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[Parvovirus B19 infection. New physiopathological approaches].

Knowledge of the pathophysiological mechanisms governing Parvovirus B19 infection has been modified with the recent discovery of its cellular receptor. The cell lines susceptible to infection can be identified on the basis of the nature and distribution of the virus in the human organism. The Parvovirus B19 can undergo two types of cycles within the host cell. The first is a complete cycle within the infected cell leading to cell death by lysis. In the second, the cycle aborts and cell death is caused by an association of immunological phenomena and the accumulation of viral proteins toxic to the cell. It is not known why complete cycles are restricted to a single erythrocyte line. These new data not only give a more precise explanation of the classical clinical expression of the disease, but also suggest possible mechanisms for the pathogenic power of the Parvovirus B19, some of which have already been proposed on the basis of clinical observations.

AIDS-Related Opportunistic Infections

Infections caused by parvovirus B19.

Parvovirus B19 was discovered in 1974 by Cossart et al; is a single stranded unenveloped DNA virus, which virion is isometric, uniform and has icosagedral symmetry. B19 infection has been found in all countries, it is almost certainly world-wide in distribution. Infections occurs most frequently in late winter, spring and early summer months and are transmitted by respiratory route. Erythema infectiosum is the most common manifestation of human parvovirus B19 infection, is most commonly acquired between 4 and 10 years of age and at least 60% of adults are seropositive. Erythema Infectiosum is characterized by three stages of rash that involves the face and may also involves trunk and extremities. In adult patients, particularly women, arthralgia or arthritis have been associated with up to 80% of Erythema Infectiosum casually starts in the small joints of the hand. Maternal parvovirus B19 infection with or without rash, can affect fetus. Transient aplastic crisis can be caused by HPV B19 in patient who have increased rate of RBC destruction or loss. Others diseases or symptoms complexes may be associated with B19 infection in the coming years as this virus and its infections continues being an interesting field of investigation.

Adolescent

Autonomous parvovirus transduction of a gene under control of tissue-specific or inducible promoters.

Several classes of viruses are in use, or are being developed, as gene therapy vectors. Viruses with small genomes containing few essential genes have the advantage of requiring only simple complementation systems to allow packaging of foreign DNA, substituted for the entire viral coding sequences. Retroviruses and the dependent parvovirus AAV (adeno-associated virus) have been used in this way, and both possess an efficient integration mechanism which should allow long-term expression of transduced genes. In some situations, however, long-term persistence may be undesirable and there is a need for small, non-integrating viral vectors. Autonomous parvoviruses, such as LuIII, have potential as such vectors for short-term expression of therapeutic genes. We previously described recombinants of LuIII that transduced reporter genes, expressed using the viral constitutive promoter, P4. We have now generated several recombinants containing regulated promoters. A virus including a liver-specific enhancer directed 10- to 20-fold preferential expression of the luciferase reporter in transduced human hepatoma (HepG2) versus HeLa cells. In additional LuIII recombinants, the luciferase reporter was linked with chimeric promoters containing binding sequences for either the yeast GAL4 protein or the bacterial tetracycline repressor. Luciferase expression was strongly activated when these viruses were used to infect cells containing a cognate trans-activator (GAL4 or tTA, a tetracycline repressor fusion with VP16 of herpes simplex), introduced by transfection. The response to tTA could be abolished, or reduced in a graded manner, by exposure of the infected cells to tetracycline. Further results suggested that an increase in basal expression, apparently mediated by the viral left terminal inverted repeat, could be minimized by interposing polyadenylation signals between this sequence and the promoter. These results confirm that appropriate transcriptional regulation can be achieved for genes transduced by an autonomous parvovirus vector. Such vectors therefore show promise for the delivery of therapeutic genes in situations requiring cell-specific, short-term expression, eg in targeting suicide genes for ablation of cancer cells.

Cell Line

Various associations of human parvovirus B19 infection.

A variety of diseases encountered in association with human parvovirus B19 infection seen at Paediatric clinic during 6 months is presented and their relation to parvovirus B19 is discussed. We conclude that investigation of parvovirus B19 in variable diseases by using the newly developed methods of molecular biology will enlighten many etiopathogenetic mechanisms.

Antibodies, Viral

[Human parvovirus B19 infection in a child suffering from chronic arthritis].

The pathogenicity of the human parvovirus B19 has been disclosed in the last two decades. Different syndromes (erythema infectiosum or hydrops fetalis) can be produced by this virus as well as aplastic crisis in patients with haemolytic anaemia. It is a common infection both in adults and in children. The frequency of joint symptoms in erythema infectiosum is about 8% in childhood but tenfold of it in the adults. However, the arthropathy could be the only symptom without constitutional complains or rash. The joint problems used to be solved after some weeks in most cases but occasionally they could keep for some months or years. The disease is thought to be rheumatoid arthritis if the possibility of a parvovirus B19 infection has not been considered. In this paper the authors present a case report of a 14 years old boy with fever of unknown origin, skin eruptions and arthritis. On that connection, they discussed the recent knowledge about the human parvovirus B19 and refer to its importance in differential diagnosis of joint problems.

Adolescent

[Parvovirus B19 in the Czech Republic. Seroepidemiologic study].

Erythema infectiosum which is caused by parvovirus B 19 is notified in the Czech Republic similarly as some other viral exanthemas under the diagnosis "Other viral infections affecting the skin and mucosae, not listed elsewhere" (B08). Analysis of the epidemiological position in the Czech Republic in 1993-1995 was based on EPIDAT data, documentation of epidemic of 1993 in the Liberec district and serologically confirmed minor epidemics (1994, 1995). An increased number of cases (in particular in late winter and early spring) is observed in several years' (cca four-year) cycles and only in some districts. Children aged 3-10 years (88.2%) are affected predominantly. All the year round however sporadic cases affecting people of all age groups are notified. Concurrent illness of several family members (usually two) was confirmed by laboratory tests only in 9 of cca 200 investigated cases. The source of infection is usually not identified. The increase in the number of cases in a given locality rose rapidly after brief time intervals. The longest interval between two cases was 24 days. In families all affected members contracted the disease with 24 hours. According to the seroprevalence of the IgG parvovirus B 19 in different age groups the majority of cases in subadult and adult subjects is not diagnosed and notified. Seroprevalence of IgG antibodies of the parvovirus B 19 in subjects with arthropathies was 72.4%, in subjects with suspect borreliosis 69.9% an in the normal population cca 50%.

Adolescent

Parvovirus particles in a fetal-heart with myocarditis: ultrastructural and immunohistochemical study.

We report on the occurrence of parvovirus particles and VP1 (84 kDa) and VP2 (58 kDa) viral antigens in the heart of a case of fatal myocarditis in a fetus of a 26 year old women. Numerous cells containing intranuclear inclusions were identified within the blood vessels of the heart in a close apposition to muscle fibers. These cells were characterized by plentiful mitochondria and were consistent with erythroblasts. Typically, inclusions consisted of electrondense marginated chromatin and granular and amorphous "cores". At higher magnification, parvovirus particles, approximately 23 nm in diameter, were visualized either as relatively small clusters or forming large paracrystalline arrays. Virus buds were never observed. In addition, unusual membrane proliferation was seen. These findings support a notion that parvovirus may invade the fetal heart.

Adult

Raised IgM antibodies to parvovirus B19 in juvenile rheumatoid arthritis.

To delineate the role of human parvovirus B19 in the etiopathogenesis of juvenile rheumatoid arthritis (JRA), IgM and IgG antibodies specific for parvovirus B19 surface protein antigen(s) were estimated in the sera using commercial ELISA kits. Sera of 69 JRA patients (median age 16 yr, male : female ratio 1.1:1) satisfying the criteria of American Rheumatism Association along with 26 sera of rheumatoid arthritis (RA) and 12 sera of healthy children as disease and normal controls respectively were screened. Of the 69 patients with JRA, 19 (27.5%), 35 (50.7%) and 9 (13%) were positive for IgM, IgG and both IgG and IgM antibodies respectively. Of the 26 disease control sera, 11 (42.3%) were positive for IgG antibodies while none had elevated IgM antibodies. Among 12 healthy controls, 7 (58.3%) were positive for IgG and 1 was positive for both IgG and IgM antibodies. Thus, a statistically significant proportion of children with JRA had evidence of parvovirus B19 infection.

Adolescent

Spontaneous recovery from severe parvovirus B19 pure red cell aplasia, in a heart transplant recipient, as demonstrated by marrow culture.

A 61-year-old heart transplant recipient with parvovirus B19 infection, presented as a severe pure red cell aplasia (PRCA) with hemoglobin level of 5 g/dl. Both blood and bone marrow cells were positive for parvovirus B19 DNA, whereas specific immunoglobulins IgG and IgM were not informative. Bone marrow smears revealed erythroid hypoplasia without giant pronormoblasts. Autologous and allogenic bone-marrow cultures revealed a high inhibition by patient's serum on BFU-E growth whereas the number of CFU-GM were normal. Spontaneous remission of the anemia was observed despite the persistence of severe immunodeficiency as demonstrated by development of a monoclonal EBV lymphoproliferative disorder two months later. The "recovery" serum reversed the initial serum BFU-E inhibiting property. This case pinpointed the usefulness of blood or marrow cultures in parvovirus B19 infection of immunocompromised patients without normal Ig responses, as in other PRCA. Further, it argues that the usual immunoglobulin therapy may not be necessary in order to obtain a viral clearance.

Bone Marrow Cells

[Parvovirus B19 primo-infection and cold agglutinins].

INTRODUCTION: Parvovirus B19 infection is frequent. Primary infection leads to diverse skin manifestations including the recently described gloves-and-socks papulopurpura. CASE REPORT: A patient presented with a papulopurpuric eruption on the nose, hands, feet and perineum with cheilitis and high-grade fever. Parvovirus B19 serology showed characteristic IgG on the 15th day after the initial eruption demonstrating the seroconversion. Cold agglutinins were positive during the eruption and negative after regression. DISCUSSION: The gloves-and-socks papulopurpura syndrome was initially described in 1990. Since that time 20 cases have been reported. In 7 cases, primary parvovirus B19 infection was proven and viral infections were suspected in the others (measles, coxsackie B6, hepatitis B, Epstein-Barr virus). Our case evidenced here to undescribed skin manifestations and the development of cold agglutinins. The presence of cold agglutinins at eruption could explain the acral localizations observed in this syndrome.

Acrodermatitis

Recombinant human granulocyte colony-stimulating factor for treatment of puppies with neutropenia secondary to canine parvovirus infection.

OBJECTIVE: To determine the effect of treatment with recombinant human granulocyte colony-stimulating factor (rhG-CSF) for puppies with neutropenia secondary to canine parvovirus infection. DESIGN: Randomized controlled clinical trial. ANIMALS: 23 puppies. PROCEDURE: Diagnosis was confirmed by use of an ELISA for detection of canine parvovirus antigen in feces, and all puppies received standard treatment for parvoviral enteritis. All puppies had neutropenia (< 1,000 neutrophils/microliter) at the time of admission to the hospital or within 4 days afterward. Eleven puppies were treated with rhG-CSF daily until neutrophil count was > 1,500 cells/microliter; the remaining 12 puppies were not treated with rhG-CSF. RESULTS: We did not detect any significant differences between groups regarding duration of hospitalization, neutrophil count when neutropenia was first detected, lowest neutrophil count, or time until neutrophil count was > 1,500 cells/microliter. CLINICAL IMPLICATIONS: Results suggest that treatment with rhG-CSF may not be beneficial in puppies with neutropenia secondary to canine parvovirus infection.

Animals

Fetal hydrops in the first trimester associated with maternal parvovirus infection.

We present a case of fetal hydrops associated with maternal parvovirus infection during the first trimester of pregnancy that sonographically mimicked findings associated with fetal aneuploidy. The transabdominal sonograms of this fetus at 12.9 weeks' gestational age were consistent with increased nuchal translucency thickness. Transvaginal sonographic evaluation of the fetus showed generalized subcutaneous sonolucency suggestive of early fetal hydrops. An etiologic evaluation identified serologic evidence of recent maternal parvovirus infection and a normal karyotype. The pregnancy ended in fetal demise. Our findings suggest that visualization of nuchal translucency thickening in the first trimester should prompt a complete sonographic evaluation for fetal hydrops, which, if identified, should lead to serologic evaluation for parvovirus infection.

Adolescent

Diagnosis of human parvovirus infection by dot-blot hybridization using cloned viral DNA.

The human parvovirus can be detected in serum by the immunological techniques of immune electron microscopy (IEM), counterimmunoelectrophoresis (CIE), and radioimmunoassay (RIA). A portion of the genome of this virus has been cloned in pAT153 and used as a 32P-labelled probe in dot-blot hybridization assays to detect parvovirus DNA in serum specimens. This test proved a highly sensitive means of detecting virus in microlitre volumes of serum, giving positive results for samples containing 0.5 pg viral DNA, equivalent to 10(4) virus particles. Unlike CIE and RIA the test is not affected by the presence of parvovirus-specific antibody in serum specimens, and has permitted virus to be detected in specimens obtained up to 11 days after the onset of clinical symptoms of aplastic crisis.

Anemia, Hemolytic

Intrauterine infection with human parvovirus B19: a light and electron microscopy study.

Recent reports have documented human parvovirus B19 infection in pregnancy, which may lead to spontaneous abortion, stillbirth or hydrops fetalis. Transplacental infection in a case of hydrops fetalis is demonstrated by light and electron microscopy observation of virus inclusions in all tissues examined. Parvovirus particles measuring approximately 20 nm were observed within the nuclei of erythropoietic cells. The parvovirus virions were observed most commonly as randomly distributed particles and rarely in crystalline assays. Thus definitive evidence of fetal infection confined to red cell precursors is documented.

Edema

Human parvovirus infection in haemophiliacs first infused with treated clotting factor concentrates.

A group of 27 first infused haemophiliacs was studied for association between heat-treated clotting factor concentrates and transmission of human parvovirus B19. The prevalence rate of B19 antibody, detected by the Immunoelectroosmophoresis (IEOP) reaction, was 55.5% in this group of first infused subjects, significantly higher than the 29.3% of the control group of 58 healthy blood donors but lower than the 93.3% of antibody positive subjects in a group of 30 haemophiliacs multitreated with unheated products. Five of 17 B19 antibody negative patients produced human parvovirus IgM, detectable by radioimmunoassay, after the first treatment with heated concentrates; two of them developed viraemia 6 and 10 days, respectively, after the first infusion dose. These results lead to the conclusion that human parvovirus is transmissible by blood derivatives even when they have been exposed to steam- or dry-heat treatment.

Adolescent

Maternal serum biochemical markers in pregnancies with fetal parvovirus B19 infection.

Hydrops fetalis and fetal death caused by fetal parvovirus B19 infection have been reported to be associated with elevated maternal serum alpha-fetoprotein (AFP), based on a total of six cases. It has been suggested that the absence of AFP elevation may be reassuring. Maternal serum levels of the Down syndrome screening markers unconjugated oestriol and human chorionic gonadotropin in cases of fetal parvovirus infection have not been previously reported. We report four cases of hydrops fetalis and fetal death caused by fetal parvovirus infection, each with unremarkable second-trimester levels of AFP, unconjugated oestriol, and human chorionic gonadotropin.

Erythema Infectiosum

The complete nucleotide sequence of parvovirus LuIII and localization of a unique sequence possibly responsible for its encapsidation pattern.

Parvovirus LuIII encapsidates single-stranded DNA of either plus or minus polarity with equal frequency, whereas the rodent parvoviruses MVMp and H-1 encapsidate minus strand DNA only. A full-length, infectious clone of LuIII was constructed and the complete nucleotide sequence of the genome was determined. Comparison of the LuIII sequence with those of MVMp and H-1 revealed that these viruses are virtually identical with respect to the genomic organization, location of regulatory signals, mRNA splicing patterns, and amino acid sequences of viral proteins. However, two regions of the LuIII sequence differ significantly from those of the rodent parvoviruses. At mu 92, LuIII has only one copy of a sequence found as a direct repeat in MVMp and H-1. Upstream of this sequence, at mu 89, there is an A-T-rich region, 47 nucleotides in length, unique to the LuIII genome. This A-T-rich region could represent a signal responsible for the totally different encapsidation patterns observed for these viruses.

Base Sequence

Structure, sequence, and function correlations among parvoviruses.

The capsid protein sequences of 10 representative parvoviruses were aligned against the sequence and three-dimensional structure of canine parvovirus (CPV). The structure of CPV was then analyzed after mapping onto it position-dependent sequence similarity scores and the locations of residues that are phenotypically important in other parvoviruses. Antigenicity is primarily associated with external exposed loops of high sequence variability. Amino acids in the canyon, a surface depression encircling each fivefold axis, are well conserved, but may have a function other than external receptor binding. Residues important to parvoviral cell specificity and erythrocyte binding are scattered near the rim of a less-conserved depression near the twofold axis, and on a shoulder of the threefold spike. The number of residues involved in various interactions and their conservation and properties suggest that uncoating may involve separation of fivefold and twofold related subunits before those related by threefold symmetry. The inner surface residues of the capsid are generally more highly conserved than those on the outer surface, presumably due to interactions with DNA, although the binding site that contains ordered DNA in the structure is not especially conserved.

Amino Acid Sequence