Brote por Parvovirus B19 asociado a la atención sanitaria en un hospital al norte del Perú / Parvovirus B19 outbreak associated with healthcare in a hospital in northern Peru

RESUMEN Fundamento: parvovirus humano B19 es el agente causal de la quinta enfermedad en los niños y de la poliartropatía y la eritroblastopenia aguda en los adultos. Objetivo: determinar los aspectos clínicos, epidemiológicos y analíticos de la infección por parvovirus B19 durante un brote nosocomial. Métodos: se realizó un estudio trasversal descriptivo en los servicios de Medicina y Pediatría en el Hospital Regional de Lambayeque durante los meses de noviembre y diciembre de 2017. Se realizó un estudio de serie de casos en base a las historias clínicas de pacientes y personal de salud, con resultado positivo a la infección por PVB1, mediante la técnica de ELISA. El universo estuvo constituido por 153 pacientes atendidos en los servicios de Medicina y Pediatría en el tiempo mencionado. De los cuales se seleccionó una muestra de 16 casos, cumpliendo los criterios mencionados. Resultados: se identificaron 16 pacientes positivos de los servicios de Medicina y Pediatría, con títulos de IgM contra parvovirus B19 superiores a 17 UI/mL, cuyas edades oscilaron entre los seis meses y 38 años. Entre ellos ocho y 16 pacientes presentaron comorbilidades de las cuales 3/8 correspondieron a enfermedades autoinmunes. Se evidenciaron contactos intrahospitalarios en ambos servicios. Se encontró una mayor morbilidad en el personal de salud femenino de mediana edad. Conclusiones: la infección por parvovirus B19 en el hospital u otro medio sanitario representa un riesgo para el personal de salud.

ABSTRACT Background: human parvovirus B19 is the causative agent of fifth disease in children and of polyarthropathy and acute erythroblastopenia in adults. Objective: to determine the clinical, epidemiological and analytical aspects of parvovirus B19 infection during a nosocomial outbreak. Methods: a descriptive cross-sectional study was carried out in the Medicine and Pediatrics services of the Regional Lambayeque Hospital during the months of November and December 2017. A study of a series of cases was carried out based on the patients and health personnel historical charts, with a positive result to the PVB1 infection, through the ELISA technique. The universe was constituted by 153 patients treated in the Medicine and Pediatrics services. Of which it was selected a sample of 16 cases, based on the criteria. Results: 16 positive patients from the Medicine and Pediatrics departments were identified, with IgM titers against parvovirus B19 greater than 17 IU / mL, whose ages ranged from 6 months to 38 years. Among them 8/16 patients presented comorbidities of which 3/8 corresponded to autoimmune diseases. In-hospital contacts were evident in both services. Greater morbidity was found in middle-aged female health personnel. Conclusions: Parvovirus B19 infection in the hospital or other health environment represents a risk mainly for health personnel.

Infecção por parvovírus B19 em receptores de transplante renal: série de caso / Parvovirus B19 infection in kidney transplant recipients: a case series

Os receptores de transplante renal são mais suscetíveis a infecções, entre elas o parvovírus B19, que pode ser transmitido por via respiratória, adquirido por meio do enxerto ou por reativação de infecção latente. A anemia normocítica normocrômica, com diminuição dos reticulócitos e resistência ao tratamento com eritropoietina, é a principal forma de apresentação da infecção por parvovírus B19 em transplante renal. O diagnóstico requer alto índice de suspeição clínica e realização de testes diagnósticos selecionados. Tratamento com imunoglobulina e suspensão dos imunossupressores durante a infecção mostraram-se eficazes. Os autores relatam sua experiência com cinco casos de infecção por parvovírus B19 em receptores de transplante renal de um hospital universitário. Os aspectos clínicos, diagnósticos e terapêuticos são revistos.

Kidney transplant recipients are more susceptible to infections, including by parvovirus B19, spread through the respiratory tract, acquired through the graft or reactivation of latent infection. Normocytic normochromic anemia, with decreased reticulocytes and resistance to erythropoietin treatment, is the most common presentation of Parvovirus B19 infection in renal transplant. Diagnosis requires a higher clinical suspicion and the performance of selected diagnostic tests. Treatment with immunoglobulin and suspension of immunosuppressive therapy during the infection may be effective. The authors report five cases of PB19 infection in kidney transplant patients at a hospital. The clinical, diagnostic, and treatment features are reviewed.

Epidemiological, clinical and pathological features of canine parvovirus 2c infection in dogs from southern Brazil / Aspectos epidemiológicos, clínicos e patológicos da infecção pelo parvovirus canino 2c em cães do Sul do Brasil

Canine parvovirus type 2c (CPV-2c) emerged in Europe in the early 2000's and rapidly spread out worldwide. Clinical and molecular data have demonstrated its circulation in Brazilian dogs, yet detailed descriptions of cases are still lacking. This article describes the epidemiological, clinical and pathological features of 24 cases of CPV-2c-associated disease in dogs submitted to veterinary clinics and laboratory diagnosis in southern Brazil (2014-2016). Most affected dogs presented signs/lesions suggestive of parvovirus enteritis: diarrhea, vomiting, hyperemia and hemorrhage of the serous membrane of the small intestine, diffuse segmental granulation, atrophy of the villi, necrosis and fusion of crypts, squamous metaplasia and epithelial syncytia. A number of cases presented features divergent from the classical presentations, including a wide variation in the color of feces (reddish and/or yellowish, light-brownish, orange-brown and brownish), involvement of adults (4/24) and vaccinated dogs (12/24), extensive involvement of the small intestine (8/20) and the presence of pulmonary edema (7/24) and convulsions (3/24). Feces and intestinal fragments submitted to PCR for the CPV-2 VP2 gene and to virus isolation in cell culture yielded positive results in 100% and 58.3% (14/24) of the cases, respectively. Nucleotide sequencing revealed a high nucleotide identity in VP2 (99.4 to 100%) and a consistent mutation at amino acid 426 (asparagine to glutamic acid), considered a signature of CPV-2c. These results confirm the involvement of CPV-2c in the described cases and demonstrate the importance of CPV-2c infection among Brazilian dogs, calling attention of veterinarians to correctly diagnose the disease, mainly considering the frequent atypical presentations.(AU)

O parvovírus canino tipo 2c (CPV-2c) surgiu na Europa no início do ano 2000 e rapidamente se espalhou pelas populações de cães ao redor do mundo. Dados clínicos e moleculares demonstraram a sua circulação em cães brasileiros, porém descrições detalhadas desses casos ainda são escassas. Este artigo descreve os aspectos epidemiológicos, clínicos e patológicos de 24 casos de doença gastroentérica associada com a infecção pelo CPV-2c em cães atendidos em clínicas veterinárias e submetidos ao diagnóstico laboratorial no Sul do Brasil (2014-2016). A maioria dos cães afetados apresentaram sinais e/ou lesões sugestivas de enterite por parvovírus: diarreia, vômitos, hiperemia e hemorragia na membrana serosa do intestino delgado, granulação segmentar difusa, atrofia das vilosidades, necrose e fusão de criptas, metaplasia escamosa e sincícios epiteliais. Alguns casos apresentaram características divergentes das apresentações clássicas, incluindo uma grande variação na cor das fezes (avermelhada e/ou amarelada, marrom-claro, marrom-alaranjada ou amarronzada), a participação dos adultos (4/24) e cães vacinados (12/24), um amplo envolvimento do intestino delgado (8/20), a presença de edema pulmonar (7/24) e convulsões (3/24). As fezes e fragmentos intestinais foram submetidos ao teste de PCR para o gene VP2 do CPV-2, e ao isolamento do vírus em cultura de células produziram resultados positivos em 100% e 58,3% (14/24) dos casos, respectivamente. O sequenciamento dos nucleótidos revelou uma alta identidade de nucleótidos na VP2 (99,4-100%) e uma mutação no aminoácido 426 (asparagina para ácido glutâmico), considerada uma assinatura de CPV-2c. Estes resultados confirmam o envolvimento do CPV-2c nos casos descritos e demonstra a importância da infecção pelo CPV-2c entre os cães do Brasil, chamando a atenção de veterinários para diagnosticar corretamente a doença, principalmente considerando-se as apresentações atípicas frequentes.(AU)

Serological and molecular analysis of parvovirus B19 infection in Mayan women with systemic lupus erythematosus in Mexico / Análisis serológico y molecular de la infección por parvovirus B19 en mujeres mayas con lupus eritematoso sistémico en México

Abstract Background: Systemic lupus erythematosus (SLE) is a systemic autoimmune disease that mainly affects women, characterized by the production of autoantibodies. Its causal agent is unknown, but the combination of environmental, hormonal and genetic factors may favor the development of the disease. Parvovirus B19 has been associated with the development of SLE, since it induces the production of anti-single stranded DNA antibodies. It is unknown whether PV-B19 infection is an environmental factor that trigger or reactivate SLE in the Mexican Mayan population. Aim: A preliminary serological and molecular study of PV-B19 infection in Mayan women with established SLE was done. Methods: IgG and IgM anti PV-B19 were evaluated in 66 SLE patients and 66 control subjects, all women of Mayan origin. Viral DNA and viral load were analyzed by qPCR. Results: Insignificant levels of IgM were observed in 14.3% (4/28) of the patients and 11.4% (4/35) of control subjects. IgG was detected in 82.1% (23/28) of the patients and 82.9% (29/35) of control subjects, but were significantly higher in patients. Viral DNA was found in 86.0% (57/66) of the patients and 81.0% (54/66) of control subjects. Viral load, quantified in 28/66 patients and 31/66 controls which were positive for IgM and IgG, was significantly higher in controls. Conclusion: The high prevalence of PV-B19 in Yucatan, and the presence of IgM, IgG, and viral load in Mayan women with established SLE suggest that PV-B19 infection could be an environmental factor to trigger or reactivate SLE.

Resumen Antecedentes: Lupus eritematoso sistémico (LES) es una enfermedad sistemica autoinmune que afecta principalmente a las mujeres, caracterizada por la producción de autoanticuerpos. El agente causaal es desconocido. Pero la combinación de factores ambientales, hormonales y genéticos podría favorecer el desarrollo de la enfermedad. El parvovirus B19 se asoció con el desarrollo de LES, debido a que induce la producción de anticuerpos anti-cadena simple de DNA. Es desconocido si la infección PV-B19 es un factor ambiental que desencadena o reactiva LES en la población mexicana Maya. Objetivo: Se realizó un estudio serológico y molecular preliminar de la infección de PV-B19 en mujeres Mayas con LES. Métodos: Se evaluó IgG and IgM anti PV-B19 en 66 pacientes con LES y 66 controles sanos, todas las mujeres fueron de origen Maya. DNAViral y la carga viral fueron analizadas por qPCR. Resultados: Se determinaron niveles insignificantes de IgM en el 14.3% (4/28) de las pacientes y en el 11.4% (4/35) de los controles. IgG se detectó en el 82.1% (23/28) de los pacients y en el 82.9% (29/35) de los controles. Hubo un alta significancia en los pacientes con LES. DNA viral se encontró en el 86.0% (57/66) de los pacientes y en el 81.0% (54/66) de los controles. La carga viral se cuantifico en 28/66 pacientes y en 31/66 de los controles, la cual fueron positivos para IgM e IgG; fue significativamente mas alta en los controles. Conclusión: La alta prevalencia de PV-B19 en Yucatan y la presencia de IgM, IgG y una carga viral en mujeres Mayas con LES sugiere que la infección con PV-B19 poria ser un factor ambiental que desencadene o reactive el LES

Detection and analysis of human bocavirus in children with acute respiratory infection in Nanjing / 中华检验医学杂志

Objective To investigate the possible existence of HBoV in children with acute respiratory infections in Nanjing area and explore its relationship with clinical characteristics.Methods A total of 397 nasopharyngeal secretion samples were collected from children with acute respiratory infection,admitted from July 2009 to June 2010 in Nanjing Children'S Hospital affiliated to Nanjing Medical University,and 50 cases of children without symptoms of respiratory infection were recruited as control group,whose nasopharyngeal secretion samples were also collected.HBoV was determined by real-time fluorescence quantitative PCR.MP and CT were detected by real-time fluorescence quantitative PCR in those HBoV-positive samples.RSV,ADV,IVA,IVB,PIV-1,PIV-2,PIV-3 and hMPV were detected by direct antigen-specific immunofluorescence assays.HBoV NP-1 fragments were amplified and sequenced in 5 HBoV positive samples randomly selected.The results were compared with the known GenBank sequence,and thereby the phylogenetic tree was established.The epidemiological characteristics,clinical presentation and the final clinical diagnosis of HBoV were analyzed according to the clinical data of the HBoV-positive patients.Results Thirty-three HBoV-positive cases were detected by real-time fluorescence quantitative PCR method with a positivity rate of 8. 3% ( 33/397 ). Among the 33 HBoV-positive cases, 19 cases (57.6%) were multiple infections with HBoV and other pathogens, the top three of which were MP (27.3% ,9/33 ),RSV (24.2% , 8/33 ) and PIV-3 ( 12. 1% ,4/33 ). Affected children aged from 7 to 36 months old accounted for 75.8% of the total ( 25/33 ). The measured HBoV NP-1 gene sequences of 5 specimens were consistent,indicating a high homology (99% to 100% ) with the stl, st2 and WHL-1. Conclusions HBoV is one of the pathogens of children's acute respiratory infections in Nanjing. HBoV NP-1 gene is highly conserved,with little variation in different seasons and in different regions and therefore can be used as a marker for real-time fluorescence quantitative PCR and other methods.

Seroprevalence of human parvovirus B19 in a suburban population in São Paulo, Brazil

OBJETIVO: Analisar a prevalência de anticorpos IgG ao parvovírus humano B19. MÉTODOS: Estudo transversal em uma comunidade de subúrbio de São Paulo, Brasil, de novembro 1990 a janeiro de 1991. Amostras aleatórias (N=435) e representativas de soro foram coletadas de crianças sadias a partir de 15 dias de idade e de adultos com até 40 anos. Os anticorpos IgG ao parvovírus humano B19 foram detectados pelo teste ELISA. RESULTADOS: A prevalência de anticorpos IgG ao parvovírus B19 foi de 87 por cento dos recém-nascidos. A prevalência de anticorpos IgG de origem materna decaiu exponencialmente até o 19o mês de idade. Baixa prevalência de anticorpos foi observada nos primeiros quatro anos de vida, aumentando até 72 por cento no grupo etário de 31-40 anos. A idade média de aquisição da primeira infecção nesta comunidade é de 21 ± 7 anos. A idade ótima para se vacinar as crianças desta comunidade com uma vacina hipotética é de um ano de idade. CONCLUSÕES: A prevalência de anticorpos IgG ao parvovírus B19 foi alta entre recém-nascidos e no grupo etário 31-40 anos. A análise por estrutura etária mostrou padrão similar aos estudos prévios relacionados à baixa prevalência de infecção em crianças que aumenta com a idade.

Detection and identification of first human bocavirus infection in Guangdong / 中华传染病杂志

Objective To study human bocavirus (HBoV) induced respiratory tract infection in Guangdong Province in China. Methods HBoV was deteced by using polymerase chain reaction (PCR) technology and was identified by DNA sequences. Results One strain of HBoV was detected and identified from 50 samples collected from children with acute respiratory tract infections. This was the first clinical case of HBoV infection reported in Guangdong and was named as GD-1 strain. The HBoV capsid protein (VP) gene amplified from the specimen by PCR was identified by sequencing and was compared with gene sequences in GenBank. Phylogenetic trees were constructed for sequence homology analysis. The nucleotides similarities between GD-1 and Beijing strains, France strains and Canada strains were over 98%, while the simlilarity was over 36% compared with Korea KNIH-2K6GJ2713 strain and over 77% compared with US NH4549 strain. Conclusion HBoV infection does exist in Guangdong Province. It is valuable to start systemic study on it.