The microbiology, epidemiology, transmission, pathogenesis, treatment, and prevention of this infection, as well as issues of infection during pregnancy, are discussed elsewhere. Parvovirus b19 infection also known as fifth disease, slapped cheek, slapped face, erythema infectiosum including symptoms, treatment and prevention. Erythema infectiosum fifth disease is the most recognizable presentation of parvovirus b19 infection. Parvovirus b19 infection workup medscape reference. Individuals congenitally lacking p antigen are not susceptible to pv b19 infection. Acute parvovirus b19 infection frequently causes falsepositive results in epsteinbarr virus and herpes simplex virusspecific immunoglobulin m determinations done on. See clinical manifestations and diagnosis of parvovirus b19 infection and treatment and prevention of parvovirus b19 infection. Clinical presentations of parvovirus b19 infection jessica t.
Infection a parvovirus b19 et grossesse emconsulte. Acute parvovirus b19 infection is suggested to be involved in the pathogenesis of some ht cases. It has now been attributed to several other aetiologies including viral infections. The clinical presentation is influenced by the infected individuals age and hematologic and immunologic status. Persistent b19 parvovirus infection in patients infected. Reamy, col, usaf, mc, uniformed services university of the. Infection a parvovirus b19 et grossesse request pdf. A case report on parvovirus b19 associated myositis.
B19v infection is associated with a wide spectrum of clinical. Parvovirus b19 most commonly causes fifth disease, a mild rash illness that usually affects children. Parvovirus b19 b19v is a singlestranded dna virus of the family parvoviridae and genus erythrovirus. In adults, and in women especially, arthralgia is a common manifestation of parvovirus b 19 infection. Parvovirus b19 infection is a mild rash illness that occurs most commonly in children. Parvovirus b19 infection presenting with neutropenia and. Parvovirus b19 about human parvovirus b19 fifth disease cdc. Hightitre viral dna using pcr analysis, to confirm the diagnosis of parvovirus b19 infection. Infection a parvovirus b19 et grossesse sciencedirect. B19 has a tropism for erythroid progenitors and causes pure red cell aplasia prca. The clinical manifestations and diagnosis of parvovirus b19 infection will be discussed here. Neurological aspects of human parvovirus b19 infection. Parvovirus b19 is a widespread infection that may affects 15% of pregnant women, mainly with normal pregnancy outcome 1,2.
In some cases, however, infection is associated with sufficiently severe complications that treatment is indicated and may be lifesaving. The prevalence of infection is very high before 10 years old and children are especially responsible for transmission to pregnant women. 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. The association with a disease was unclear in the first time after the discovery of b19v, but meanwhile, the usually droplet transmitted b19v is known as the infectious agent of the fifth disease, a rather harmless childrens illness.
We present two cases of myositis as a result of parvovirus b19 infection. Parvovirus b19 pv is a nonenveloped, singlestranded linear dna virus and spreads mainly through the respiratory system. If parvovirus b19 infection is suspected in a person who is immunocompromised, has a haematological disorder, or is in early transient aplastic crisis, arrange urgent blood testing for. The clinical presentations associated with b19 infection vary greatly, ranging from benign to life threatening. They are usually mild or asymptomatic, and do not require treatment. Parvovirus b19 infection in a fatal case of acute liver fail. The aim of this study was to assess the prevalence of parvovirus b19 in a cohort of hiv infected patients with severe anaemia. In immunocompetent hosts, b19v infection either can be subclinical or can cause a wide spectrum of clinical manifestations such as erythema infectiosum in children, arthropathy in adults, transient aplastic crisis in patients with hemolytic disorders and nonimmune hydrops during pregnancy. Acute hepatitis as a manifestation of parvovirus b19 infection. B19 virus is present throughout the year, in temperate climates outbreaks of infection are more common in the spring and summer. Arthropathy due to parvovirus b19 infection was first reported in 1985 3, 4.
Complications t hought to be associated with parvovirus b19 infection include encephalopathy, epilepsy, meningitis, myocarditis, dilated cardiomyopathy, and autoimmune hepatitis1,6. The treatment of all forms of parvovirus b19 infection is purely symptomatic and supportive. Classification there are three genotypes within the erythroparvovirus genus. In the elderly, as many as 90% have antibodies against b19 fields 2372. Masayuki nara, yuko shirata, toshiaki kikuchi and michio hongo, adult human parvovirusb19 infection presenting with hearing difficulty and dizziness, the tohoku journal of experimental medicine, 224, 1. Parvovirus b19 infection can trigger an acute transient aplastic crisis or chronic red cell aplasia. Parvovirus b19 infection in otherwise healthy children and adults has an extremely low. Parvovirus infection symptoms and causes mayo clinic. During pregnancy, infection with b19v can be transmitted vertically from mother to fetus in up to 3050% of cases and cause severe fetal complications, such as severe anemia. There are few reports in the literature of hepatitis as a manifestation of parvovirus b19 infection. 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. Diagnostic tests for human parvovirus b19 infection including blood tests, urine tests, swabs, diagnostic tests, lab tests, and pathology testing. What are the signs and symptoms of parvovirus b19 b19v. Parvovirus b19 infections american family physician.
Parvovirus b19 infection may affect the development of arthritis. It most commonly causes fifth disease, a mild rash illness that usually affects children. 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. Neurological manifestations of human parvovirus b19 infection. The clinical spectrum can range from benign myalgias to more serious complications in certain risk groups. Our case was linked to a primary parvovirus b19 infection. These outbreaks are centred around primary schools where up to 40% of pupils may be infected. Clinical manifestations of parvovirus b19 infection can be divided into three main categories heegaard and hornsleth, 1995.
Feb 05, 2012 parvovirus b19 in pregnancy parvovirus is a member of the family parvoviridae. Parvovirus b19 is the infectious agent responsible for an illness called fifth disease. Women are approximately twice as likely as men to experience arthritis after parvovirus infection. Erythrovirus b19 is found worldwide and can cause sporadic infection or epidemic outbreaks, with a cyclical pattern of epidemic outbreaks occurring every 25 years.
It can also provoke transient aplastic crises in patients with sickle cell disease or other. The five wellestablished syndromes associated with parvovirus b19 are. Patients with iron deficiency anemia, hiv, sickle cell disease, thalassemia, or spherocytosis are at greatest risk. Request pdf infection a parvovirus b19 et grossesse small virus contagious during spring, parvovirus b19 is responsible for fifth disease of children. 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. Schwarz tf, roggendorf m, hottentrager b, deinhardt f, enders g, gloning kp, schramm t, hansmann m.
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. Neurologic manifestations associated with parvovirus b19. Parvovirus b19related anemia in hivinfected patients aids. This test is used to assess the presence of and immunity from parvovirus b19 e. Clinical manifestations and diagnosis of parvovirus b19. A pregnant woman who is infected with parvovirus b19 can pass the virus to her baby. Infection maternofoetale a parvovirus associee a une peritonite meconiale antenatale. B19 infection is an uncommon cause of anemia in the hiv positive population, especially in non epidemic years. Pet dogs and cats can get infected with other parvoviruses that do not infect humans. Parvovirus b19 is a virus that can cause a variety of conditions, including fifth disease. Viral myositis and parvovirus b19 associated myositis should be considered in adults presenting with significant myalgia.
Primary human parvovirus b19 infection in an hiv patient. Many people infected with parvovirus b19 do not have any symptoms, or they have only mild, nonspecific rash illness, not unlike the. 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. Aug 15, 2005 human parvovirus b19 causes erythema infectiosum and is associated with arthritis, fetal death, and transient aplastic crisis, as well as persistent infection in immunocompromised persons, in whom it manifests as chronic anemia. While antiparvovirus igm develops one to two weeks after initial exposure, igg appears a few weeks later and increases during the active phase of infection and stabilizes after recovery. But b19v infects erythrocyte progenitor cells and thus, acute b19v infection in patients with a high. The failure to produce neutralizing antibodies to the virus following b19 infection in immunodeficient persons may result in persistent viremia. Pv is also known to cause a variety of hematological manifestations. Complications t hought to be associated with parvovirus b19 infection include encephalopathy, epilepsy, meningitis, myocarditis, dilated cardiomyopathy, and autoimmune hepatitis footnote 1, footnote 6.
High doses of ascorbic acid treatment were initiated due to the failure of conventional analgesic therapy. Fifth disease is a viral infection caused by parvovirus b19. Erythropoietin epo levels in a patient with hiv and most anaemias are generally lower for the degree of anaemia and treatment with epo. Human parvovirus b19 b19v is a small singlestranded dna virus, which is responsible, mainly in children, for erythema infectiosum or fifth disease. Parvovirus b19 and the new century clinical infectious. But it can cause different signs and symptoms, depending on your age and overall health. Alternatively, parvovirus b19 infection may manifest with purpuric rash, erythema multiforme, or pruritus of the soles of the feet.
Baboon syndrome was formerly considered simply as a skin condition. Recovery is linked to the development of specific neutralising antibodies. 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 ill child typically has a slappedcheek rash on the face and a lacy red rash on the trunk and limbs.
Most patients were children, and twothirds had central nervous system manifestations. The human parvovirus b19 causes parvovirus infection. When checking for a misdiagnosis of human parvovirus b19 infection or confirming a diagnosis of human parvovirus b19 infection, it is useful to consider what other medical conditions might be possible misdiagnoses or other alternative conditions relevant to diagnosis. We report the case of a 54yearold caucasian woman with chronic arthralgia due to persistent parvovirus b19 viremia. 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. You can get your pets vaccinated to prevent infection from such parvoviruses. Most infections are spread by the respiratory route, although spread via contaminated blood is also possible. Parvovirus b19, the first known parvovirus to cause disease in humans, was discovered in london by australian virologist yvonne cossart in 1974. Persistent parvovirus b19 viremia with chronic arthralgia. The association with a disease was unclear in the first time after the discovery of b19v, but meanwhile, the usually droplet transmitted b19v is. The mortality related to parvovirus b19induced anemia remains higher than that in alloimmunization cases. This is different from the parvovirus seen in dogs and cats, so you cant get the infection from a pet or vice versa. Primary human parvovirus b19 infection in an hiv infected. Vernazza et al 23 described persistent b19 infection as an uncommon cause of anemia in these patients, due to preservation of an adequate humoral immune response until the late stages of hiv infection.
Parvovirus b19 infection should continue to be considered in the differential diagnosis of anemia in hivinfected children. Human parvovirus b19 hpvb19 is well known as a cause of erythema infectiosum during childhood, pure red cell aplasia in immunocompromised persons, transient aplastic crisis in patients with hereditary hemolytic anemia, and hydrops fetalis during pregnancy. We describe a case of parvovirus b19 associated acute hepatitis diagnosed based on a positive serologic test igm and molecular detection of parvovirus b19 dna in a liver biopsy specimen. Parvovirus b19 infection definition of parvovirus b19. Parvovirus b19 home parvovirus b19 and fifth disease cdc. Adults can get infected with parvovirus b19 resulting in fifth disease too. Parvovirus b19 the face and a lacy red rash on the trunk. Servey, lt col sel, usaf, mc, travis air force base, california brian v.
The b19 parvovirus is a remediable cause of severe chronic anemia in hivinfected patients. Lindblom a, heyman m, gustafsson i, norbeck o, kaldensjo t, vernby a. Adults developing primary human parvovirus b19 b19 infection may present with arthralgia, fever, and maculopapular rash. Parvovirus b19 is the predominant parvovirus pathogen in humans and the prototype genotype 1 strain. Parvovirus b19 is a virus that commonly infects humans. In adults and perhaps some children, parvovirus b19 can lead to a seronegative arthritis which is usually easily controlled with analgesics. Pv b19 infection results in the consistent ablation of erythroid precursors early in the disease course with accompanying reticulocytopenia. Case of persistent parvovirus b19 infection with bilateral. The degree of resulting anemia largely depends on the red cell halflife and immune status of the individual. Bloom mc, rolland m, bernard jd, fournie a, berrebi a, regnier c. Parvovirus b19 is the cause of fifth disease in children and can trigger transient arthropathy in adults. Some 50% of children and 6090% of adults are seropositive.
Small virus contagious during spring, parvovirus b19 is responsible for fifth disease of children. 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. These alternate diagnoses of human parvovirus b19 infection may already have. A small number of groups, living in remote geographical locations, have not been exposed to human parvovirus. The age distribution is similar to that observed in the united states. Fetal anemia is often diagnosed incidentally, and it is almost always severe and associated with fetal hydrops. Also, a cat or dog cannot catch parvovirus b19 from an infected person. In south africa, the prevalence of parvovirus b19 infection in the hiv infected population with severe anaemia is not known. Dogs and cats may be immunised against parvovirus, but these are animal parvoviruses that do not infect humans. Parvovirus b19 causes exanthem and other clinical syndromes. We sought to describe the characteristics and outcome of the systemic manifestations of hpvb19. Epidemiology of parvoviruses b19 infection, epidemiology of.
Parvovirus b19 infection can trigger an acute cessation of red blood cell production, causing transient aplastic crisis, chronic. In immunosuppressed patients, including those with hiv infection, such humoral responses are impaired and severe chronic bone marrow suppression and arthritis may occur. Objectiveto determine the fetal infection rate and outcome of pregnancy among women who acquire infection with human parvovirus b19 in the antenatal. Approximately 50% of women old enough to procreate have stigmas serologic of old infection. Diagnosis can also be established by culturing the virus from bone marrow or by elisa detection of the antigen in serum. Acute parvovirus b19 infection can be confirmed by a rapid rise and fall of igm antibody. The prevalence of infection is higher during epidemics between 3 and 20% with seroconversion rate of 334% 3,4. The child is not very ill, and the rash resolves in 7 to 10 days. Symptomatic parvovirus b19 infection associated with severe chronic anemia is an uncommon problem in hivinfected children who live to up to 2 years of age and are not severely immunocompromised. Common symptoms of parvovirus b19 b19v infection include a mild nonspecific prodromal illness that may consist of fever 1530% of patients. Systemic manifestations associated with parvovirus b19.
Acute parvovirus b19 infection frequently causes false. Since parvovirus b19 infects only humans, a person cannot catch the virus from a pet dog or cat. In the immunocom promised host, persistent b19 infection is manifested as pure red cell aplasia and chronic anemia. This virus can cause polymorphic skin signs and constitutes a differential diagnosis for rash in baboon syndrome. This emedtv article takes an indepth look at this virus, including information about how it is transmitted, the various conditions it can cause, and more. Diagnostic tests for human parvovirus b19 infection. Pv infection is usually asymptomatic and causes selflimiting nonspecific symptoms, such as rash, fever, myalgia, and arthralgia in healthy individuals.
Parvovirus b19 can also spread through blood or blood products. Prospective study of human parvovirus b19 infection in. Clinical benefit was observed with a simultaneous loss of biological parvovirus b19 viremia. Clinical presentations of parvovirus b19 infection american family. Does an intrauterine exchange transfusion improve the fetal. 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. Infection during pregnancy can cause a variety of other signs of fetal damage. A substantial proportion of infected adult women may also have arthropathy in association with parvovirus b19 infection woolf et al. 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. Oct 11, 2019 parvovirus b19 b19v is a singlestranded dna virus of the family parvoviridae and genus erythrovirus. Symptoms can include a low fever, cold symptoms, and a headache. Parvovirus b19 infection is globally prevalent and common in childhood. Parvovirus b19 pb19 infection is common in childhood, but its clinical manifestations vary considerably in relation to patient age and.
What is the mortality rate of parvovirus b19 b19v infection. Parvovirus b19 fifth disease fact sheet fact sheets. Parvovirus b19 dna was detected by polymerase chain reaction in the brain. Human parvovirus b19 infection in hivpositive patients.