected to history taking, examination and investigations including; Complete blood count, serum creatinine, blood urea, hepatitis B surface antigen (HBsAg), anti hepatitis C virus antibody (anti HCV), reticulocytic count, anti B19 IgM and IgG. ResultsAnti-B19 IgM antibodies (recent infection) were detected in 14.5% (8 patients), while anti B19 IgG antibodies (prior infection) were detected in 18.2% (10 patients) of transfusion dependent thalassemic patients. There was a significant statistical correlation between the history of other siblings with beta thalassemia major, the hepatitis C virus and hepatitis B virus infection regarding absent, prior and recent infection. ConclusionParvovirus B19 infection is detected in high rates among children with beta thalassemia major. Measures to avoid iatrogenic and nosocomial transmission have to be implemented including screening of donated blood for B19 especially blood given to patients with hematological disorders. Also data from this study support the need for introduction of an approved B19 vaccine that primarily protects children with thalassemia major against that infection.

Original Research: Parvovirus B19 infection in children with sickle cell disease in the hydroxyurea era.

Parvovirus B19 infection causes transient aplastic crisis in sickle cell disease (SCD) due to a temporary interruption in the red blood cell production. Toxicity from hydroxyurea includes anemia and reticulocytopenia, both of which also occur during a transient aplastic crisis event. Hydroxyurea inhibits proliferation of hematopoietic cells and may be immunosuppressive. We postulated that hydroxyurea could exacerbate parvovirus B19-induced aplastic crisis and inhibit the development of specific immune responses in children with SCD. We conducted a retrospective review of parvovirus B19 infection in 330 children with SCD. Altogether there were 120 known cases of aplastic crisis attributed to parvovirus B19 infection, and 12% of children were on hydroxyurea treatment during the episode. We evaluated hematological and immune responses. Children with HbSS or HbSβ(0)-thalassemia treated with hydroxyurea, when compared with untreated children, required fewer transfusions and had higher Hb concentration nadir during transient aplastic crisis. Duration of hospital stays was no different between hydroxyurea-treated and untreated groups. Children tested within a week following aplastic crisis were positive for parvovirus-specific IgG. Immune responses lasted for the duration of the observation period, up to 13 years after transient aplastic crisis, and there were no repeat aplastic crisis episodes. The frequencies of parvovirus-specific antibodies in all children with SCD increased with age, as expected due to the increased likelihood of a parvovirus exposure, and were comparable to frequencies reported for healthy children. Approximately one-third of children had a positive parvovirus B19-specific IgG test without a documented history of transient aplastic crisis, and 64% of them were treated with hydroxyurea. Hydroxyurea may reduce requirements for blood transfusions and may attenuate symptoms during transient aplastic crisis episodes caused by parvovirus B19 infections. Children with SCD, whether treated or untreated with hydroxyurea, generate sustained and protective parvovirus B19-specific immune responses.

PARVOVIRUS B19 INFECTION IN CHILDREN IN THE DISTRICT PEDIATRICIAN'S PRACTICE

At present, an increasing number of researchers are turning their attention to various exanthemas. The article provides a brief literature review of the current concepts of parvovirus B19 infection in children, and personal observations of district paediatricians in a municipal children's clinic. Based on the obtained findings, practical recommendations for pediatricians and general practitioners are offered.

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

Acute encephalitis and encephalopathy associated with human parvovirus B19 infection in children.

Reports of neurologic manifestations of human parvovirus B19 (B19) infection have been on the rise. Acute encephalitis and encephalopathy is the most common, accounting for 38.8% of total B19-associated neurological manifestations. To date, 34 children with B19 encephalitis and encephalopathy have been reported, which includes 21 encephalitis and 13 encephalopathy cases. Ten (29%) were immunocompromised and 17 (39%) had underlying diseases. Fever at the onset of disease and rash presented in 44.1% and 20.6% of patients, respectively. Neurological manifestations include alteration of consciousness occurred in all patients, seizures in 15 (44.1%) patients, and focal neurologic signs in 12 (35.3%) patients. Anemia and pleocytosis in cerebrospinal fluid (CSF) occurred in 56.3% and 48.1% of patients, respectively. Serum Anti-B19 IgM (82.6%) and CSF B19 DNA (90%) were positive in the majority of cases. Some patients were treated with intravenous immunoglobulins and/or steroids, although an accurate evaluation of the efficacy of these treatment modalities cannot be determined. Nineteen (57.6%) patients recovered completely, 11 (33.3%) patients had some neurological sequelae and 3 (8.8%) patients died. Although the precise pathogenesis underlying the development of B19 encephalitis and encephalopathy is unclear, direct B19 infection or NS1protein of B19 toxicity in the brain, and immune-mediated brain injuries have been proposed.

Evaluation of Parvovirus B19 Infection in Children with Malignant or Hematological Disorders

Evaluation of Parvovirus B19 Infection in Children with Malignant or Hematological Disorders

Clinical and hematological study for Parvovirus b19 infection in children with acute leukemia

The role of Parvovirus B19 in acute leukemia is under debate. This study aimed to detect parvovirus B19 DNA together with its antibodies in the sera of children with recent acute leukemia and those with acute leukemia receiving chemotherapy to clarify the contribution of this infection to changes observed in hematological and clinical presentations in these populations. Two groups were included: Group I comprised 45 children with acute leukemia receiving chemotherapy and Group II comprised 40 children with recently diagnosed acute leukemia. Serum parvovirus B19 IgG and IgM were investigated by enzyme-linked immunosorbant assay and the virus DNA was sought by polymerase chain reaction assay. Viral DNA was found in 22.2% of Group I patients and in 45% of Group II patients. Hemoglobin levels were significantly reduced in patients with recent infection, accompanied by statistically significant lymphocytosis in Group I patients. Group II patients with recent infection had marked neutropenia with lymphocytosis and thrombocytopenia. There was statistically significant lymphadenopathy and hepatosplenomegaly in patients with recent infection in both groups. Parvovirus B19 infection is an important cause of cytopenia in children with acute leukemia both when recently diagnosed and receiving chemotherapy. This can affect the schedule of chemotherapy. Moreover, the presence of Parvovirus B19 is associated with marked lymphadenopathy and hepatosplenomegaly.

Parvovirus B19 Infection in Children with Acute Lymphoblastic Leukemia is Associated with Cytopenia Resulting in Prolonged Interruptions of Chemotherapy

Parvovirus B19 infection causes severe cytopenia and can mimic a leukemic relapse or therapy-induced cytopenia in patients with hematologic malignancies. We evaluated the complications of parvovirus B19 infection, including delays in the scheduled course of chemotherapy, in children with acute lymphoblastic leukemia (ALL). Consecutive bone marrow samples were collected from 117 children with ALL and were analyzed for parvovirus B19 DNA by polymerase chain reaction. Clinical and laboratory data were collected from the Nordic Childhood Leukemia Registry and from medical records. Among the 117 children with ALL, 18 (15%) were found to be parvovirus B19 DNA positive. The infection was suspected on clinical grounds in only 1 of these 18 patients. Patients with viremia at diagnosis or during therapy for infection had lower viral loads (median viral load, 7 x 10(4) copies/mL) than did those who became viremic during maintenance therapy (median viral load, 2 x 10(8) copies/mL). The former group also had fewer clinical complications. Indeed, when parvovirus B19 DNA was present during the maintenance treatment, the number of complications (including cytopenia) increased, causing significantly longer periods without chemotherapy (median duration without chemotherapy, 59 days vs. 30 days; P < or = .05) and a higher number of blood transfusions (P = .018) in parvovirus B19 DNA-positive patients than in parvovirus B19 DNA-negative patients. Children with ALL who were infected with parvovirus B19 became cytopenic, leading to reduced treatment intensity and to complications during treatment. Screening for parvovirus B19 DNA by quantitative polymerase chain reaction in pediatric patients with ALL and unexplained cytopenia is suggested.

Parvovirus B19 infection in children with a variety of hematological disorders

This study was carried out to detect Parvovirus B19 (PB19) DNA together with its antibodies in the sera of children with a range of hematological disorders to clarify the contribution of this infection to changes observed in hematological picture in those populations. This study included 85 pediatric patients with different hematological disorders. Twenty healthy subjects with matched age and sex were included as controls. Patients were classified into four groups; group I included 25 patients with hemolytic anemia in aplastic crisis, group II included 20 patients with hemolytic anemia without aplastic crisis, group III included 20 acute leukemia patients under chemotherapy, group IV included 20 patients with recently diagnosed acute leukemia. Virological study for PB19 included determination of specific IgG & IgM together with viral DNA by polymerase chain reaction (PCR).In all groups of patients with positive markers for PB19, there were statistically significant differences in the mean Hb concentration and RBC count (P < 0.001 for each), presence of neutropenia (P = 0.003) and lymphocytosis (P < 0.001) compared to controls. There was statistically significant difference in the prevalence of PB19 IgM, IgG and PCR among studied groups compared to control group. In group I and group II IgG had the highest positive rate (56 and 35%, respectively). In group III IgG also had a high positive rate (45%). However, in group IV IgM had the highest positive rate (50%) followed by PCR (45%) then IgG (40%).In conclusion, PB19 infection is detected in high rates among children with hematological disorders. PB19 must be suspected and screened for when there is anemia in those patients associated with neutropenia and lymphocytosis. In patients with acute leukaemia under chemotherapy who have unexpected anemia, neutropenia and lymphocytosis Parvovirus infection should be considered before a change of chemotherapy protocol. Screening of blood for PB19 may be helpful in understanding the epidemiology of infection with this virus. The direct detection of DNA by PCR in sera needs to be coupled with serology for a more reliable diagnosis of PB19 infections in these children.

Parvovirus B19 Infection in Children with Acute Illness and Rash

Parvovirus B19 is responsible for a variety of cutaneous diseases, including erythema infectiosum and papular purpuric gloves-and-socks syndrome. It is also associated with other dermatologic diseases, such as systemic lupus erythematosus. To study the prevalence of parvovirus B19 infection in children with acute illness and rash, we did a prospective study of 110 children at the Chiang Mai University teaching hospital from January 2001 to November 2003. Sera from these patients were analyzed for immunoglobulin M and immunoglobulin G antibodies against human parvovirus B19 using enzyme-linked immunosorbent assay techniques. From a total of 110 patients with acute illness and rash, there were paired serum samples for 90 patients and single serum sample for 20 patients. For those with paired serum samples, there were three patients with recent parvovirus B19 infection that presented with erythema infectiosum, urticaria, and lupus erythematosus, respectively. Immunoglobulin G antibodies were tested in serum samples of 103 children; 28.2% were positive. These data indicate that parvovirus B19 is not a common cause of acute illness and rash in children.

Human parvovirus B19 infection in children with new onset Type 1 diabetes mellitus

Human parvovirus B19 infection in children with new onset Type 1 diabetes mellitus

Acute Chest Syndrome Is Strongly Associated Parvo Virus B19 Seroconversion in Patients with Hemoglobin SC Disease.

Parvovirus B19 replicates principally in human erythrocyte precursors resulting in temporary cessation of erythropoiesis. In patients with sickle hemoglobinopathies, parvovirus B19 infection has been associated with acute chest syndrome and may lead to transient aplastic crisis. Evidence of prior infection with parvovirus B19 is found in 50 to 60% of adults. Infection appears to be followed by lifelong immunity. The objectives of the Study of Seroprevalence and Incidence of Parvovirus B19Infection in Children with Sickle Hemoglobinopathies are to determine the prevalence of parvovirus B19 antibodies in children less than 16 years old; determine the rate of parvovirus B19 seroconversion; and determine whether parvovirus B19 seroconversion is associated with the occurrence of aplastic crisis or acute chest syndrome. Between April 2000 and June 2002 a total of 1039 children from eight Comprehensive Sickle Cell Centers (CSCC) were enrolled in the study and 898 had at least one follow up visit. Participants ranged in age from <1 month to 16 years at enrollment (mean age 7.2, + 4.5 years), 47% were female, 53% were male. 67% had homozygous Hb SS disease, 24% had Hb SC disease, 6% had Hb SB+ disease, 3% had Hb SB0 disease, and <1% had other S sickle cell disease. The seroprevalence of parvovirus B19 in the cohort was 35%. Prevalence varied significantly by age, ranging from a low of 8% for children 1–2 years of age to 69% for children 13+ years of age (p<0.0001). The greatest increase in seroprevalence occurred between 6 and 7 years of age. Adjusted for age, there were no significant differences in seroprevalence by gender, clinical center, geographic area of residence (northeast, southeast, midwest, and west) sickle hemoglobinopathy, number of siblings, hemoglobin level, reticulocyte %, or among recipients of treatment with transfusion or hydroxyurea. Parvovirus B19 seroconversion was strongly associated with an increased risk of aplastic crisis in both SS (odds ratio of 29, 95% CI (11.3, 74.4)) and SC patients (odds ratio of 110, 95% CI (9.6, 1270.4)), even when controlling for age. Seroconversion was associated with an increased risk of acute chest syndrome in SC patients, (odds ratio of 6.4, 95% CI (1.9, 21.9)) but did not reach statistical significance in SS patients.These data show a clear causal relation between parvovirus B19 seroconversions and acute chest syndrome in subjects with hemoglobin SC disease and confirm the previously known association aplastic crisis.