Parvovirus B19 Viremia Research Articles

Prevalence of Parvovirus B19 Viremia Among German Blood Donations and the Relationship to ABO and Rhesus Blood Group Antigens.

Asymptomatic blood donors can transmit human parvovirus B19 (B19V). We assessed the B19V prevalence among a large cohort of blood donations collected in Germany during 2015-2018. In total, 167 123 donations were screened for B19V deoxyribonucleic acid with 22 cases of viremia identified (0.013% positive). Infections peaked at a 4-year interval and the highest number of cases occurred in the summer months. All 22 infections were found in rhesus D-antigen-positive donations, suggesting a protective factor in donors who lack this antigen. These findings contribute to our understanding of risk factors for B19V infection among central European blood and plasma donors.

Prevalence of anti-parvovirus B19 IgG and IgM and parvovirus B19 viremia in pregnant women in an urban area of Northern Italy.

Parvovirus B19 (B19V) infection in pregnancy is mostly asymptomatic, but can cause complications including abortion and fetal hydrops. Although its infection is ubiquitous, seroprevalence among pregnant women varies according to different geographical areas. Since seroprevalence data in Italy are limited, the prevalence of antibodies and DNA in pregnant women was evaluated retrospectively, correlating the clinical situation of mothers and newborns. One thousand eight hundred and ninety-three sequential sera were examined from pregnant women (60.8% in the first trimester, 16.6% in the second one, and 22.6% in the third one, respectively) for anti-B19V IgG and IgM (confirmed by immunoblot); 1402 (74.1%) were of Italian origin and 491 (25.9%) non-Italian women. Molecular tests were used to search for viral genome. One thousand three hundred and fifteen (69.5%) samples were IgG-positive, 21 (1.1%) IgM-positive,and 578 (30.5%) nonimmune. The difference in IgG seroprevalence between Italian (71.1%) and non-Italian women (64.8%) was statistically significant. Of the 21 IgM-positive women, 16 were confirmed positive also by immunoblot (prevalence: 0.8%), of which 11 were viraemic (prevalence: 0.6%; mean 1.3 × 104 geq/ml). Mothers were asymptomatic, and the newborns had no clinical signs of congenital infection. IgG seroprevalence in Italy is high, with differences between Italian women and non-Italian women from geographic areas with lower endemic levels of B19V. The consistent migratory flows in place could lead to an increase in the number of susceptible women. The prevalence of viremia is low, and has not been associated with evident fetal damage at birth.

Recurrent parvovirus B19 viremia resulting in two episodes of hemophagocytic lymphohistiocytosis

BackgroundHemophagocytic lymphohistiocytosis (HLH) is a hyperinflammatory condition with uncontrolled activation of lymphocytes and macrophages. Besides a primary (genetic) form, HLH can also be triggered by malignant, autoimmune and infectious diseases. HLH recurrences are rarely described, usually only in primary HLH. Parvovirus B19 (PVB19) Infection is one of the rare and rather benign causes of HLH. Since the infection usually results in long-lasting immunity, recurrent viremia is very uncommon.Case presentationWe report an unusual case of a young female with recurrent PVB19 infection that led to repeated episodes of HLH. The first episode occurred at the age of 25 years with a three-week history of high fever and nonspecific accompanying symptoms. The diagnosis of HLH was confirmed by HLH-2004 criteria and HScore, PVB19 viremia was detected as underlying cause. Following guideline-based therapy, the patient was symptom-free for one year, before similar symptoms recurred in a milder form. Again, PVB19 was detected and HLH was diagnosed according to HScore. After successful treatment and a nine-month symptom-free interval, a third phase of hyperinflammation with low PVB19 viremia occurred; this time, treatment with a corticosteroid and intravenous immunoglobulin was initiated before the presence of clear diagnostic criteria for HLH. No further events occurred in the following three years.ConclusionsIn the case of our patient, the recurrent viremia triggered three episodes of hyperinflammation, two of which were clearly diagnosed as HLH. To our knowledge, this is the first published case of recurrent HLH due to PVB19 infection. Therefore, the case gives new insights in triggering mechanisms for HLH.

Molecular Evaluation of Human Parvovirus B19 Infection and Associated Risk Factors among Pregnant Women in Bushehr Province, Southern Iran.

Given the importance of human parvovirus B19 infection during pregnancy and the potential risks to the fetus, this study was designed to determine the prevalence, genotypic pattern, and risk factors of parvovirus B19 infection among a population-based sample of pregnant women in Bushehr Province, southern Iran. A total of 824 pregnant women were enrolled in this study. Serum samples were screened for the detection of anti-parvovirus B19 IgM and IgG by ELISA. The molecular evaluation was performed by nested polymerase chain reaction, targeting the non-structural protein 1-viral protein 1 unique region of the genome, and sequencing. Of 824 pregnant women, 330 (40.1%) were positive for anti-parvovirus B19 IgG and 50 women (6.1%) had anti-parvovirus B19 IgM. A greater rate of anti-parvovirus B19 IgG seroprevalence was observed in women older than 39 years, in Afghan immigrants, and in those women with more parities. Anti-parvovirus B19 IgM seroprevalence decreased with increasing gestational age and was significantly greater among women in the first trimester of pregnancy and among residents of the city of Borazjan. Moreover, 0.73% of the pregnant women had parvovirus B19 viremia with genotype 1 and subtype 1a. Parvovirus B19 DNA was detected in the samples collected in late autumn and winter, which is a rainy season associated with temperate climes in southern Iran. According to the results of this study, approximately 60% of pregnant women in this region are serologically negative and susceptible to parvovirus B19 infection. Therefore, assessment for maternal parvovirus B19 infection is important and should be considered as part of the fetal-maternal health policy in Iran.

A meta-analysis On Association Between Viral Infections and Kawasaki Disease in Children

Aim: To investigate the association between different viral infections and the development of Kawasaki disease (KD) in children. Materials & methods: Electronic databases were searched for relevant studies published from inception to May 2020. The pooled odds ratios (ORs) of the association of different viral pathogens with KD were estimated using a random-effects model weighted by the inverse variance method. Results: The strongest associations were found between KD and human parvovirus B19 viremia (OR = 41.05; 95% CI: 5.13–328.28; I-square = 0%), EBV IgM seropositivity (OR = 7.18; 95% CI: 3.65–14.12, I-square = 0%) and human herpesvirus-6 IgG seropositivity (OR = 5.83; 95% CI: 1.06–32.01). Conclusion: Human parvovirus B19, EBV and human herpesvirus-6 are highly suspected to be key contributors to the development of KD.

Парвовірус В19-віремія. Клініко-лабораторна презентація

Парвовірус В19-віремія. Клініко-лабораторна презентація

High-dose polyclonal intravenous immunoglobulin therapy for refractory viral infections including viremia after allogeneic hematopoietic cell transplantation

Refractory viremia/viral disease is a major life-threatening complication that may arise among patients undergoing allogeneic hematopoietic cell transplantation (allo-HCT). This study aimed to clarify the therapeutic effect of high-dose polyclonal intravenous immunoglobulin (IVIG) against viremia/viral diseases after allo-HCT. We conducted a pilot study to investigate the therapeutic effect of 400 mg/kg of IVIG given for 5 consecutive days against refractory viremia/viral disease after allo-HCT. Overall, 7 patients were drug-resistant and the other 7 had not previously received any drug for their viremia/viral disease. All patients completed the 5-day therapy regimen of IVIG. A complete response at Day 56 was observed for 8 of 14 patients (57.1%). Additionally, 10 of 14 patients (71.4%) were alive at Day 56, although only one death occurred due to the viremia/viral disease. Remarkably, all 3 cases who developed exogenous viremia/viral diseases including respiratory syncytial virus pneumonia/bronchitis and human parvovirus B19 viremia achieved a complete response, suggesting that high-dose polyclonal IVIG may be more effective against exogenous viruses rather than endogenous ones. Congestive heart failure was observed in 1 patient. High-dose polyclonal IVIG could be an effective and feasible therapy for refractory viremia/viral disease after allo-HCT.

Treatment of parvovirus B19 viremia to facilitate kidney transplantation in a patient with collapsing glomerulopathy

Collapsing glomerulopathy (CG) is a severe form of glomerulopathy which results in nephrotic syndrome and often ensues in rapid progression to end-stage kidney disease (ESKD). Although most commonly a result of HIV infection, other conditions such as parvovirus B19 (PB19) infection have been associated with CG. We present a case of an 18-year-old male with CG associated with PB19 infection who was heterozygous for APOL1 G1 and G2 genetic variants. In an attempt to treat, he was started on intravenous immunoglobulin (IVIg), however rapidly progressed to ESKD. During workup for a living donor kidney transplant he was found to have persistent low-grade PB19 viremia. Despite having no major immunodeficiency and given subsequent courses of IVIg, viremia continued to persist. In a final attempt to eradicate the PB19 we began treatment with cidofovir, an antiviral agent with in vitro efficacy against PB19. Subsequent to initiation of cidofovir, PB19 viremia slowly cleared after which he received a living unrelated kidney transplant. The patient had an early cellular rejection treated with rabbit antithymocyte globulin after which he recovered kidney function without signs of recurrent CG. Our case report suggests efficacy of IVIg and cidofovir for persistent PB19 infection in ESKD to allow subsequent transplantation, while minimizing the risk of recurrent CG.

Seroprevalence of acute human parvovirus B19 viraemia among anaemic children in ibadan city, Nigeria

Objective: To determine the seroprevalence of B19V IgM as a measure of acute infection and associated risk factors among 0.05). Conclusions: The seroprevalence of 14.7% among anaemic children confirm that these infections are endemic in Nigeria. This level of infectivity suggests that there is a high risk of transmission to healthy children as well as children with underlying haemolytic or acquired anaemia in Nigeria.

No evidence of persistent parvovirus B19 viremia among Iranian patients with HIV after a 1-year follow-up.

Recent studies have demonstrated that, in common with other latent viruses, parvovirus B19 infection can be controlled by the host immune response but may persist in some places such as the bone marrow. Persistent B19 infection has been found in both immunocompetent and immunocompromised individuals, such as patients infected with human immunodeficiency virus (HIV). However, there is limited data regarding long-term B19 viremia in HIV patients. In this study, we investigated virological and hematological findings, and also the clinical outcome, of seven cases of HIV/B19 coinfection (confirmed by PCR) after one year. These cases were provided from a previous study on patients with HIV infection that found B19 DNA in 13 cases. Seven of these 13 patients were available after 1 year, and we retested them for B19 viremia and B19-specific antibodies. B19 IgG was tested by ELISA, and B19 DNA was assessed by nested PCR. Anemia was not observed in these cases. All subjects had cleared viremia, but B19 IgG seroconversion occurred in two cases. No significant changes in CD4 and hemoglobin occurred. The results of this study indicate that B19 infection in HIV patients is a subtle infection and that B19 viremia is not a long-term event.

Parvovirus B19 viremia in Egyptian adults with systemic lupus erythematosus

Objective This study was undertaken to investigate the seroprevalence of parvovirus B19 DNA in systemic lupus erythematosus (SLE) patients and its correlation with disease activity. Background Infection with parvovirus B19 (B19) has been suggested to contribute to the pathogenesis of SLE. B19 infection may simulate both clinical and laboratory features of SLE, presenting either as a potential first-time diagnosis of SLE or as an exacerbation of previously established disease. Patients and methods Sera from 30 adult patients with SLE and from 15 normal controls were examined for parvovirus B19 infection by means of nested PCRs to detect B19 DNA. Results B19 DNA was detected in two of 15 (13.5%) controls and in 12 (40%) of 30 SLE patients, with no significantly positive rates observed in SLE patients compared with healthy controls ( P > 0.05). B19 was positive in seven (58.5%) patients with severe activity compared with 8.3% without activity, 16.7% patients with mild activity, and 16.7% patients with moderate activity. No significant differences were observed between patients with virological positivity and those with virological negativity for B19 infection as regards the activity of SLE or any clinical manifestations of SLE. Conclusion Parvovirus B19 infection is not associated with SLE.

A Case of Encephalopathy in an Immunocompetent Adult with Persistent Parvovirus B19 Viremia

Parvovirus B19 (PVB19) is a ubiquitous airborne virus; it is well known to cause erythema infectiosum (fifth disease) in children. Neurologic complications after PVB19 exposure are thought to be transitory and infrequent in the adult population. Herein, we report an interesting case of a young woman who developed cognitive deficits, white matter changes and persisting viremia for over a year after exposure to PVB19.

A Case of Encephalopathy in an Immunocompetent Adult with Persistent Parvovirus B19 Viremia

A Case of Encephalopathy in an Immunocompetent Adult with Persistent Parvovirus B19 Viremia

Parvovirus B19, rubella, Epstein-Barr, and cytomegalovirus and idiopathic thrombocytopenia in Egyptian children, single-center study

Background Idiopathic thrombocytopenic purpura (ITP) in children is usually a self-limiting disorder. It may follow a viral infection or immunization and is caused by an inappropriate response of the immune system. Many viruses, such as parvovirus B19, cytomegalovirus (CMV), Epstein–Barr virus (EBV), and rubella, are implicated in the occurrence of ITP. Aim The aim of the study was to investigate the occurrence of viral-associated ITP in Egyptian children. Materials and methods Viral studies included specific immunoglobulin M for rubella, EBV, and CMV. In addition, molecular detection for parvovirus B19 was carried out. Results Positive viral markers either by positive serology immunoglobulin M for rubella, CMV, or EBV or by a molecular study for parvovirus B19 were detected in 19 patients (38.8%). The most common viral infection was parvovirus B19 (30.6%), followed by EBV (16.3%), rubella (12.12%), and CMV (10.2%). Conclusion We conclude that in a large proportion of children with ITP in our region, an association with markers of acute viral infections similar to those of rubella, EBV, and CMV is present. Moreover, a significant proportion of the children had occult parvovirus B19 viremia. A study of occult viral infections is recommended in children with ITP.

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.

Chronic hepatitis caused by persistent parvovirus B19 infection

BackgroundHuman infection with parvovirus B19 may lead to a diverse spectrum of clinical manifestations, including benign erythema infectiosum in children, transient aplastic crisis in patients with haemolytic anaemia, and congenital hydrops foetalis. These different diseases represent direct consequences of the ability of parvovirus B19 to target the erythroid cell lineage. However, accumulating evidence suggests that this virus can also infect other cell types resulting in diverse clinical manifestations, of which the pathogenesis remains to be fully elucidated. This has prompted important questions regarding the tropism of the virus and its possible involvement in a broad range of infectious and autoimmune medical conditions.Case PresentationHere, we present an unusual case of persistent parvovirus B19 infection as a cause of chronic hepatitis. This patient had persistent parvovirus B19 viraemia over a period of more than four years and displayed signs of chronic hepatitis evidenced by fluctuating elevated levels of ALAT and a liver biopsy demonstrating chronic hepatitis. Other known causes of hepatitis and liver damage were excluded. In addition, the patient was evaluated for immunodeficiency, since she had lymphopenia both prior to and following clearance of parvovirus B19 infection.ConclusionsIn this case report, we describe the current knowledge on the natural history and pathogenesis of parvovirus B19 infection, and discuss the existing evidence of parvovirus B19 as a cause of acute and chronic hepatitis. We suggest that parvovirus B19 was the direct cause of this patient's chronic hepatitis, and that she had an idiopathic lymphopenia, which may have predisposed her to persistent infection, rather than bone marrow depression secondary to infection. In addition, we propose that her liver involvement may have represented a viral reservoir. Finally, we suggest that clinicians should be aware of parvovirus B19 as an unusual aetiology of chronic hepatitis, when other causes have been ruled out.

Symptomatic, prolonged Parvovirus B19 infection and accompanying illness in otherwise healthy adults

Results In a 21-month period, 11 patients (7 females and 4 males), with a mean age of 36.9 (range 27-46) years with a symptomatic Parvovirus B19 infection were recorded and followed-up. Intrafamiliar exposure and occupational (health care) exposure were identified in two cases each. Clinical signs and symptoms included fever (100% of cases), polyarthralgia (90%), followed by headache (80%), anemia (70%), and rash. A mild-tomoderate myelosuppression of all hematological lines characterized 8 cases of 11 (72.7%), while increased serum transaminases were associated in 63.6% of patients. Three patients of ours deserved hospitalization (mean 10.8 days of admission), and five more cases were followed on Day-Hospital basis (for a median 75-day period); in four patients a treatment with i.v. highdosage human immunoglobulins was performed. Elevated levels of specific serum anti-Parvovirus B19 IgM antibodies were detected in all cases. In a 33-year-old female a severe anemia and a persisting headache, vomiting, and neck stiffness, led to RBC transfusion and a diagnosis of meningoencephalitis, with positive search of IgM antibodies and Parvovirus B19 viremia (detected by RT-PCR) in the cerebrospional fluid which lasted up to three months, despite treatment with i.v. serum immunoglobulins.

Symptomatic, long-term Parvovirus B19 infection in otherwise healthy adults

Background: Parvoviridae are part of air-, parenteral- and perinatal-transmitted ubiquitous viruses, whose associated signs and symptoms strongly depend on patient's age and immune defence. Methods: All cases of symptomatic Parvovirus B19 infection in otherwise healthy adults which came to our attention since spring 2006 were prospectively investigated and followedup. Results: In a 21-month period, 11 patients (7 females and 4 males), with a mean age of 36.9 (range 27-46) years with a symptomatic Parvovirus B19 infection were recorded and followed-up. Intrafamiliar exposure and occupational (health care) exposure were identified in two cases each. Clinical signs and symptoms included fever (100% of cases), polyarthralgia (90%), followed by headache (80%), anemia (70%), and rash. A mild-to-moderate myelosuppression of all hematological lines characterized 8 cases of 11 (72.7%), while increased serum transaminases were associated in 63.6% of patients. Three patients of ours deserved hospitalization (mean 10.8 days of admission), and five more cases were followed on Day-Hospital basis (for a median 75-day period); in four patients a treatment with i.v. highdosage human immunoglobulins was performed. Elevated levels of specific serum anti-Parvovirus B19 IgM antibodies were detected in all cases. In a 33-year-old female a severe anemia and a persisting headache, vomiting, and neck stiffness, led to RBC transfusion and a diagnosis of meningoencephalitis, with positive search of IgM antibodies and Parvovirus B19 viremia (detected by RT-PCR) in the cerebrospional fluid which lasted up to three months, despite treatment with i.v. serum immunoglobulins. Conclusion: Parvovirus B19 infection may play a significant role also in adult, immunocompetent subjects, and the disease sometimes is not mild and self-limiting, requiring admission and/or frequent outpatient interventions in a significant number of cases. The causes supporting a persistant infection in immunocompetent subjects have not been investigated to date, as well as the pathogenesis of myelosuppression and severe polyartrhalgia. Symptomatic Parvovirus B19 infection is still an underestimated clinical condition, and therapeutic perspectives are extremely limited until now. Abstracts for SupplementInternational Journal of Infectious DiseasesVol. 14Preview Full-Text PDF Open Archive

Parvovirus B19 in Solid Organ Transplant Recipients

Parvovirus B19 is a common, ubiquitous human pathogen.It is a small, single-stranded linear, nonenveloped DNAvirus classified into three different genotypes (genotype1, Au and Wi strains; genotype 2, LaLi and A6 strains; andgenotype 3, V9 strains). Its worldwide genetic variability islow, and there is no clear correlation between genotypeand distinctive clinical manifestation. Parvovirus B19 repli-cates most efficiently and preferentially in human erythro-cyte precursors; thus, the virus is classified as a memberof the Erythrovirus genus of the Parvoviridae family. Mostpeople are infected between the ages of 5 and 15 years;by adulthood, up to 80% are seropositive (1). Infection ap-pears to confer lifelong immunity to immunocompetenthosts, but reinfection is possible in a minority of cases(2). It has been hypothesized that Parvovirus B19 can per-sist in the bone marrow and other tissues (3), support-ing possible reactivation rather than reinfection in certainseropositive patients. Parvovirus B19 infection can be ei-ther symptomatic or asymptomatic, depending on the age,hematologic and immunologic status of the host. Whilemostpatientsrecollectonlynonspecificflu-likesymptoms,distinctive clinical entities have been associated with Par-vovirus B19 infection in both immunocompetent hosts (4)and solid organ transplant (SOT) recipients (5). The mostcommonclinicalmanifestationsofParvovirusB19aresum-marizedinTable1.Although large, prospective surveillance studies are lack-ing, earlier studies reported an incidence of Parvovirus B19disease of

Melkersson–Rosenthal syndrome associated with parvovirus b19 viraemia and haemophagocytic lymphohistiocytosis

We describe a 23-year-old patient who presented acutely with haemophagocytic lymphohistiocytosis (HL) and Melkersson-Rosenthal syndrome (MRS). MRS and HL are two unusual and complex clinical patterns that may present acutely and to our knowledge, an association between them has never been reported. The clinical investigations in this patient led to identification of parvovirus B19 (PB19) viraemia by PCR. Parvovirus infection has been reported as a cause of virus-associated HL, but the presence of PB19 has never been sought or reported as a possible trigger for MRS. This observation suggests a possible association between PB19 and HL, and opens the possibility of its association also with acute-onset MRS. Further investigations for the presence of PB19 in cases of MRS are warranted.