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Parvovirus B19 has different clinical manifestations dependent on age and sex. In children it is usually a mild febrile exanthematous illness but in adults 60% of women and 30% of men have an arthropathy which may be severe and persistent. The pathogenesis of this arthropathy is not known. Our studies establishing the clinical manifestations of parvovirus infection and examining their pathogenesis are reviewed.
Five cases of acute polyarthritis in individuals with serologic evidence of recent human parvovirus B19 infection were seen in one medical practice. Several individuals had had direct exposure to children with rash, and fifth disease was endemic in the community. All cases were associated with the presence of both IgG and IgM antibody to human parvovirus.
The commonest clinical manifestation of an acute parvovirus B 19 infection is "infectious erythema (E.i.)". Both in connection with "E.i." and without typical skin symptoms, transient arthralgias can be observed relatively frequently. Moreover, patients suffering from juvenile chronic arthritis (jcA) have now been described, in whom the initial symptoms were closely related to an acute parvo B 19 infection. Fife of our own patients with arthropathies of different kinds and a well documented acute parvovirus B 19 infection are presented here and all the relevant contemporary scientific problems are discussed.
Human B19 parvovirus infection may be associated with hydrops fetalis and perinatal loss. This report documents a case of unexplained elevation of maternal serum alpha-fetoprotein with normal amniotic fluid alpha-fetoprotein before hydrops and in the absence of placental inflammatory reaction. More than 14 weeks elapsed from maternal exposure until fetal death. Both antenatal and histologic evidence suggest that a fetal myocarditis preceded the hydrops. This case corroborates two previous reports of infection by B19 parvovirus of fetal myocardium.
The virucidal activity of 8 disinfectants was analyzed towards 3 groups of viruses responsible for diseases in animals (pneumovirus, coronavirus, parvovirus). Whether organic matter is present or not, parvoviruses are the most resistant, since concentrations of disinfectants 20-500 times higher than those inactivating coronaviruses and pneumoviruses must used. When organic matters are present the activity of disinfectant is considerably reduced. Among the products tested, 0.8% soda and sodium hypochlorite with 1 degree chlorometric were the most active.
The well-known condition of erythema infectiosum is caused by parvovirus B19, a single-stranded DNA virus discovered in 1975. The characteristic erythema obviously does not always appear: antibodies are present in 50%-60% of all adults. The virus is transmitted by airborne droplets, and the incubation period is 13-17 days. Clinically, there are unspecific prodromes, and aside from exanthema these can take the form of lymphadenopathy, influenza-like symptoms, and arthralgia. Parvovirus B19 has a marked affinity for erythropoietic cells. The infection may be of clinical importance in patients with haematological disease and can cause fetal death during pregnancy. The diagnosis is confirmed by detection of specific antibodies of the IgM or IgG class.
A previously healthy 11-year-old white female presented with a Coomb's positive hemolytic anemia and reticulocytopenia. The patient was treated with prednisone (6.4 mg/kg/day) and had a stable hemoglobin with subsequent recovery of reticulocytes by 7 days. Bone marrow aspiration showed hypercellularity with arrest of red cell maturation. The patient's serum contained specific IgM and IgG antibodies to parvovirus B19. Our report confirms parvovirus B19 as a cause of reticulocytopenia at presentation in autoimmune hemolytic anemia. Immunosuppressive therapy with prednisone did not appear to significantly prolong the course of the B19 infection.
The effects of canine parvovirus (CPV) infection in dogs with hemolytic anemia was compared with the clinical effects of human parvovirus-induced aplastic anemia in human beings with chronic regenerative anemias. Phenylhydrazine was used to induce a transient, severe, hemolytic anemia in dogs to evaluate the effects of CPV infection on rapidly dividing bone marrow precursors. Erythrocyte colony-forming unit bone marrow cultures and cytologic examination of bone marrow were used to determine the effects of CPV infection on erythroid bone marrow precursors. The induced hemolytic anemia regenerated rapidly and although the bone marrow was infected, it was determined that CPV infection did not induce a detectable decrease in erythroid progenitors in dogs with severe hemolytic anemia.
A serological survey to detect the presence of porcine parvovirus (PPV) infection in Italy and its geographic distribution was conducted. 1,332 samples of serum collected in 1983/1984/1985 were taken from pig breeding herds and, to a lesser extent, from fattening piggeries of representative regions of Italy. They were tested using the hemagglutination inhibition test (HIT). The results of the serological study indicate that parvovirus infection is widespread in Italian herds having 70.3% of sera antibodies to this virus; the most frequent titer detected was 1:8192 or higher. Sera from adult sows showed a higher rate (73.1%) of positive titers than those from 3-6 month-old pigs (40.7%). Positive samples were more relevant in the regions of northern Italy when compared with those from the southern Italy, Sicily and Sardinia.
A small hemagglutinating virus belonging to the Parvoviridae Family was isolated from a 70 day-old pig fetus in a breeding herd in which infertility, metritis and abortions were reported. The virus, named 85/193L, was isolated either in primary pig kidney (PK) cells or in a continuous cell line of minipig kidney origin (MPK), both cell cultures actively growing. It produced a typical cytopathic effect (CPE) starting from the 3rd passage and intranuclear inclusions surrounded by a halo were observed in stained preparations. The isolate was completely resistant to ether, chloroform and to pH 3; it was not inactivated after treatment at 56 degrees C for 4 h and at 70 degrees C for 2 h, while it was completely inhibited by the 80 degrees C/30 min temperature. It contained deoxyribonucleic acid (DNA). The highest infectious titer was reached at 96 h post infection. The infectivity and the hemagglutinating activity of the isolated strain were both inhibited by the reference immune serum against NADL-2 pig parvovirus. This further confirmed that the 85/193L isolate belongs to the parvovirus genus.
An outbreak of slapped cheek syndrome (erythema infectiosum) occurred in Chepstow between March and June 1986. About 50 children with the illness were seen in one general practice. During the same period five women in the practice developed arthritis associated with human parvovirus infection and four of them suffered marked pruritus. It is suggested that if pruritus is a feature in any patient with an acute onset arthritis, parvovirus infection should be considered as a possible cause.
The present study establishes the in vitro system for studying the oncosuppression activity of parvovirus and discovers that parvovirus H-1 can be grown cytolytically in various human cancer cell lines, which include 4 hepatoma cell lines (QGY-7703, SMMC-7721, Bel-7402, PLC/PRF/5), 3 gastric cancer cell lines (SGC-7901, MGC-80-3, MKN-28) and 1 naspharynx cancer cell line (CNE). The growth of two primary gastric cancer cell cultures from surgical cancer tissue were also inhibited by the infection of H-1. The sensitivity of cancer cells to H-1 may relate to their differentiation states. On the contrary, H-1 can neither be grown cytolytically in normal liver or stomach cells, nor inhibit their growth. Transformation of human skin fibroblasts with Simian Virus 40 activated their sensitivity to H-1. Our results thus indicate that the antineoplastic activity of H-1 in vivo involves at least its direct inhibiting or killing malignant cells.
The relationship between parvovirus B19 infection and classic rheumatoid arthritis remains to be determined. We describe two adult patients with serologically documented acute parvovirus B19 infection who presented with sudden onset of symmetric polyarthritis, skin eruption, and rheumatoid factor positivity. Rheumatoid factor positivity and symptoms resolved within five months. We conclude that a diagnosis of B19 arthropathy should be considered in any patient with recent acute or subacute onset of symmetric polyarthralgia or polyarthritis and rheumatoid factor positivity, which would otherwise suggest a diagnosis of early rheumatoid arthritis.
Serum samples (n = 137) from 47 wild wolves (Canis lupus; 21 pups and 26 adults) were evaluated from 1975 to 1985 for antibodies against canine parvovirus, using the hemagglutination inhibition (HI) test. In addition, several blood samples (n = 35) from 14 of these wolves (6 pups and 8 adults) were evaluated simultaneously for erythrocyte and leukocyte counts, and for hemoglobin and blood urea nitrogen concentrations. Sixty-nine (50%) of the serum samples (35 wolves) had HI titers of greater than or equal to 256, whereas 68 (50%) of the samples (16 wolves) had HI titers of less than or equal to 128. Significant differences in the geometric mean titers were not found between pups and adults or between males and females. Of the 47 wolves evaluated, 12 (25%) developed a greater than or equal to fourfold increase in antibody titers during the 11-year period, with 2 wolves developing serologic conversions in 1976. The data indicate that canine parvovirus may have begun infecting wolves before or at the same time that it began infecting the dog population in the United States.
A rapid screening assay for determining antibodies to canine parvovirus in dog serum using monoclonal antibodies and enzyme-linked immunosorbent assay (ELISA) technology was developed. The ELISA could be read visually, and the results correlated well with serum neutralization (SN) and hemagglutination inhibition (HI) titers. Sera with SN less than or equal to 1:4 or HI less than or equal to 1:10 had an 87.9% correlation with ELISA and sera with SN greater than or equal to 1:64 or HI greater than or equal to 1:80 had a 94.4% correlation. The assay took only 10 to 15 minutes to perform and did not require specialized equipment. The ELISA should be useful in monitoring dogs for the presence of maternal antibodies against parvovirus and for determining seroconversion after vaccination.
Human skin fibroblasts which are naturally resistant to Parvovirus H-1 can be lysed by this virus after SV40 transformation. This observation raises the possibility that oncosuppression by Parvovirus involves a direct oncolytic effect.
An acute, transient aplastic crisis in a 15-month old boy revealed the presence of homozygous beta-thalassaemia. The crisis was very likely due to a parvovirus infection, in view of the presence of specific IgM at the onset and of seroconversion to total antibodies. Later, requirements for transfusions were in favour of an intermediate type thalassaemia. The responsibility of the parvovirus is discussed in the light of recent data concerning the inhibitory action of this virus on bone marrow erythropoiesis.
From March to August 1984, 26 patients with hereditary hemolytic anemia in northeastern Ohio developed acute, profound red cell aplasia. The patients included 14 males and 12 females 2 to 23 years old, with sickle cell anemia (20 cases), hemoglobin SC-disease (4 cases), sickle-beta-thalassemia (1 case), or hereditary spherocytosis (1 case). All had an acute onset of severe reticulocytopenia and anemia and prodromal symptoms of illness including fever, abdominal symptoms, headache, and arthralgias. Twenty-two received transfusions. Reticulocytosis occurred spontaneously within 2 to 14 days of presentation. In five acute-phase sera, 10(8) to 10(12) viral particles/mL were detected by electron microscopy. Human parvovirus B19 DNA was demonstrated in high concentration by hybridization in the same five acute-phase sera and in low concentration in sera of eight additional patients. The five highly viremic sera inhibited erythroid colony formation in vitro. B19-specific IgM was detected in sera of 24/26 patients, and B19-specific IgG in 21 of 22 patients tested. Our results indicate that human parvovirus B19 was the etiologic agent in this large epidemic of life-threatening acute red cell aplasia in patients with hereditary hemolytic anemia.