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Lupus-like presentation of human parvovirus B19 infection.

The diagnosis of systemic lupus erythematosus (SLE) was a leading initial consideration in 2 patients with rash, arthritis and hypocomplementemia. One patient also had leukopenia and thrombocytopenia. Spontaneous regression occurred. In both patients antinuclear antibodies were negative. Serologic studies indicated recent human parvovirus B19 infection. We propose adding human parvovirus B19 infection to the list of conditions that may masquerade as SLE.

Adult↗

Parvovirus infection of the human fetus and newborn.

Human parvovirus B19 is a recently recognized cause of hydrops fetalis. It is a small, single-stranded DNA virus, which preferentially infects late erythroid precursors and produces red blood cell (RBC) aplasia, fetal anemia, and cardiac failure. Infection is accompanied by characteristic intranuclear inclusions in fixed and circulating RBC precursors. These inclusions have been shown to contain virus particles by electron microscopy and in situ hybridization. Infection of the fetus, mother, and newborn infant can be diagnosed by serological and molecular methods selected to match the stage of the infection. Recent work has shown that parvovirus B19 can infect cells other than erythroid precursors, and that additional mechanisms such as myocarditis may contribute to hydrops fetalis in some cases. Infected fetuses are not always hydropic. Maternal infection results in increased abortion and stillbirth even in the absence of transplacental transmission, which occurs in approximately one third of infected mothers. The overall risk of fetal loss following maternal exposure is much less than previously thought, and may be less than 3% in the first 20 weeks of gestation or approximately 10% if the mother is actually infected. Although parvoviruses are teratogenic in animals, there is no evidence that B19 is a significant teratogen in man. The long-term outlook of survivors of intrauterine infection, including those successfully treated by intrauterine blood transfusion, appears to be good, but requires further study.

Erythema Infectiosum↗

Fetal medicine.

Fetal therapy continues to be an exciting yet controversial field. In utero treatment of a variety of fetal conditions is discussed: parvovirus B19 infection, fetal thyroid dysfunction, fetal ovarian cysts, twin-twin transfusion syndrome, and fetal hemolytic disease. Fetal surgery continues to be controversial. Despite considerable publicity, fetal surgery appears to be rarely, if ever, truly indicated. A new area of fetal therapy, ie, antenatal transplantation of fetal liver stem cells, is discussed.

Cystic Adenomatoid Malformation of Lung, Congenita↗

Outbreaks caused by parvovirus B19 in three Portuguese schools.

This paper reports the study of outbreaks of an acute exanthematous disease among children of three schools in the municipality of Braga (Portugal). Laboratory tests were performed for five cases, showing that the disease was not due to infection by measles or rubella virus, and infection with parvovirus B19 was confirmed. There were 41 cases in children: 12 in the kindergarten, 17 in the secondary school and 12 in the primary school. There was only one case in a staff member, who worked in the kindergarten. Eight cases were identified among household contacts; two of them were brothers, one from the kindergarten and another from the secondary school, where the outbreak occurred after the kindergarten outbreak. The estimated values of the basic reproduction number R0 were very low and it is very likely that asymptomatic infectious cases have occurred. The local health authority produced written documents and met with staff members and parents. Primary healthcare facilities and the obstetric department of the local hospital were also informed. As we are approaching the elimination of measles in Portugal and the rest of Europe, with very high vaccine coverage, it is very likely that a high proportion of infectious non-vesicular exanthemas will be due to B19 infections. This is to be taken into account in the design and conduct of surveillance activities, in the context of measles and rubella elimination programmes.

Child↗

[Hematopoietic failure of a healthy child with human parvovirus B19 infection--studies on the hematopoiesis].

An 8 year-old boy, who had been healthy since his birth, presented fever, ecchymosis and nasal bleeding. His peripheral blood picture showed pancytopenia and bone marrow showed erythroblastopenia, but these findings recovered spontaneously in two weeks. The diagnosis of human parvovirus B19 (HPVB19) infection was made by the presence of anti HPVB19 IgM antibodies in the sera. In order to investigate the mechanisms of erythroblastopenia and pancytopenia, we performed in vitro hematopoietic cell culture in both acute phase and the convalescent phase (3 months after the onset). In the acute phase, the formation of CFU-E colony was inhibited but that of BFU-E, CFU-G, GEMM colony was not inhibited. Unexpectedly, HPVB19 DNA was detected in CFU-GEMM colony cells with the PCR technique. It is suggested that HPVB19 infected not only to erythroid progenitor cells but also to other progenitors.

Cells, Cultured↗

[Parvovirus B19 infection revealed by acute renal insufficiency].

Human adult Parvovirus B19 infection is a well known disease most frequently seen in haematology and cancerology. To our knowledge, however, renal involvement in this context has never been reported. A case of severe infection caused by this virus is reported, where multiple organ involvement is associated with acute renal failure. The outcome was favourable with temporary dialysis and symptomatic treatment. Mechanisms of renal failure, presumably multifactorial, are discussed in the light of this case.

Acute Kidney Injury↗

Prevalence of human parvovirus B19 in sickle cell disease and healthy controls.

The serological HPV status of 35 patients with SCA (Hb SS), randomly chosen from a sickle cell clinic in rural south-west Togo and of 13 household members with normal haemoglobin type (Hb AA) was assessed. No difference in HPV-IgG seropositivity rate was found. In 30 urban hospital patients from Abidjan, Ivory Coast, who were in acute painful sickle cell crisis HPV-IgG seropositivity rate increased with age. In only one (HIV positive) patient HPV-IgM antibodies were detected. It is concluded that HPV-infection exists in West Africa (1) and that there is no evidence for increased seroprevalence in SCA (2). HPV does not seem to trigger acute painful crises in SCA (3). The age-specific HPV seropositivity increase in urban patients may be due to differing transmission rates in urban and rural areas.

Anemia, Sickle Cell↗

Papular purpuric gloves and socks syndrome. Presentation of a clinical case.

Papular-Purpuric Glove-and-Sock Syndrome is a rare, infectious disease, of viral etiology, characterized by the presence of pruritus, edema and symmetrical erythema, very well defined at the wrists and ankles with a gloves-and-socks distribution. Other areas can be affected, with a moderate erythema appearing in cheeks, elbows, knees, armpits, abdomen, groin, external genitalia, internal face of the thighs and the buttocks. Erosions, small ulcers, enanthema and blisters can be observed in the oral cavity and lips, and less frequently in other mucous membranes. Complications are rare, although they can be severe, 50% of the published cases are related with the Parvovirus B19. Due to its oral involvement stomatologists should be aware of this syndrome in order to carry out a correct diagnosis of the disease.

Child↗

[Obstructive respiratory tract diseases in children and Parvovirus B19 infections].

Acute respiratory diseases (ARD) due to parvovirus B 19 infection can be observed relative frequently in children. In 21 children (infants, toddlers and school children) we have seen acute or prolonged obstructive bronchitis/bronchiolitis (15 infants), acute subglottic laryngitis (3 toddlers) and acute asthmatic attacks (3 children of school age) in connection with parvovirus B 19 infection. Other respiratory viruses (adeno-, influenza, parainfluenza and RS-virus) could be excluded as agents causing the ARD. We suggest that parvovirus B 19 can provoke ARD with obstructive ventilatory disturbances of the upper or lower airways in children with a specific endogenous predisposition (small or unstable bronchial walls, or bronchial or tracheal mucosal hyperreactivity).

Airway Obstruction↗

[Human Parvovirus B19--really only fifth disease? Unusual disease course in children and adolescents].

The human parvovirus B19 agent causes infectious erythema (fifth disease). However, a wide range of other pathological manifestations may also be seen: atypical exanthema, ARD (also obstructive forms, e.g. bronchiolitis), acute gastroenteritis, chronic anemia or aplastic crises (in constitutional or malignant hematological diseases or immunological deficiency), arthralgia/arthritis (e.g. rheumatoid arthritis, jcA), diseases of the central nervous systems (e.g. febrile convulsions in young children), lymphadenopathies (e.g. lymphadenitis mesenterialis or pseudoappendicitis); prenatal infection can lead to fetal death (not malformations!). Infection occurring concomitantly with vaccination may suggest complications of the latter. To clarify the true etiological situation, modern laboratory investigations are then required. Vaccination against parvovirus B19 (initially indicated in the case of non-immune girls and women wanting children) is a desirable future development.

Adolescent↗

[Human parvovirus B19 infection during pregnancy. 2 cases].

We report two cases of non immunologic hydrops fetalis associated with intra-uterine human parvovirus B19 (PV B19) infection. The outcome was stillbirth in both cases. Infection by PV B19 was suspected by the presence of intranuclear inclusions in fetal erythroblasts. It was confirmed by the presence of specific immunoglobulins M (IgM) against PV B19 in maternal sera. Intra-uterine infection with human PV B19 is known since 1984; this virus may cause non immunologic hydrops fetalis and stillbirth; teratogenic effects have also been suggested. Epidemiological studies, published in 1988 and 1990 have evaluated the risk of PV B19 fetal related death at 9% and no association was found between infection and congenital anomalies. Subsequent management of infected pregnancies is studied. We emphasize the interest of pathological examination of hydropic stillbirth for this diagnosis.

Adult↗

[Maternofetal infection with human parvovirus B19. Apropos of 2 cases].

Two cases of maternal-fetal human parvovirus B19 infection are reported. The first case involved a feto-placental anasarca occurring during the third trimester and complicated by in-utero death with expulsion of a fetus with multiple malformations. The second case involved meconial peritonitis during the second trimester with favourable outcome after cesarean section and resolution of the digestive syndrome. Proof of PV B19 infection was obtained by identifying M specific immunoglobulins and viral DNA. After a review of the clinical situations most often encountered and the particular features of these two cases, therapeutic attitudes are proposed for this infection of major gravity during pregnancy.

Adult↗