Primary Parvovirus B19 Infection Research Articles

Association between parvovirus B19 virus and childhood acute lymphoblastic leukemia: A cross-sectional study in Tehran; Iran

Objective: The propose of study was to determine the viral load of Parvovirus B19 in children with proven acute lymphoblastic leukemia (ALL) Methods: A cross-sectional study designed in pediatric ward of Rasoul-e-Akram Hospital (educational, third referral) in Tehran, Iran (2015 – 2016). Sixty-nine children (mean age: 6.57 ± 4.25 years) in preservative phase of ALL selected. BMA had done, and the viral load for Parvovirus B19 determined by quantitative PCR. Results: Type of ALL was Pre B cell: 76.8%; Pro B cell: 14.5% and T-cell type: 7.8%. Low viral load determined in 18.8% (n=13); intermediate in 39.1% (n=27). High and very high viral load observed in 27.1% 15 (n=15) and 20.3% (n=1) of cases respectively. Viral load was related to Pro B cell type (p = 0.050) and lymphadenopathy (p = 0.040), but not related to gender (p = 0.350) and severity of ALL (p = 0.403); like hepatosplenomegaly, anemia, thrombocytopenia or need to transfusion. Conclusion: Parvovirus B19 is a common viral infection in young Iranian population. Near one-third of childbearing age, women in Iran are at risk for primary Parvovirus B19 infection. Here, to evaluate the possible role of parvovirus B19 Infection in the etiology of ALL, 42 % of ALL cases had high and very high viral load (21.7% and 20.3); the low or intermediate viral load is detectable in all cases. The viral load was related to Pro B cell type of ALL (p = 0.050) and the presence of lymphadenopathy. However, there is no relationship observed between Parvovirus B19 viral load and the severity of ALL and gender. It probably might be due to viral detection in the early stages of the ALL

Simultaneous Presentation of Parvovirus B19 Infection and Systemic Lupus Erythematosus in a Patient: Description and Review of the Literature.

We present the case of a 25-year-old woman without medical history, presenting with acute respiratory failure needing mechanical ventilation. Aetiologic screening showed PVB19 primary infection and concomitant SLE flare-up. We discuss the causative interactions between PVB19 and SLE in the pathogenesis of the disease. Difficulty diagnosing inaugural SLE flare-up concomitant with PVB19 infection can lead to delayed diagnosis and treatment. Inversely, overtreating a SLE-mimicking PVB19 infection with immunosuppressive agents can be highly detrimental.LEARNING POINTSThe differential diagnosis between parvovirus B19 primary infection and systemic lupus erythematosus flare-up can be difficult.Parvovirus B19 primary infection can elicit authentic severe systemic lupus erythematosus flare-up that requires urgent immunosuppressive therapy.Parvovirus B19 primary infection can also mimic systemic lupus erythematosus.

Parvovirus B19 infection and kidney injury: report of 4 cases and analysis of immunization and viremia in an adult cohort of 100 patients undergoing a kidney biopsy

BackgroundThe seroprevalence of human Parvovirus B19 (PVB19) is 70–85% in adults worldwide. PVB19 is the etiologic agent of the fifth disease, is a cause of aplastic anemia, and can be associated with kidney injury. We aimed to describe the cases of 4 patients with kidney injury related to PVB19 primary infection, and to evaluate the seroprevalence of PVB19 and the incidence of PVB19 primary infection in patients undergoing a native kidney biopsy.MethodsCases of PVB19 infection with kidney injury were reviewed from the archives of the department of Nephrology. A systematic screening of anti-PVB19 IgG and IgM antibodies and viral DNA was performed in sera from 100 consecutive patients with a kidney biopsy in 2017–2018.ResultsThe 4 patients with PVB19 infection-associated kidney disease displayed: one lupus-like glomerulonephritis (GN) without lupus auto-antibodies, one minimal change disease with tubular necrosis, one secondary hemolytic and uremic syndrome and one membrano-proliferative GN. In the 100 patients biopsied, 67 had elevated anti-PVB19 IgG, among whom 8 had elevated IgM, without circulating viral DNA, without any particular renal pathological pattern. One additional patient showed a seroconversion at the time of kidney biopsy, which revealed a class V lupus nephritis.ConclusionPVB19 primary infection can be associated with different kidney diseases. The seroprevalence of PVB19 among patients with a kidney biopsy is similar to the overall population, and primary infection is rarely documented (1%) after systematic screening. Whether PV19 is nephrotoxic, or triggers renal endothelial injury and immune activation, remains to be elucidated.

L’infection à Parvovirus B19, diagnostic différentiel de toxidermie dans le syndrome Babouin

IntroductionBaboon syndrome is a rare form of rash affecting the large skin folds. We report a case involving primary infection with parvovirus B19. Patients and methodsA 34-year-old female patient with no particular history consulted for a pruriginous rash on the large skin folds in a setting of fever present for 6 days. She was not taking any medication. Clinical examination showed large symmetrical erythematous purpuric plaques on flexion folds. No mucosal damage or systemic signs were seen. The laboratory tests showed inflammatory syndrome. A skin biopsy demonstrated leukocytoclastic vasculitis. The viral serology was positive for parvovirus B19 (immunoglobulins, IgM). The patient was treated with antihistamines and emollients, and the skin lesions regressed spontaneously after 10 days. DiscussionBaboon syndrome was formerly considered simply as a skin condition. It has now been attributed to several other aetiologies including viral infections. Our case was linked to a primary parvovirus B19 infection. This virus can cause polymorphic skin signs and constitutes a differential diagnosis for rash in Baboon syndrome.

Parvovirus B19.

Primary parvovirus B19 infection is an infrequent, but serious and treatable, cause of chronic anemia in immunocompromised hosts. Many compromised hosts have preexisting antibody to B19 and are not at risk. However, upon primary infection, some patients may be able to mount a sufficient immune response to terminate active parvovirus B19 infection of erythroid precursors. The most common consequence of B19 infection in the compromised host is pure red-cell aplasia, resulting in chronic or recurrent anemia with reticulocytopenia. Anemia persists until neutralizing antibody is either produced by the host or passively administered. Parvovirus B19 should be suspected in compromised hosts with unexplained or severe anemia and reticulocytopenia, or when bone-marrow examination shows either giant pronormoblasts or absence of red-cell precursors. Diagnosis is established by detection of B19 DNA in serum in the absence of IgG antibody to B19. In some cases, IgG antibody is detected but is not neutralizing. Anti-B19 IgM may or may not be present. Therapy includes any or all of the following: red-cell transfusion, adjustment in medications to restore or improve the patient's immune system, and administration of intravenous immunoglobulin (IVIG). Following treatment, patients should be closely monitored, especially if immunosuppression is unchanged or increased. Should hematocrit trend downward and parvovirus DNA trend upward, the therapeutic options above should be revisited. In a few instances, monthly maintenance IVIG may be indicated. Caregivers should be aware that B19 variants, though rarely encountered, can be missed or under-quantitated by some real-time polymerase-chain reaction methods.

Parvovirus B19-associated eruptive pseudoangiomatosis in a child: The paradigm of paraviral eruptions

A 12-year-old otherwise healthy boy developed eruptive pseudoangiomatosis (EPA) of the upper limbs. Meanwhile parvovirus B19 seroconversion became evident. Histology revealed ectasia of blood vessels in the superficial dermis without noteworthy inflammatory cell infiltration. No parvovirus B19 antigens were demonstrated by immunohistochemistry in the endothelial cells, suggesting that this case report of EPA represented a possible paraviral eruption. To the best of our knowledge, this case study is the first to relate primary parvovirus B19 infection and EPA. We suggest that parvovirus B19 could be added to the list of viral agents associated with EPA.

Different patterns of skin manifestations associated with parvovirus B19 primary infection in adults

Skin involvement is reported during primary parvovirus B19 infection in adults. We sought to describe the cutaneous presentations associated with parvovirus B19 primary infection in adults. We conducted a descriptive, retrospective, multicenter study. The patients included (>18 years old) had well-established primary infections with parvovirus B19. Twenty-nine patients were identified between 1992 and 2013 (17 women, 12 men). The elementary dermatologic lesions were mostly erythematous (86%) and often purpuric (69%). Pruritus was reported in 48% of cases. The rash predominated on the legs (93%), trunk (55%), and arms (45%), with a lower frequency of facial involvement (20%). Four different but sometimes overlapping patterns were identified (45%): exanthema, which was reticulated and annular in some cases (80%); the gloves-and-socks pattern (24%); the periflexural pattern (28%); and palpable purpura (24%). The limitations of this study were its retrospective design and possible recruitment bias in tertiary care centers. Our findings suggest that primary parvovirus B19 infection is associated with polymorphous skin manifestations with 4 predominant, sometimes overlapping, patterns. The acral or periflexural distribution of the rash and the presence of purpuric or annular/reticulate lesions are highly suggestive of parvovirus B19 infection.

Acute Transverse Myelitis Associated With Human Parvovirus B19 Infection

We describe severe acute transverse myelitis in a previously healthy 9-year-old boy in whom primary human parvovirus B19 infection was confirmed serologically and B19 DNA was detected in his serum and cerebrospinal fluid. Besides erythema infectiosum, parvovirus B19 infection has various clinical manifestations; however, central nervous system involvement is rare. Even more unusual is parvovirus B19-associated acute transverse myelitis.

Manifestations cliniques et biologiques de la primo-infection à parvovirus B19 chez l’adulte immunocompétent : étude rétrospective de 26 observations

PurposeParvovirus B19 causes erythema infectiosum in children, transient aplastic anemia in patients with hemoglobinopathies, pur red cell aplasia in immunocompromised persons and hydrops fetalis in pregnancy. The spectrum of clinical and biological manifestations in immunocompetent adult continues to grow up. MethodsWe report on a case series of 26 patients with primary parvovirus B19 infection in immunocompetent adults. This is a retrospective study over the period 2000 to 2010 in two departments of internal medecine. The diagnostic was clinical, serological or molecular. ResultsThere was a female predominance (sex-ratio 3.33/1). Median patient age at diagnostic was 38.8 years (range: 18–68). The predominant symptoms were fever (65%), peripheral and symmetrical polyarthralgia (62%) and skin rash (58%). Two patients had neurological manifestations (sixth cranial nerve palsy, distal paresthesia) and one patient had myocarditis. Abnormal laboratory values included increased acute phase reactants (73%), thrombocytopenia (43%), lymphopenia (38%) and elevated liver enzymes (37%). Antinuclear (19%), anti-DNA (28%) and anti-phospholipids antibodies (14%), and hypocomplementemia (32%) were observed. False reaction with anti-CMV and anti-EBV IgM positivity was documented in 27% of cases. Two patients had persistent parvovirus B19 infection. ConclusionThe diversity of the clinical manifestations of parvovirus B19 infection may be misleading for the clinician. However, the diagnosis should be suspected in immunocompetent adults to limit the risk of transmission to the patients who could develop a severe infection such as pregnant women or immunocompromised patients.

Item 94 – Maladies éruptives de l’enfant

Skin involvement is reported during primary parvovirus B19 infection in adults.We sought to describe the cutaneous presentations associated with parvovirus B19 primary infection in adults.We conducted a descriptive, retrospective, multicenter study. The patients included (>18 years old) had well-established primary infections with parvovirus B19.Twenty-nine patients were identified between 1992 and 2013 (17 women, 12 men). The elementary dermatologic lesions were mostly erythematous (86%) and often purpuric (69%). Pruritus was reported in 48% of cases. The rash predominated on the legs (93%), trunk (55%), and arms (45%), with a lower frequency of facial involvement (20%). Four different but sometimes overlapping patterns were identified (45%): exanthema, which was reticulated and annular in some cases (80%); the gloves-and-socks pattern (24%); the periflexural pattern (28%); and palpable purpura (24%).The limitations of this study were its retrospective design and possible recruitment bias in tertiary care centers.Our findings suggest that primary parvovirus B19 infection is associated with polymorphous skin manifestations with 4 predominant, sometimes overlapping, patterns. The acral or periflexural distribution of the rash and the presence of purpuric or annular/reticulate lesions are highly suggestive of parvovirus B19 infection.

Guillain-Barré Syndrome Associated with Primary Parvovirus B19 Infection in an HIV-1-Infected Patient

Parvovirus B19 (B19V) infection has rarely been reported as responsible for Guillain-Barré syndrome (GBS). We present the case of a 63-year-old man with AIDS who presented with rapidly progressing weakness of his inferior limbs and a newly appeared pancytopenia. CSF examination and electromyography were characteristic for GBS. Very high CSF and serum B19V DNA concentrations were present, in the absence of IgG or IgM against B19V. The neurologic and hematologic abnormalities improved after a 5-day course of i.v. immunoglobulins in parallel with a dramatic decrease in the B19V viral load.

Exanthème à type de « syndrome babouin » au cours d’une primo-infection par le parvovirus B19 : deux cas

Primary parvovirus B19 infection may present a wide variety of dermatological features. We report two cases of parvovirus infection presenting as flexural erythema of baboon syndrome induced by various drugs, but associated with purpuric or oedematous features. A pregnant 23-year-old woman at 39 weeks of amenorrhoea and a 49-year-old woman consulted for flexural eruption in a setting of fever. In both cases, clinical examination revealed erythematosus rash in the major skin folds, with vesicles and elements of purpura in the former patient and bullous oedema in the latter. In both cases, the diagnosis of primary parvovirus B19 infection was confirmed by positive PCR screening of viral genome and by seroconversion after two weeks. The skin lesions regressed spontaneously within several days. Although initially linked solely with systemic drug toxicity, baboon syndrome has since been reported in connection with other allergens (drug reactions, contact dermatitis, viral and streptococcal infection). Among these causes, parvovirus B19 infection merits particular interest.

Immune reconstitution to parvovirus B19 and resolution of anemia in a patient treated with highly active antiretroviral therapy

Immune reconstitution inflammatory syndrome (IRIS) is an unsolved problem in the treatment of human immunodeficiency virus (HIV)-1 infection. Despite the high seroprevalence of parvovirus B19 (PVB19) among HIV-1-positive patients, reports on PVB19-induced anemia, especially that associated with PVB19-related IRIS, in these patients are limited. We present the case of a man with acquired immunodeficiency syndrome who developed severe transfusion-dependent anemia and was seropositive and borderline positive for immunoglobulin-M and IgG antibodies against PVB19, respectively. PVB19-DNA was also detected in his serum. The patient was diagnosed with pure red cell anemia (PRCA) caused by a primary PVB19 infection and was treated with periodical blood transfusions. However, he subsequently tested negative for IgG antibodies and developed chronic severe anemia with high levels of PVB19 viremia. This indicated a transition from primary to persistent infection. After initiation of highly active antiretroviral therapy, the patient showed an inflammatory reaction with rapid deterioration of anemia and seroconversion of the IgG antibody to PVB19. Subsequently, PRCA was completely resolved, but the patient's serum still contained low levels of PVB19-DNA. Thus, this was a case of IRIS associated with PVB19 infection. Our report highlights the significance of seroconversion to PVB19 in the diagnosis of IRIS and re-emphasizes the finding that persistently high levels of PVB19 viremia after primary infection are probably because of the lack of protective antibodies.

Parvovirus B19 Infection

Primary parvovirus B19 infection is not uncommon during pregnancy, and is often asymptomatic in the mother (de Jong et al, J Clin Virol. 2006;36:1–7). Vertical transmission to the fetus occurs in roughly 30% of patients with primary infection (Koch et al, Pediatr Infect Dis J. 1998;17:489–494). The risk of an adverse fetal outcome following parvovirus B19 infection is low; however, severe infections can lead to fetal hydrops and intrauterine fetal demise (de Jong et al, J Clin Virol. 2006;36:1–7; Koch et al, Pediatr Infect Dis J. 1998;17:489–494; Young et al, N Engl J Med. 2004;350:586–597). Diagnosis of parvovirus B19 infection can be made by identification of the characteristic findings within the placenta, including a grossly hydropic placental disc and the presence of intranuclear inclusions within fetal red blood cells (Koduri et al, Am J Hematol. 1998;58:95–99; Quemelo et al, Inst Med Trop Sao Paulo. 2007;49:103–107). Similar inclusions can be seen in various tissues of fetuses who experience an intrauterine demise and present for autopsy (Rodriguez et al, Pediatr Dev Pathol. 2002;5:365–374; O'Malley et al, Pediatr Dev Pathol. 2003;6:414–420). The current case report illustrates an example of parvovirus B19 infection in a pregnant woman whose fetus subsequently developed hydrops fetalis and died in utero. The accompanying placental and fetal pathology depict classic findings of parvovirus B19 infection. The differential diagnosis of parvovirus B19 infection in a placental specimen is also discussed.

Relapsing severe anaemia due to primary parvovirus B19 infection after renal transplantation: a case report and review of the literature

In renal transplant recipients Parvovirus B19 (PB19) infection can lead to severe anaemia, due to lytical replication within erythroid progenitor cells. Clearance of PB19-infection and protective immunity is assumed to be provided by specific PB19-IgG-antibodies [1]. In fact, passive transfer of PB19-IgG-antibodies by means of intravenous immunoglobulin (IvIg) preparations is successfully used to treat PB19-related anaemia [1,2]; however, several reports have shown that PB19related anaemia can recur despite treatment with IvIg [2–11]. In this report we describe in detail a renal transplant patient who experienced relapsing severe PB19-related anaemia and we reviewed the current literature regarding factors associated with relapsing disease. Our data suggest that primary PB19-infection after kidney transplantation and polyclonal T-cell depleting therapies are risk factors for relapsing PB19-related anaemia. In addition, they support the concept that a PB19specific cellular immune response is critical to control PB19-infection and establish protective immunity.

Parvovirus B19 infection as a cause of cytopenia with a lupus-like presentation in the elderly: A case report

Most cases of parvovirus B19 infection are asymptomatic and occur in childhood; half of all 15-year-old adolescents have specific anti-parvovirus B19 antibodies. Here, we report a rare case of parvovirus B19 primary infection, rare due to (1) its occurrence in a geriatric patient (an 82-year-old woman), (2) its lupus-like presentation, and (3) its potential role in precipitating congestive heart failure.

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

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

Acute polyarthritis during a parvovirus B19 primary infection

Parvovirus B19 classically causes erythema infectiosum in children, febrile arthralgia or acute erythroblastopenia in adult. The clinical spectrum of adult primary infection is sometimes misleading. We report an observation of an acute rheumatoid-like arthritis following primary parvovirus B19 infection in a 42-year-old woman.

Parvovirus B19 primary infection with vasculitis: DNA identification in cutaneous lesions and sera

Parvovirus B19 primary infection with vasculitis: DNA identification in cutaneous lesions and sera

Acute urticaria and dry cough with interstitial pneumonia: a clue for the diagnosis of primary parvovirus B19 infection

Acute urticaria and dry cough with interstitial pneumonia: a clue for the diagnosis of primary parvovirus B19 infection