Clinical presentations of parvovirus b19 infection american family. Apr 15, 2020 the human parvovirus b19 causes parvovirus infection. This finding indicates that b19 pcr should be included in. Parvovirus b19 infection is a mild rash illness that occurs most commonly in children. Rarely, acute infection in pregnancy may lead to fetal loss or hydrops fetalis. Parvovirus b19 infection during pregnancy uptodate. Neurologic manifestations associated with parvovirus b19. Neurological aspects of human parvovirus b19 infection. The first thing to do for management of parvovirus b19 is the study of parvovirus b19 specific igg and igm. Parvovirus b19 infection and autoimmune disease request pdf. Parvovirus b19 b19 was discovered serendipitously in 1974 and is the only member of the family parvoviridae known to be pathogenic in humans.
Clinical aspects of parvovirus b19 infection broliden 2006. The child is not very ill, and the rash resolves in 7 to 10 days. Pet dogs and cats can get infected with other parvoviruses that do not infect humans. Parvovirus b19 infection causes erythema infectiosum, or fifth disease, in normal hosts, aplastic crisis in patients with hemolytic disorders, and chronic anemia in immunocompromised hosts. Critical function of the cd40 pathway in parvovirus b19 infection revealed by a hypomorphic cd40 ligand mutation article pdf available in clinical immunology 1173. The ill child typically has a slappedcheek rash on the face and a lacy red rash on the trunk and limbs. A pregnant woman who is infected with parvovirus b19 can pass the virus to her baby. Since parvovirus b19 infects only humans, a person cannot catch the virus from a pet dog or cat. Infections with campylobacter, salmonella, or yersinia may result in a postinfectious reactive arthritis. However, in pregnant women, parvovirus b19 infections can cause serious. It can also provoke transient aplastic crises in patients with sickle cell disease or other.
Cytomegalovirus, parvovirus b19, varicella zoster, and. This is different from the parvovirus seen in dogs and cats, so you cant get the infection from a pet or vice versa. Also, a cat or dog cannot catch parvovirus b19 from an infected person. Guidance for control of parvovirus b19 infection in healthcare. Parvovirus b19 infections american family physician. Mar 15, 2005 the reliance of this virus on human erythroid progenitor cells for propagation and its highly immunogenic capsid explain the clinical spectrum and populations susceptible to the complications of parvovirus b19 infection. Primary human parvovirus b19 infection in an hiv infected. In immunocompromised patients, persistent b19 infection may develop that manifests as pure red. Parvovirus b19 fifth disease fact sheet fact sheets. White blood cell, platelet, and reticulocyte counts were reduced.
Parvovirus b19 infection in human pregnancy lamont. Parvovirus b19 infection may affect the development of arthritis. Oct 10, 2019 she had mild pyrexia for four days and the rash for two days. Rheumatoid arthritis after human parvovirus b19 infection. Many women that work with children have antibodies to parvovirus b19 and are not at risk for infection. Clinical presentation of parvovirus b19 infection in. Pdf critical function of the cd40 pathway in parvovirus. Human parvovirus hpv b19 infection is the most common viral agent associated with rashes in schoolaged children. Parvovirus b19 home parvovirus b19 and fifth disease cdc. Parvovirus b19 associated with pseudoappendicitis pdf free. Clinical presentations of parvovirus b19 infection jessica t. Parvovirus b19 the face and a lacy red rash on the trunk and.
Parvovirus b19 can also spread through blood or blood products. Likewise, her unborn baby usually does not have any problems because of the parvovirus b19 infection. Parvovirus b19 b19 can cause chronic anemia due to persistent infection in immunocompromised hosts who cannot produce neutralizing antibody necessa we use cookies to enhance your experience on our website. Acute encephalitis and encephalopathy is the most common, accounting for 38. This sheet talks about whether exposure to fifth disease may increase the risk for birth defects over that background risk. She had mild pyrexia for four days and the rash for two days. Hydrops fetalis secondary to parvovirus b19 infections. Parvovirus b19 the face and a lacy red rash on the trunk. Parvovirus b19 is a virus that commonly infects humans. Acute parvovirus b19 infection causes nonspecificity. Up to 50% of women are nonimmune and susceptible to b19v infection. The prevalence of infection is higher during epidemics between 3 and 20% with seroconversion rate of 334% 3,4.
Most patients were children, and twothirds had central nervous system manifestations. It is a frequent disease in children, mainly in preschool and school age, but very little known by parents and that is why, in this article, we explain everything about parvovirus b19. In the immunocom promised host, persistent b19 infection is manifested as pure red cell aplasia and chronic anemia. Once you recover from fifth disease, you develop immunity that generally protects you from parvovirus b19 infection in the future. Serologic and cerebrospinal fluid csf test results, treatment, and sequelae among reported cases of parvovirus b19 pvb19 infection with neurologic manifestations in patients with altered immune status. Parvovirus b19 preferentially replicates in erythroid progenitor cells. Reamy, col, usaf, mc, uniformed services university of the. Parvovirus b19 infection during pregnancy causes up to. In these patients, the production of precursors of red blood cells increases to compensate the dissolution of red blood cells.
Parvoviruses and bone marrow failure stem cells journals. Asymptomatic or mild infection occurs most often when b19 affects immunocompetent adults. These cover the cheek, arms and legs, which can be caused by parvovirus b19 or also called erythema infectiosum. The virus is widespread, and manifestations of infection vary with the immunologic and hematologic status of the host. Parvovirus infection is a common and highly contagious childhood ailment sometimes called slappedcheek disease because of the distinctive face rash that develops. Clinical signs of cpv2 infection can vary, depending on how long the dog has been infected and the severity of the infection. Pdf critical function of the cd40 pathway in parvovirus b19. Parvovirus infection symptoms and causes mayo clinic. However, there have been few reports of pb19 infection in neonates or young infants aged 2890. Infection during pregnancy can cause a variety of other signs of fetal damage. Infections caused by human parvovirus b19 can result in a wide spectrum of manifestations, which are usually influenced by the patients immunologic and hematologic status. Parvovirus b19, the first known parvovirus to cause disease in humans, was discovered in london by australian virologist yvonne cossart in 1974. But for some people, parvovirus b19 infection can cause serious health complications, such as chronic anemia that requires medical treatment. Parvovirus b19 infects especially thalassemia and sickle cell anemia patients.
Parvovirus b19 associated with pseudoappendicitis sir,parvovirus b 19 infection has been associated with aplastic crisis in patients with chronic haemolytic anaemias and erythema infectiosum fifth disease in children. In immunosuppressed patients, including those with hiv infection, such humoral responses are impaired and severe chronic bone marrow suppression and arthritis may occur. During school outbreaks, 1060% of exposed children develop symptoms consistent with parvovirus b19 infection centers for disease control cdc, 1989. Pdf parvovirus b19 infection in pregnancy frans walther.
Parvovirus b19 is a common, selflimiting, usually benign childhood virus that causes erythema infectiosum, also known as fifth disease. Maternal b19v infection can give rise to serious fetal complications during pregnancy. Fetal infection by human parvovirus b19 is a common cause of fetal anemia, nonimmune hydrops fetalis, and spontaneous abortion and can result in fetal death. Parvovirus b19 infection is a common childhood illness. If you are not immune to the disease, and work with children, there is a risk that you will be infected. Parvovirus b19 may cause a papularpurpuric glovesandsocks syndrome ppgss, which manifests as an erythematous exanthem of the hands and feet with a distinct margin at the wrist and ankle joints. Normal transmission is presumably by the respiratory route via droplet aerosol. Parvovirus b19 pb19 is an important human pathogen that results in a wide spectrum of clinical outcomes, from mild, selflimiting erythema infectiosum in immunocompetent children and arthralgia in adults to lethal cytopenia in immunocompromised patients and intrauterine fetal death. About 50% of adults have igg antibodies against the virus which persist in the blood stream for life after an infection with b19, suggesting a previous infection. Most outbreaks of parvovirus infection are acquired by direct contact with respiratory secretions and primarily occur in the spring. Parvovirus infection in neonates better safer care. Experimental infections of voluntary subjects have provided. In adults and perhaps some children, parvovirus b19 can lead to a seronegative arthritis which is usually easily controlled with analgesics. A substantial proportion of infected adult women may also have arthropathy in association with parvovirus b19 infection woolf et al.
Clinical aspects of parvovirus b19 infection wiley online library. Jan 24, 2019 parvovirus b19 infection is a common childhood illness. Infection with parvovirus b19 during pregnancy can cause several serious complications in the fetus. Human parvovirus b19 is a small nonenveloped virus that contains singlestranded dna. Pregnant women who are exposed to, or who develop symptoms of, parvovirus b19 infection should be assessed to determine whether they are susceptible to infection nonimmune or have a current.
In the elderly, as many as 90% have antibodies against b19 fields 2372. Protecting and promoting the health and safety of the people of wisconsin. A pregnant woman what is exposed to or develops signs or symptoms of parvovirus b19 infection should perform both parvovirus b19 specific igg and igm. Parvovirus b19 infection can trigger an acute cessation of red blood cell production, causing transient aplastic crisis, chronic. The prevalence of infection is higher during epidemics between 3 and 20% with seroconversion rate of 334% 3, 4. Keiki nagaharu, yuka sugimoto, yuji hoshi, takanori yamaguchi, ryugo ito, keiji matsubayashi, keiki kawakami and kohshi ohishi, persistent symptomatic parvovirus b19 infection with severe thrombocytopenia transmitted by red blood cell transfusion containing low parvovirus b19 dna levels, transfusion, 57, 6, 14141418, 2017. Cytomegalovirus cmv, parvovirus b19, varicella zoster virus vzv, and toxoplasmosis are common infections associated with moderatetosevere. B19v infection is associated with a wide spectrum of clinical manifestations, some of which were well established and some are still controversial. Since its discovery in the 1970s of last century 1, human parvovirus b19 b19 has been linked with a broad spectrum of clinical syndromes, including erythema infectiosum ei, transient aplastic crisis, persistent infection manifesting as pure red cell aplasia in immunocompromised individuals, nonimmune hydrops fetalis, and arthritis.
Parvovirus infection an overview sciencedirect topics. You may be at risk for serious complications from fifth disease if you have a weakened immune system caused by leukemia, cancer, organ transplants, or hiv infection. Parvovirus b19 exposureinfection during pregnancy clinical. Acute infection with parvovirus b19 b19v may likewise initiate transient or chronic arthropathy. Differences in clinical manifestations of b19 infection have not been. Parvovirus b19 is a significant human pathogen that causes a wide. Sometimes, however, parvovirus b19 infection will cause the unborn baby to have severe anemia and the woman may have a miscarriage. Recent improvements in diagnosing parvovirus infections and the availability of intrauterine transfusion have reduced the overall rate of fetal loss after maternal exposure. Reports of neurologic manifestations of human parvovirus b19 b19 infection have been on the rise. Parvovirus b19 is a significant human pathogen that causes a wide spectrum of. Polyarthropathy associated with human parvovirus b19 b19 is usually transient, but often resembles rheumatoid arthritis ra. Parvovirus b19 was discovered fortuitously in 1975 by cossart and colleagues,1 who unexpectedly found viral particles in the sera of asymptomatic patients being screened for hepatitis b infection. For example, infection with borrelia burgdorferi, the etiologic agent of lyme disease, may in the late phase manifest as arthropathy.
Parvovirus b19 infection can trigger an acute cessation of red blood cell production, causing transient aplastic crisis, chronic red cell aplasia, hydrops fetalis, or congenital anemia. However, it is known that pv b19 infection can persist until term or after birth, even when infection occurs in early gestation12. Parvovirus b19 infection and disruption of erythropoesis. Parvovirus b19 is the cause of fifth disease in children and can trigger transient arthropathy in adults. Jun 15, 2005 parvovirus b19 hereafter, b19 infection can occur asymptomatically or with mild, nonspecific symptoms, but it can also lead to numerous acute diseases, such as erythema infectiosum fifth disease, postinfectious arthropathies, transient aplastic crises in patients with hemolytic disorders, and fetal hydrops. The excess fetal loss or hydrops attributable to parvovirus b19 infection during the first 20 weeks of gestation is estimated to be at %, while a lower risk 0. In adults, and in women especially, arthralgia is a common manifestation of parvovirus b 19 infection.
Parvovirus b19 infection also known as fifth disease, slapped cheek, slapped face, erythema infectiosum including symptoms, treatment and prevention. Most children have encountered the virus by their teenage years, but those who escape infection as children are susceptible as adults. Human parvovirus b19 infection in hemophiliacs first infused with two highpurity, virally attenuated factor viii concentrates. B19 infections lead to suppression of the erythrocytes formation and acute erythroblastopenia often called transient aplasia crisis which. Parvovirus b19 infection is a common viral infection with a seroprevalence of 5070% in the adult popula tion. Adults developing primary human parvovirus b19 b19 infection may present with arthralgia, fever, and maculopapular rash. Pdf fetal pathology in human parvovirus b19 infection. Parvovirus b19 infection in pregnancy parvovirus b19 b19v is the causative agent of the relatively benign childhood disease, erythema infectiosum fifth disease. Recovery is linked to the development of specific neutralising antibodies. Parvovirus cannot be cultivated in routine cell culture, and thus serologic testing rising igg titers or the presence of igm antibody is the mainstay of diagnosis. Parvovirus b19 igm and igg were determined by enzymelinked immunosorbent assay lab corp. Critical function of the cd40 pathway in parvovirus b19 infection revealed by a hypomorphic cd40 ligand mutation. The prevalence of parvovirus b19 igg antibodies increases with age.
The virus binds to its cellular receptor, the panti gen, and has a tropism for immature erythrocytes in the bone marrow or fetal liver. Parvovirus b19 fifth disease page 1 of 2 communicable diseases factsheet parvovirus b19 infection is a mild rash illness that occurs most commonly in children. Women are approximately twice as likely as men to experience arthritis after parvovirus infection. Association of human parvovirus b19 infection with acute. Dogs and cats may be immunised against parvovirus, but these are animal parvoviruses that do not infect humans. The main target cell of parvovirus b19 is the proerythroblast pronormoblast, which expresses the primary receptor gb4cer globoside as well as the coreceptors ku80 autoantigen and a5b1 integrin required for attachment and virus internalisation by. You can get your pets vaccinated to prevent infection from such parvoviruses. You can ask your health care provider to do a blood test for antibodies to parvovirus b19 to see if you are immune to fifth disease. Human parvovirus infection is most common among elementary schoolage children during outbreaks in the winter and spring months, but anyone can become ill with it anytime of. Permanent congenital abnormality andor congenital anaemia have also been identified as rare consequences of intrauterine infection. Fifth disease parvovirus b19 in every pregnancy, a woman starts out with a 35% chance of having a baby with a birth defect. Parvovirus b19 is a member of the large parvoviridae family, which includes pathogenic animal viruses that have long been of interest to veterinarians and virologists. Acute infection in pregnancy can cause b19 infection in the fetus, leading to nonimmune fetal hydrops or fetal loss, depending on gestational age at the time of infection.
Inactivation and neutralization of parvovirus b19 genotype 3. Servey, lt col sel, usaf, mc, travis air force base, california brian v. Parvovirus b19 is a small singlestranded dna virus and a potent inhibitor of erythropoiesis, due to its cytotoxicity to erythroid progenitor cells. Symptomatic parvovirus b19 infection caused by blood. Parvovirus b19 is the cause of a common childhood illness, erythema infectiosum fifth disease, characterized by fever and a rash with erythematous cheeks. Pv b19 infection includes close monitoring with weekly ultrasonography and doppler interrogation of the mca for at least a 10week period11.
Sep 28, 2016 identification of parvovirus b19 infection in a pregnant woman is important, as parvovirus infection in the first half of pregnancy may cause intrauterine death and fetal hydrops. Firsttrimester treatment of fetal anemia secondary to. Parvovirus b19 is the causative agent of fifth disease ie, erythema infectiosum, slapped cheek syndrome, which usually produces a mild illness characterized by an intensive erythematous maculopapular facial rash. Persistent congenital anemia has been observed in infants born after intrauterine parvovirus b19 infection. The presenting features of parvovirus infections in individuals with and without hemolytic anemias were compared. Parvovirus infection has also been known as fifth disease because, historically, it was one of five common childhood illnesses characterized by a rash. To find out the incidence and clinical presentation of parvovirus b19 meningoencephalitis, we tested samples of cerebrospinal fluid from 162 patients one from each patient with undiagnosed meningoencephalitis, who presented between march, 1997, and march, 1998 an outbreak period using nested pcr for b19 genes. Although parvoviruses commonly cause disease in animals, it was only in 1975 that the first human pathogen of this family was discovered by cossart and colleagues while screening normal blood bank donors sera for the hepatitis antigen one. The only known natural host cell of parvovirus b19 is the human erythroid progenitor. Cossart and her group were focused on hepatitis b and were processing blood samples when they discovered a number of false positives later identified as parvovirus b19. The presence of parvovirus b19 specific igm was considered as proof of new or recent infection.