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Parvovirus B19: a new emerging pathogenic agent of inflammatory cardiomyopathy.

The human parvovirus B19 (PVB19), an erythrovirus causing diverse clinical manifestations ranging from asymptomatic or mild to more severe outcomes such as hydrops fetalis, is the only currently known human pathogenic parvovirus. Recently, PVB19 has been identified as a causative agent of pediatric and adult inflammatory cardiac diseases. The first hints for a possible etiopathogenetic role of the PVB19 infection and the development of cardiac dysfunction were demonstrated by molecular biology methods such as in situ hybridization (ISH) and polymerase chain reaction (PCR). In this regard, PVB19-associated inflammatory cardiomyopathy is characterized by infection of endothelial cells of small intracardiac arterioles and venules, which may be associated with endothelial dysfunction, impairment of myocardial microcirculation, and penetration of inflammatory cells in the myocardium.

Cardiomyopathies↗

Transient blood plasmacytosis in parvovirus B19 infection: a report of two cases.

Two patients with sickle cell disease were diagnosed with aplastic crisis caused by acute parvovirus B19 infection. One patient also developed thrombocytopenia associated with hemophagocytic histiocytosis in the bone marrow biopsy. Both patients developed transient blood plasmacytosis and hypocomplementemia soon after admission to the hospital. Transient blood plasmacytosis may be an immunological response to acute parvovirus B19 infection.

Adult↗

Biochemical and genomic characterization of muscovy duck parvovirus.

A duck parvovirus (DPV) isolated from muscovy ducks during the epizootic in France in 1989 was purified from inoculated allanto-amniotic fluids by CsCl density gradient centrifugation and characterized. Full and empty non-enveloped icosahedral viral particles were observed banding at densities of 1.39 to 1.42 and 1.38 respectively, with a diameter of 22 to 23 nm. Viral proteins were analyzed by SDS-PAGE and the estimated molecular weights of the 3 major proteins were 91, 78 and 58 kDa. The nucleic acid was shown to be a single-stranded DNA of about 5,300 bases with terminal palindromic hairpins. These results confirm the previous classification of the virus in the family Parvoviridae established by Jestin et al. [14] on morphological and serological bases. The DPV DNA was reannealed indicating that complementary DNA strands were encapsidated. A partial restriction endonuclease map was also established. This work constitutes the first biochemical and genomic description of a muscovy duck parvovirus.

Animals↗

Extent of sequence variability in a genomic region coding for capsid proteins of B19 parvovirus.

Genomic variability in human parvovirus B19 was analysed by direct partial sequencing of different isolates collected in Italy between 1989 and 1994. DNA was purified from viremic serum samples and the region of viral genome coding for structural proteins was amplified by polymerase chain reaction and partially sequenced (nt. 2400-3400). Data were compared to reference isolates Wi (U.K., 1973) and Au (U.S.A., 1982). The average relative distance between isolates was estimated at the low level of 0.61%, comparable with the distance to reference isolates. Out of 22 nucleotide substitutions found, 9 resulted in amino acid changes. From our results, this region of human parvovirus B19 genome appears to be stably conserved.

Amino Acid Sequence↗

DNA replication of parvovirus B 19 in a human erythroid leukemia cell line (JK-1) in vitro.

A major limitation of studies on the parvovirus B 19, a causative agent of transient aplastic crisis, has been the absence of appropriate cell lines permissive for the virus. In the present study, a human erythroid leukemia cell line (JK-1) was shown to support B 19 virus DNA replication in vitro. Forty-eight hours after virus inoculation of JK-1 liquid cell cultures, the average number of B 19 genome copies was estimated at 3,000 per cell by DNA dot blot analysis. The addition of erythropoietin increased B 19 copy number to 10,000 per cell. The presence of replicative forms of the B 19 virus genome was genome was demonstrated by Southern blot analysis. Although persistent infection of B 19 virus was not observed in JK-1 cells, this culture system will be of value in elucidating the molecular basis of the erythroid specificity of parvovirus B 19.

DNA Replication↗

Subunit interaction in B19 parvovirus empty capsids.

B19 parvovirus is a small single-stranded DNA virus with a genome that encodes only two structural proteins, designated VP1 and VP2. 60 copies of the structural proteins assemble into the viral capsid, with approximately 95% VP2 and 5% VP1. Recombinant empty capsids composed of VP2 alone or of VP2 and VP1 self-assemble into particles that are morphologically indistinguishable from full virions. Empty capsids containing both VP2 and VP1 elicit a strong neutralizing antibody response when used to immunize rabbits. Capsids containing only VP2 are similarly antigenic but elicit only weak neutralizing activity. We performed fine structure epitope mapping by measuring the reactivity of antisera raised against capsids composed of VP2 and VP1 or VP2 alone against 85 overlapping peptides spanning the sequence of the two structural proteins. A profile of the antigenic difference between empty capsids with and without VP1 was produced from the resulting data. This profile divided the sequence of the structural proteins into four regions that correlated well with expected viral structures. Thus, the addition of a small number of VP1 residues altered the antigenicity of the entire capsid. The major area of enhanced antigenicity is homologous to the spike of canine parvovirus, an area known to contain both neutralizing and host-range determinants. Our data are consistent with a model in which the unique region of VP1 is necessary for the virus to assume its mature capsid conformation.

Amino Acid Sequence↗

Parvovirus B19 infection.

Human parvovirus B19, discovered in 1974, is a single-stranded DNA virus which causes erythema infectiosum, arthralgia, aplastic crisis in patients with red cell defects, chronic anaemia in immunocompromised patients, and fetal hydrops. Seroprevalence in developed countries is 2-10% in children less than 5 years, 40-60% in adults more than 20 years, and 85% or more in those over 70 years. The virus may be transmitted by the respiratory route and by transfusion of infected blood and blood products. After an incubation period of six to eight days, viraemia occurs, during which reticulocyte numbers fall dramatically resulting in a temporary drop in haemoglobin of 1 g/dl in a normal person. Clearance of viraemia is dependent on development of specific antibody to the B19 structural proteins, VP1 and VP2. The red cell receptor for the virus is blood group P antigen. Diagnosis in immunocompetent persons depends on detection of specific IgM in serum. Diagnosis in immunocompromised persons depends on detection of B19 antigen or DNA in serum. There is no specific treatment for B19 infection; however, human normal immunoglobulin may be used as a source of specific antibody in chronically infected persons. A recombinant parvovirus B19 vaccine is under development.

Adult↗

Diamond Blackfan anaemia: apparent relapse due to B19 parvovirus.

A spontaneous remission occurred after 3 years of regular transfusions in a cortico resistant Diamond Blackfan anaemia. However after 1 year of transfusion independence an apparent relapse was observed which was transient and could be attributed to a B19 parvovirus primary infection. Previous inapparent impairment of erythropoiesis can be transiently spotlighted by B19 parvovirus primary infection.

Antibodies, Viral↗

Persistence of parvovirus B19-DNA in blood of a child with severe combined immunodeficiency associated with chronic pure red cell aplasia.

In a female child with severe combined immunodeficiency, pure red cell aplasia was observed which required regular transfusions of erythrocytes. Parvovirus B 19 DNA (but no antibodies) was detected in stored serum samples after the death of the patient. We suggest that the anaemia was a consequence of parvovirus infection which persisted for at least 2 years due to the immunodeficiency.

Chronic Disease↗

Kawasaki disease associated with parvovirus B19 infection.

UNLABELLED: In a 9-week-old boy with Kawasaki disease an active parvovirus B19 infection was diagnosed serologically. CONCLUSION: This case supports the hypothesis of an aetiological relationship between parvovirus B19 infection and Kawasaki disease.

Antibodies, Viral↗

Parvovirus infection causing red cell aplasia and leukopenia in rheumatoid arthritis.

A case of acute parvovirus B19 infection causing fever, anaemia, leukopenia, and red cell aplasia, in a patient with chronic rheumatoid arthritis is described. The patient had received low doses of corticosteroids for several years, and a small dose of methotrexate recently. There was no evidence of haemolytic anaemia, iron deficiency or drug toxicity. Recovery was associated with the development of antibodies against parvovirus B19, and clearance of viraemia as detected by the polymerase chain reaction. Possible mechanisms for the development of leukopenia are discussed, but there was no evidence for haemophagocytosis.

Arthritis, Rheumatoid↗

Acute outbreak of porcine parvovirus infection in Mozambique.

Investigations were made to determine the causal agent of an acute outbreak of abortions recorded in a swine herd in Mozambique. Isolation of porcine parvovirus and demonstration of its specific antibodies accomplished by using enzyme-linked immunosorbent assay, haemagglutination inhibition and immunofluorescent tests, indicated that porcine parvovirus was the causal agent of the abortions. Other pathogenic agents causing reproductive failure, e.g. pseudorabies virus, Leptospira or Brucella species, were ruled out because investigations of these agents proved to be negative.

Abortion, Veterinary↗

Human parvovirus B19-associated disease in bone marrow transplantation.

Human parvovirus B19 can persist in immunocompromised patients and may produce severe clinical illness. In this retrospective study the incidence of B19-associated infections in bone marrow transplant patients was investigated. During 1 year 60 patients received bone marrow grafts (eight autografts and 52 allogeneic transplantations). In case of early onset, atypical or steroid-resistant erythrodermia the patients' blood and/or tissue specimens were screened for B19 infection by polymerase chain reaction (PCR). Additionally, specimens of patients with severe organ failure were tested. A total of 64 PCRs was performed in 27 patients. Seven patients with erythrodermia and one with vulvovaginitis proved to be PCR positive. In patients with organ failure B19 DNA was detected in the myocardium and liver. The incidence of B19 infections in this cohort was 15% and the B19-associated mortality rate 7%. In conclusion, parvovirus B19-associated infections may be more common in immunocompromised patients than previously anticipated.

Adolescent↗

Expression of p53 and Ki-67 antigen in bone marrow giant proerythroblasts associated with human parvovirus B19 infection.

Giant proerythroblasts are hallmarks of human parvovirus B19 infection. We attempted to characterize these cells in 5 patients with parvovirus B19-induced pure red cell aplasia using immunostaining of paraffin-embedded bone marrow sections with antibodies against erythroid-lineage-specific proteins, viral capsid antigen VP-1, and apoptosis- and cell-cycle-related proteins. Giant proerythroblasts are immunohistochemically consistent with early erythroid precursors of cells in the differentiation stage of CD34-, cytoplasmic spectrin+, glycophorin A-, and band-3-. VP-1 was expressed in the nucleus and cytoplasm of small- to medium-sized spectrin+ erythroid cells but not in giant proerythroblasts. The giant proerythroblasts displayed nuclear staining for p53 (41%+/-16%) and Ki-67 antigen (100%+/-0%) and cytoplasmic staining for Bax (65%+/-11%) and procaspase-3 (78%+/-10%), whereas they were not stained for p21Wafl/Cip1, active form of caspase-3, or terminal deoxynucleotidyltransferase-mediated deoxyuridine nick-end labeling (TUNEL). Antiapoptotic proteins, Bcl-2 and Mcl-1, were not expressed in the giant cells, and Bcl-x was infrequently expressed in these cells (11%+/-4%). These immunohistochemical findings suggest that giant proerythroblasts are proliferating erythroid precursors with accumulation of nonfunctional p53.

Adolescent↗

[Dermatologic symptoms of parvovirus B19 infections].

Infections with parvovirus B19 are often characterized by the well-known erythema infectiosum, usually accompanied by fever and arthralgia. Furthermore the virus may cause a lethal hydrops fetalis during the pregnancy or a severe aplastic crisis in patients suffer from chronic hemolytic anemia. We present three patients infected by parvovirus B19. Whose skin lesions included a non-specific exanthem, erythema multiforme, and purpura. The virus infection was confirmed both by serology and PCR identification. In conclusion the diagnosis of acute exanthems should include the search for virus infections.

Adult↗

Large scale production and downstream processing of a recombinant porcine parvovirus vaccine.

Porcine parvovirus (PPV) virus-like particles (VLPs) constitute a potential vaccine for prevention of parvovirus-induced reproductive failure in gilts. Here we report the development of a large scale (25 l) production process for PPV-VLPs with baculovirus-infected insect cells. A low multiplicity of infection (MOI) strategy was efficiently applied avoiding the use of an extra baculovirus expansion step. The optimal harvest time was defined at 120 h post-infection at the MOI used, with the cell concentration at infection being 1.5x10(6) cells/ml. An efficient purification scheme using centrifugation, precipitation and ultrafiltration/diafiltration as stepwise unit operations was developed. The global yield of the downstream process was 68%. Baculovirus inactivation with Triton X-100 was successfully integrated into the purification scheme without an increase in the number of process stages. Immunogenicity of the PPV-VLPs tested in guinea pigs was similar to highly purified reference material produced from cells cultured in the presence of serum-containing medium. These results indicate the feasibility of industrial scale production of PPV-VLPs in the baculovirus system, safety of the product, and the potency of the product for vaccine application.

Animals↗

Red cell aplasia caused by parvovirus B19 in AIDS: use of i.v. immunoglobulin.

We describe the case of a 34-year-old man with AIDS who developed severe anemia due to chronic pure red cell aplasia (PRCA) caused by parvovirus B19. Following initial treatment with an infusion of intravenous immunoglobulin (IVIg), 1 g/kg, PRCA resolved, but there was a recurrence of severe anemia in 3 months. Retreatment with 2 g/kg IVIg over 2 days resulted in normalization of hemoglobin and a significantly longer remission duration. Two doses of 0.4 g/kg IVIg q 4 wk failed to prevent a relapse of PRCA in our patient. The dose and schedule of IVIg in the treatment of PRCA caused by parvovirus B19 in AIDS requires further definition.

AIDS-Related Opportunistic Infections↗