An analysis of the factors involved in the diagnostic accuracy of colposcopically directed biopsy

We encountered a case of a girl where Human Parvovirus B19 infection was considered to have been concerned with the development of systemic type juvenile rheumatoid arthritis (JRA). While the affected child did not show any evident infectious erythema-like findings, changes in the serum antibody titer by the EIA method presented the pattern of first infection. During the clinical course the condition of the disease as JRA was serious and hemophagocytic syndrome developed concurrently. Furthermore, the resistance to the treatment was also noted. So the patient was treated with prednisolone combined with low dose weekly MTX therapy. The possibility of Human parvovirus B19 being concerned with the development of rheumatoid arthritis in one form or another has been suggested in recent years. In the disease type with systemic angititis as main pathophysiology, which is called systemic JRA we encountered this time, it is not clear how Human Parvovirus B19 was concerned with the development of this disease, but it appeared to hold a key position in studying pathophysiology of the development.     

Parvovirus B19 infection-related complications in renal transplant recipients: treatment with intravenous immunoglobulin

BACKGROUND: Chronic red cell aplasia can develop in immunocompromised patients including transplant recipients infected with parvovirus B19 (PV B19). Renal involvement with PV B19 infection is not well-recognized. METHODS: We diagnosed erythroid hypoplasia associated with PV B19 infection in three renal transplant recipients; one of them developed de novo collapsing glomerulopathy. These patients were treated with intravenous immunoglobulin (IVIG). RESULTS: In two patients, anemia responded promptly to IVIG therapy. One of them had recurrence of anemia that responded to a second course of IVIG. Despite IVIG treatment, persistent infection with PV B19, recurrent anemia, and de novo collapsing glomerulopathy leading to allograft failure developed in the third patient, who had received the most intense immunosuppression. CONCLUSIONS: These findings indicate that PV B19 infection in transplant recipients can cause chronic red cell aplasia that generally responds to IVIG therapy. In some patients, particularly those who are heavily immunosuppressed, infection may persist despite treatment. As the cellular receptor for PV B19 is expressed in the kidney, persistent infection may result in development of glomerulopathies in these patients.     

Thrombolytic therapy with tissue plasminogen activator for prevention of vasospasm in experimental subarachnoid hemorrhage: its efficacy and problems

Parvovirus B19 infection has been associated with fetal anaemia, hydrops, and in some cases demise. Most of the reported cases of fetal hydrops were detected in second-trimester fetuses. We report a series of three cases in which human parvovirus infection was associated with hydropic changes at an earlier gestational age. Spontaneous resolution of hydrops occurred in all fetuses. A greater understanding of the natural history of human parvovirus infection is needed prior to deciding on the mode of therapy (conservative management versus in utero fetal therapy).     

Papular-purpuric ''gloves and socks'' syndrome: not only parvovirus B19

We previously described an acute dermatosis characterized by pruritic erythematous and slightly papular lesions on the hands and feet in a 'gloves and socks' distribution associated with oral aphthoid lesions and fever (papular-purpuric 'gloves and socks' syndrome = PPGSS). We strongly suspected a viral origin, but serologic tests for a large panel of viruses remained negative. Subsequently, 2 cases of PPGSS with serologic evidence of a parvovirus B19 infection have been reported in the literature. Since then we observed 5 additional patients with a PPGSS. Parvovirus B19 infection could be confirmed in only 2 cases. Our findings suggest that the PPGSS can be another, yet undescribed manifestation of parvovirus infection. However, this cannot be shown in all the cases. As the papular acrodermatitis of childhood, this syndrome may be caused by various viral agents.     

Detection of mycoplasma infection of mammalian cells

BACKGROUND/AIMS: Idiopathic (autoimmune) thrombocytopenic purpura has been previously reported as a rare complication in children following parvovirus B19 infection. In the immunocompromised host who is unable to produce neutralizing antibody, an infection with parvovirus B19 can persist and cause chronic bone marrow failure. METHODS: We describe a child who had undergone liver transplantation and who had idiopathic thrombocytopenic purpura, whose history and laboratory findings suggested parvovirus B19 infection. The infection disappeared without persistent viremia, and the thrombocytopenia responded completely to the administration of gamma globulin while the patient was undergoing chronic immunosuppression therapy. RESULTS/CONCLUSION: Transplant physicians need to be aware of this complication, and parvovirus B19 infection should be included in the differential diagnosis of liver recipients presenting with severe thrombocytopenia.     

After the menopause: tamoxifen and other new prevention maintenance therapies

INTRODUCTION: Parvovirus B19 infection is frequent. Primary infection leads to diverse skin manifestations including the recently described gloves-and-socks papulopurpura. CASE REPORT: A patient presented with a papulopurpuric eruption on the nose, hands, feet and perineum with cheilitis and high-grade fever. Parvovirus B19 serology showed characteristic IgG on the 15th day after the initial eruption demonstrating the seroconversion. Cold agglutinins were positive during the eruption and negative after regression. DISCUSSION: The gloves-and-socks papulopurpura syndrome was initially described in 1990. Since that time 20 cases have been reported. In 7 cases, primary parvovirus B19 infection was proven and viral infections were suspected in the others (measles, coxsackie B6, hepatitis B, Epstein-Barr virus). Our case evidenced here to undescribed skin manifestations and the development of cold agglutinins. The presence of cold agglutinins at eruption could explain the acral localizations observed in this syndrome.     

Conversions and complications in 185 laparoscopic adjustable silicone gastric banding cases

CMV infection is the most severe transfusion-transmitted infection in immunosuppressed patients, and must be prevented in high-risk subjects by the use of seronegative units or by the use if leucocyte-reduced units. The value of these methods has been shown in patients who are seronegative for CMV. Allotransfusions may favor bacterial infections through negative immunomodulatory effects due to leucocytes. Finally, parvovirus can induce a more severe disease in immunosuppressed patients.     

Identification of a specific tyrosine residue in Bryodin 1 distinct from the active site but required for full catalytic and cytotoxic activity

Parvovirus B19 (B19) can cause chronic anemia due to persistent infection in immunocompromised hosts who cannot produce neutralizing antibody necessary for clearing B19. Three patients with X-linked hyper-IgM syndrome (XHIM), who were all asymptomatic until they developed B19-induced chronic anemia at the ages of 8, 14, and 17 years, respectively, were found to have mutations of the CD40L gene, including a missense mutation (T254M), a nonsense mutation resulting in a new initiation codon and loss of the intracellular domain (R11X), and a splice site mutation (nt 309+2t-->a). Antibody responses to the T cell-dependent antigen, bacteriophage phiX174, were impaired, but neutralizing antibody titers were higher than in XHIM patients with classic phenotype. All 3 patients responded to intravenous immune globulin (IVIG) treatment. Certain mutations of the CD40L gene result in a mild XHIM phenotype that may become apparent following B19 infection in patients not on IVIG therapy and therefore not protected from B19 infection.     

Parvovirus B19 infection in patients with congenital blood coagulation disorders

BACKGROUND: The aim of this study is to assess the prevalence of Parvovirus B19 infection in a group of patients affected by congenital coagulation disorders and its association with epidemiological aspects. PATIENTS AND METHODS: We have analyzed a group of 50 patients (median age 28) diagnosed with haemophilia or any other congenital coagulation disorder and 111 healthy non-transfused controls (median age 30) for IgG and IgM antibodies to Parvovirus B19 (Dako A/S, Glostrup, Dinamarca). Other issues analysed were HIV coinfection, the use of virally inactivated or non-inactivated plasma products and clinical symptoms of the infection. RESULTS: 84% of the patients (93.3% of those previously transfused) and 60.3% of the controls subjects showed IgG antibodies against Parvovirus B19. None of them had specific IgM antibodies. Five patients (all of them seronegative) had never been exposed to any plasma derivative and 11 were HIV-positive. The differences found between the prevalence of parvoviral infection in patients and controls are statistically significant, but those differences are only confirmed in younger patients (< 30) when age groups are compared. However, the severity of the haemostatic disorder, the type of plasma products infused or HIV coinfection had no influence on prevalence rates. The infection was clinically asymptomatic in all the cases. CONCLUSIONS: Haemophilic patients of any age are exposed to a higher risk of Parvovirus B19 infection than general population, although this infection had no clinical relevance in our study. The use of virally inactivated factor concentrates or the severity of the haemostatic disorder has no influence on this infectious risk.     

Spectrum of parvovirus B19 infection: analysis of an outbreak of 43 cases in Cadiz, Spain

In the spring of 1993, an epidemic of infection with human parvovirus B19 occurred in Cadiz, Spain. Evaluation of the 43 patients in whom this diagnosis was confirmed revealed four groups of predominant manifestations: (1) hematologic manifestations in six cases (13.9%), including four of aplastic crisis and two of pancytopenia; (2) dermatologic manifestations in 23 cases (53.4%), including 10 of erythema infectiosum and one of erythema multiforme ampullosum; (3) arthralgias/arthritis in nine cases (20.9%), including two with a chronic course; and (4) infection during pregnancy in three cases (7.0%), including two that ended in abortion. Of the 43 patients, 37.2% presented with fever and adenopathies, and these were the only manifestations in two cases. The appearance of clinical disease correlated with modifications in isotype and serum level of specific antibodies to parvovirus B19; the disappearance of IgM antibodies coincided with the resolution of clinical manifestations. Although their presence did not correlate with the course of the disease, the detection of circulating immune complexes in 81.6% of cases supports the possibility that some manifestations were immune mediated.     

Anticomplementary activity in serum samples from patients with acute parvovirus B19 infection

Of 65 serum samples submitted for diagnostic purposes which proved to be anti-complementary by complement fixation test, 49 were parvovirus B19 IgM positive. Forty four of the 49 serum samples were from patients with arthropathy. Acute parvovirus B19 infection should be suspected when a patient has symptoms of disease of the joints and the serum is anticomplementary.     

Parvovirus B19 as infectious agent in infants

OBJECTIVE: Since its casual discovery and implication as a human pathogen that provokes transitory aplastic crises and infectious erythema, the B19 parvovirus has been related to a wide spectrum of diseases. To better understand this clinical diversity, we reviewed the cases of a serology positive infants admitted to the hospital. PATIENTS AND METHODS: From January 1992 to June 1995, all clinical charts were reviewed and we obtained 15 patients that had positive IgM antibodies by immunoenzyme assay. RESULTS: The mean age was 12.2 months. No sex differences were seen. The incidence was higher in winter months. Over 50% of the patients belong to the last year studied. Clinical findings included 5 cases of arthritis (one juvenile rheumatoid arthritis, one polyarticular syndrome and 3 nonspecific forms), hematology disturbances in 5 cases (1 case of erythrophagocytosis, 1 of thrombocytopenic purpura, 2 of anemia and 1 chronic neutropenia), 3 cases of febrile syndrome, 1 liver dysfunction, and 1 neuromyelitis. Complementary exams were not significant and follow-up in all infants was satisfactory. CONCLUSIONS: The B19 parvovirus, a poorly understood virus, is related to many clinical situations where is true significance remains unknown.     

Clinical relevance of parvovirus B19 as a cause of anemia in patients with human immunodeficiency virus infection

Parvovirus B19 (B19) DNA was detected by dot blot hybridization in sera from 5 (17%) of 30 human immunodeficiency virus (HIV)-infected patients with hematocrits (HCT) of < or =24 and 4 (31%) of 13 HRV-infected patients with HCT of < or =20, suggesting that B19 is a reasonably common cause of severe anemia in HIV infection. The anemia promptly remitted after immunoglobulin therapy in 3 of 4 treated patients. The presence of IgM to B19, the clinical circumstance in which anemia developed, and the marrow morphology were poor predictors of chronic B19 infection. DNA hybridization studies of sera from 191 HIV-infected and 117 HIV-seronegative homosexual males attending a clinic in the Seattle area revealed that 1 (0.5%) and 2 (2%) samples, respectively, from the 2 groups contained B19. However, when assayed by polymerase chain reaction (PCR), 5% of the serum samples from HIV-infected persons and 9% from uninfected persons contained B19, although each had an HCT of > or =40. The data argue that anemia results from chronic high-titer B19 infection. Although a negative PCR assay excludes this diagnosis, DNA hybridization may be the more specific serum test.     

Sex-associated differences in cold-induced UCP1 synthesis in rodent brown adipose tissue

OBJECTIVE: To evaluate the usefulness of new ELISA for human parvovirus B19 (B19) antibodies and PCR for the diagnosis of acute onset of B19 polyarthritis. METHODS: We evaluated the reproducibility and sensitivity on the detection of anti-B19 antibody by ELISA using recombinant VP-1 and VP-2 (empty particle), and then studied for the prevalence of IgM and IgG B19 antibody in 125 samples for anti-B19 tests. The random study on anti-B19 antibody assay as well as PCR for B19-DNA was also performed in 130 cases with acute onset of arthritis excluding those with known origins, 224 with rheumatoid arthritis and 149 with other categories. RESULTS: The results by using B19-empty particle ELISA were reproducible and showed the assay was a sensitive way for clinical use. IgM anti-B19 antibodies were positive not only in all samples from erythema infectiosum, but also often in those from hemolytic anemia, pure red cell aplasia, fetal hydrops, hepatic injury, fever of unknown origin. Among 130 with acute onset of arthritis, 21 showed positive tests for IgM anti-B19 antibody and/or B19 DNA. On the other hand, 4 among 224 patients with rheumatoid arthritis were positive for IgM anti-B19 antibody, but all of 149 in control group were negative for IgM anti-B19 antibodies and for B19 DNA. CONCLUSION AND DISCUSSION: Anti-B19 ELISA using B19-empty particle which has been introduced as a routine test system, is a useful tool for the diagnosis of acute onset of B19 arthritis. An additional examination using PCR for B19 DNA may contribute for understanding persistent B19 polyarthritis or reactivation of B19 infection.     

Response of colony stimulating factor in cancer chemotherapy induced myelosuppression--a case report

BACKGROUND: The aim of the study was to describe the seroprevalence against Parvovirus B19 in a random sample of blood donors in the Hospital Universitario de Salamanca. METHODS: We studied the presence of IgG and IgM antibodies against Parvovirus B19 in 136 sera from asymptomatic blood donors by enzyme immunoassay methods. RESULTS: From 136 samples tested, 88 (64.7%) had positive absorbance values for IgG. Forty eight samples (35.5%) were negative. IgM was negative in all cases. We did not find indeterminate results. DISCUSSION: Parvovirus primoinfection usually happens in the childhood. Thus, we can expect a high percentage of general population to have antibodies against Parvovirus B19. Anti-Parvovirus B19 antibodies prevalence in blood donors was 64.7%. This failure is similar to data reported before (65%). Clinical importance of these viruses in currently related with hemathopoyesis diseases and with the possible role in theratogenesis. The presence of IgG seems to give protection except in some chronic infections recently described.     

Seroprevalence of B19 parvovirus infection in patients with acute polyarthritis

Over a period of 29 months, from January 1991 to December 1994, all cases of acute polyarthritis seen at the Rheumatology Service in our Institution were studied to determine the seroprevalence of parvovirus B19 (B19) infection. The variables studied included: age and sex of patients, presence of fever and rash, Anti-B19 IgM and IgE serological determinations (ELISA, Mardix Lab.), follow-up time and final diagnosis. The study included 36 patients (22 women and 14 men, mean age 34 +/- 19 years). Thirteen and seven patients had fever and cutaneous rash, respectively. Anti-B19 IgM serology was positive in 4 patients; in 2 of them IgG seroconversion was confirmed. The mean follow-up time was 14 +/- 9 months. Final diagnoses included undifferentiated polyarthritis, rheumatoid arthritis, B19 polyarthritis, systemic lupus erythematosus, and miscellaneous in 19, 7, 4, 2, and 4 patients, respectively. Seroprevalence of B19 infection in acute polyarthritis in our area was 11%, approximately.     

Stepwise analysis of cerebral blood flow SPECT imaging on standard brain atlas in patients with dementia of Alzheimer''s type

In 1994 the first human parvovirus B19 (B19) epidemic to be documented in Denmark was recorded from February 2 to September 30. In total, 10,333 serum samples were tested for specific B19 IgM and IgG antibodies, using IDEIA Parvovirus B19 IgM and IgG kits. The prevalence of B19 IgM positivity was 11% for the whole period and 29% at the peak of the epidemic in week 14, declining from week 39 and onwards to 1-3%. The prevalence of B19 IgG (IgM-negative samples) was 60%, indicating an earlier infection, and the same for men and women. The gender distribution of tested patients was the same at the beginning of the epidemic as at the end of the epidemic and a year after its peak, i.e. 86% of samples were from women and only 14% from men. Age distribution for women was the same for the three periods (median age 34 years). For men the median age was 32 years, 39 years and 31 years, respectively. Only a few samples from children were tested. No change in test pattern was observed during the three periods. Approximately 75% of all samples tested were from women of childbearing age (18-45 years old), suggesting a fear of fetal complications in an actual or future pregnancy, rather than a serological verification of clinical symptoms. From the sparse clinical information that accompanied the serum sample we were not able to demonstrate that women were more likely than men to have a symptomatic B19 infection. With reservations we estimate that 14% of adverse pregnancy outcome is correlated with a B19 infection.     

Association of parvovirus B19 genome in children with myocarditis and cardiac allograft rejection: diagnosis using the polymerase chain reaction

BACKGROUND: Inflammatory diseases of the heart, including myocarditis and cardiac transplant rejection, are important causes of morbidity and mortality in children. Although viral infection may be suspected in either of these clinical conditions, the definitive etiology is often difficult to ascertain. Furthermore, the histology is identical for both disorders. Coxsackievirus has long been considered the most common cause of viral myocarditis; however, we previously demonstrated by polymerase chain reaction (PCR) analysis that many different, and sometimes unexpected, viruses may be responsible for myocarditis and cardiac rejection. In this study, we describe the association of parvovirus genome identified through PCR analysis of cardiac tissue in the clinical setting of myocarditis and cardiac allograft rejection. METHODS AND RESULTS: Myocardial tissue from endomyocardial biopsy, explant, or autopsy was analyzed for parvovirus B19 using primers designed to amplify a 699-base pair PCR product from the VP1 gene region. Samples tested included those obtained from patients with suspected myocarditis (n=360) or transplant rejection (n=200) or control subjects (n=250). Parvoviral genome was identified through PCR in 9 patients (3 myocarditis; 6 transplant) and no control patients. Of the 3 patients with myocarditis, 1 presented with cardiac arrest leading to death, 1 developed dilated cardiomyopathy, and the other gradually improved. Four of the 6 transplant patients had evidence of significant rejection on the basis of endomyocardial biopsy histology. All transplant patients survived the infection. CONCLUSIONS: Parvovirus is associated with myocarditis in a small percentage of children and may be a potential contributor to cardiac transplant rejection. PCR may provide a rapid and sensitive method of diagnosis.     

Immunohistochemical and virological study of skin in the papular-purpuric gloves and socks syndrome

The pathogenesis of viral exanthems remains unclear. We have undertaken an immunohistochemical study of lesional skin biopsies in patients with the papular-purpuric gloves and socks syndrome (PPGSS) secondary to parvovirus B19 infection. Intracytoplasmic staining of the dermal endothelial cells, keratinocytes, and sweat glands was shown with an antibody to parvovirus B19. There were perivascular dermal infiltrates with T cells, sometimes with exocytosis. By polymerase chain reaction, virus DNA was detected in all skin biopsies and in one serum sample. The cutaneous manifestations of parvovirus infection seem secondary to infection of the endothelium and epidermis.     

The reinforced laryngeal mask airway (LMA) as an alternative airway device to manage the difficult airway

BACKGROUND: Infection with human parvovirus B19 (B19) has been reported in a few patients with various vasculitis syndromes. Mixed cryoglobulinaemia (MC), a model of small vessel size vasculitis, may result from numerous infectious diseases, particularly hepatitis C virus (HCV) infection. AIM: To assess the prevalence of seric B19 infection markers in a large series of patients with MC, with or without HCV infection. PATIENTS AND METHODS: Sixty-four patients were studied: essential MC (EMC, n = 19), MC associated with non-infectious diseases (non-essential MC, n = 9), and patients with HCV infection with (HCV-MC, n = 18) or without MC (HCV-no-MC, n = 18). Patients were considered to have MC if two successive determinations of their serum cryoglobulin concentration were above 0.05 g/l. Serum samples were analysed for specific IgG and IgM antibodies to B19 by enzyme immunoassay. B19 DNA detection was performed by polymerase chain reaction using a set of primers located in the VP1 gene, separately in serum and in cryoprecipitates to investigate a possible capture of B19 DNA in cryoprecipitate. The study also looked for a possible enrichment for of IgG antibodies to B19 in MC. RESULTS: The presence of specific IgG antibodies to B19 was found in 68% EMC, 56% non-essential MC, 78% HCV-MC, and 78% HCV-no-MC. No patient of either group had specific IgM antibodies to B19, or B19 DNA in serum or in cryoprecipitate. Overall, IgG antibodies to B19 were found in 46 of 64 (72%) serum samples, a prevalence quite similar to the prevalence in general adult population (> 60%). A specific enrichment of IgG antibodies to B19 in the MC was not found. CONCLUSION: These results suggest that B19 infection is neither an aetiological factor of EMC, nor a cofactor that may lead to MC production in patients with chronic HCV infection.