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Info


A. Viral Propertiesnavigator

  1. Discovered in mid-1970s (serologic reaction in plate B, position 19)
  2. Member of Parvoviridae Family
    1. Mainly pathogenic animal viruses
    2. Parvovirus B19 is the only human disease-causing member
    3. Adenoassociated viruses (AAV) infect humans but do not cause disease
    4. Feline panleukopenia virus
    5. Canine parvovirus
    6. Aleutian mink disease virus
    7. Porcine parvovirus
  3. Parvum = "Small"
    1. 25nm diameter virus
    2. Single stranded DNA virus, ~5600 nucleotides
    3. Single promoter of virus genome
    4. Nonstructural protein NS1, has replicative functions and is cytotoxic to host cells
    5. Two structural proteins VP1 and VP2
  4. Cell Surface Receptor
    1. Cell surface receptor is globoside 4 (Gb4), also called P antigen
    2. Gb4 primarily expressed on erythrocyte precursors
    3. Gb4 also expressed on granulocytes, platelets, heart, lung, liver, kidney, synovial cells

B. Human Infectionnavigator

  1. Usually occurs in childhood but also presents in adults
    1. Nearly all persons have been infected by the time they are elderly
    2. ~50% of 15 year olds have parvovirus IgG antibodies
  2. Infections usually occur in the spring
  3. Incubation period 6-18 days
  4. Usually asymptomatic
  5. Childhood Infection
    1. Rash is most common symptom, particularly in children
    2. "Slapped cheek" appearance, mainly in children, is erythema infectiosum, "Fifth Disease"
    3. Red maculopapular rash with lace-like reticular pattern, usually on extremities
    4. Transient erythroblastopenia of childhood
  6. Adult Infection
    1. Adults usually present with influenza-like illness, typically without facial rash
    2. May present with severe influenza-syndrome
    3. Pancytopenia may occur with associated symptoms
    4. Rare aplastic anemia and other bone marrow failure syndromes
    5. Fetal complications
    6. Immunological dysfunction including autoimmunity
    7. May present with polyarthritis, malaise, fever [2]
    8. May present with lupus-like syndrome (including anti-dsDNA antibodies) [8]
  7. Arthralgias and Frank Polyarthritis [2]
    1. May cause acute or chronic arthropathy
    2. Polyarthritis usually symmetric involving both large and small joints
    3. May resemble rheumatoid arthritis, but is usually self-limited
    4. Unclear whether virus actually plays role in chronic disease [3]
    5. May present with lupus-like syndrome and antinuclear ± anti-dsDNA antibodies [8]

C. Other Associated Conditionsnavigator

  1. Immune thrombocytopenia
  2. Aplastic Crisis [4]
    1. Especially in hemoglobinopathies: sickle cell disease [6], spherocytosis
    2. Immunosuppressed patients, including organ transplant recipients
  3. Infection During Pregnancy [5]
    1. May increase risk of fetal death (see below)
    2. Most often contracted from exposure to mother's household children
    3. Nursery school teachers also have increased risk
    4. Hydrops fetalis
    5. Can be confused with Blackfan-Diamond Anemia
  4. Intrauterine Fetal Death [7]
    1. 15% of cases of late fetal death positive for parvovirus B19 DNA
    2. 0% of cases of normal pregnancy at term had parvovirus DNA
    3. 5% of miscarriages but none of the cases of induced abortion had parovirus DNA
  5. Chronic Anemia
  6. Relationship to Rheumatologic Disorders
    1. May induce anti-nuclear and even anti-dsDNA antibodies [8]
    2. Some association with rheumatoid factor and rheumatoid arthritis (viral arthritis)
    3. Polyarteritis Nodosum (PAN)
  7. Acute myocarditis
  8. Encephalitis (aseptic meningitis)
  9. Brachial Plexus Neuropathy

D. Diagnosisnavigator

  1. ~50% of adults have IgG Antibody (Ab)
  2. Acute infection - increases in IgM Ab in 3-4 weeks have IgM Ab
  3. May induce positive antinuclear antibody (ANA) or positive anti-dsDNA antibody
  4. DNA hybridization / polymerase chain reaction very sensitive

E. Treatment navigator

  1. No specific anti-viral agents are available
  2. Intravenous immune globulin (IVIg) contains good levels of anti-B19 antibodies
    1. May be used for persistent infections
    2. Treat with 5-10 day course of IVIG 0.4gm/kg daily
  3. Arthropathy
    1. Non-steroidal anti-inflammatory drugs (NSAIDs)
    2. Glucocorticoids - oral prednisone 40mg qd with rapid taper will reduce symptoms
  4. Special concern: pregnancy, immunodeficiency, red cell disorder
  5. Vaccine is being developed

F. Risk in Pregnancy navigator

  1. May cause fetal hydrops, which can be fatal
  2. Low but definite risk to fetus in women exposed to virus
  3. Can also cause late stage intrauterine fetal death (see above)
  4. Test for IgM anti-parvovirus Ab
  5. Follw high risk patients with ultrasound, AFP levels (both unproven to affect outcome)
  6. Consider termination of pregnancy

References navigator

  1. Young NS and Brown KE. 2004. NEJM. 350(6):586 abstract
  2. Martin DP, Schlott DW, Flynn JA. 2007. NEJM. 357(18):1856 (Case Discussion) abstract
  3. Soderlund M, von Essen R, Haapasaari J, et al. 1997. Lancet. 349:1063 abstract
  4. Abbey E and Lacy J. 1998. Am J Med. 104(2):200 (Case Record)
  5. Valeur-Jensen AK, Pedersen CB, Westergaard T, et al. 1999. JAMA. 281(12):1099 abstract
  6. Steinberg MH. 1999. NEJM. 340(13):1021 abstract
  7. Tolfvenstam T, Papadogiannakis N, Norbeck O, et al. 2001. Lancet. 357(9267):1494 abstract
  8. Garcia FJN, Domingo-Domenech E, Castro-Bohorquez FJ, et al. 2001. Am J Med. 111(7):573 abstract