Parvovirus B19 infection in a patient of juvenile arthritis: A case report

Parvovirus B19 infection, or fifth disease or erythema infectiosum, is a self-limiting viral exanthem and can occur along with other connective tissue disorders. Occasionally, children may have preceding chronic joint complaints suggestive of juvenile idiopathic arthritis. A 7-year-old female patient presented to the outpatient department with a rash over her face, upper and lower limbs, and trunk, which was preceded by fever. The patient is a known case of juvenile arthritis. On examination, there were multiple erythematous and skin-colored plaques over cheeks; few pustules over lips; multiple erythematous papules over upper limbs, lower limbs, and trunk; multiple erythematous macules over palms; and swelling over interphalangeal joints of bilateral hands, elbow and knee joints with genu valgum deformity of limbs. The patient was given topical antibiotic and steroid combination cream and oral antihistaminic for her cutaneous complaints.

Hemophagocytic Syndrome Secondary to Human Parvovirus B19 Infection in an Acquired Immunodeficiency Syndrome Patient:Report of One Case / 中国医学科学院学报

The acquired immunodeficiency syndrome patients with compromised immunity are prone to hemophagocytic syndrome secondary to opportunistic infections.This paper reports a rare case of hemophagocytic syndrome secondary to human parvovirus B19 infection in an acquired immunodeficiency syndrome patient,and analyzes the clinical characteristics,aiming to improve the diagnosis and treatment of the disease and prevent missed diagnosis and misdiagnosis.

Relationship between parvovirus b19 and osteoarthritis: literature review / Relação entre parvovírus b19 e osteoartrite: revisão bibliográfica

ABSTRACT Osteoarthritis and Parvovirus B19 infection present silent and gradual evolution, since the former is a degenerative process while the latter is often asymptomatic and may persist in the individual's body during their life. This study aims to analyze clinical studies that establish a correlation between degenerative osteoarthritis and Parvovirus B19 infection. Of the 62 studies found, 25 were chosen for reading in full. Analyzing only the studies that establish the correlation between the pathologies, seven confirm this relationship between Parvovirus B19 and Osteoarthritis, while one reports no relationship. No objective correlation could be found between the other articles studied. Our findings suggest that there is a close relationship between Parvovirus B19 and Osteoarthritis, with a higher prevalence of acquired causes, women and older adults, but it can manifest during life. However, it is essential to carry out new studies involving family history of patients with Osteoarthritis with positivity of Parvovirus B19, cohort studies between childhood and adult-old adult, so that it can elucidate this duality of congenital-acquired cause and, finally, raise treatment alternatives. Level of Evidence II, Systematic Review of Level II Studies.

RESUMO Tanto a osteoartrite quanto a infecção pelo parvovírus B19 apresentam evolução muitas vezes silenciosa e gradual, uma vez que a primeira é um processo degenerativo, e a segunda é geralmente assintomática, podendo persistir no corpo do indivíduo por toda a sua vida. Esta revisão bibliográfica visa analisar estudos clínicos que estabeleceram a correlação entre a osteoartrite degenerativa e a infecção pelo parvovírus B19. Dos 62 artigos encontrados, foram eleitos 25 para leitura em sua totalidade. Analisando apenas os artigos que estabelecem a relação entre as patologias, temos sete que confirmaram essa relação, enquanto um deles afirmou que não há relação. Não houve correlação objetiva entre os demais artigos estudados. Nossos resultados sugerem que há estreita relação entre a osteoartrite e o parvovírus B19, que tende a ser uma doença de causa adquirida com maior prevalência em mulheres e idosos, porém que pode se manifestar durante toda a vida. Contudo, é crucial a realização de novos estudos envolvendo antecedentes familiares de pacientes com osteoartrite e com positividade para o parvovírus B19 e estudos de coorte entre a infância e o adulto-idoso, a fim de elucidar essa dualidade de causa congênita-adquirida e, enfim, levantar alternativas de tratamento. Nível de Evidência II, Revisão Sistemática de Estudos de Nível II.

HPV B19, HAV and HEV infection among voluntary blood donors in Nantong / 中国输血杂志

【Objective】 To evaluate the viability of nucleic acid test(NAT) of human parvovirus B19 (HPV B19), hepatitis A virus (HAV) and hepatitis E virus (HEV) along with routine NAT for voluntary blood donors, and to analyze HPV B19, HAV and HEV prevalence in Nantong, so as to provide reference for rational blood screening programs. 【Methods】 HPV B19 DNA, HAV RNA and HEV RNA of blood donors in Nantong from November 2021 to May 2022 were detected using NAT, and serological antibody testing was performed on NAT reactive samples. 【Results】 Three HPV B19 DNA was yielded out of 3 440 blood donors, with a positive rate of 0.09%, among which 2 were negative for HPV B19-IgM and 1 was undetermined due to insufficient sample size. HAV RNA and HEV RNA were not detected in 3 440 blood donors. HPV B19, HAV, and HEV NAT were conducted simultaneously with routine HBV, HCV and HIV screening, prolonging the test reports by 20 minutes. 【Conclusion】 Although the HPV B19 DNA, HAV RNA and HEV RNA prevalence among voluntary blood donors in Nantong is low, the risk of transfusion transmitted infection still exsits and can be reduced by NAT.

Investigation on the prevalence of human parvovirus B19 infection among voluntary blood donors / 中国输血杂志

Objective To investigate the infection of human parvovirus B19 in Suzhou voluntary blood donors under the current blood screening model. Methods A total of 893 blood donor samples from September to December 2022 were randomly collected. Samples were tested to determine the seroprevalence (anti-B19 IgG and IgM) of B19 antibodies by enzyme-linked immunosorbent assay(ELISA), and B19 DNA of positive samples was further detected by real-time polymerase chain reaction(PCR) assay. Results Among 893 samples, the total seroprevalence of B19 antibody was 20.7% (185/893), with anti-B19 IgG and IgM positive rate at 19.4% (173/893) and 1.9% (17/893), respectively, showing significant difference (P0.05). The prevalence of anti-B19 IgG statistically increased with age (P0.05). No statistical difference was not found in anti-B19 IgG and IgM samples among different blood groups. The anti-B19 IgG in repeated blood donors was higher than that in first-time donors(21.5% vs 15.9%)(P0.05). Three cases were found to be positive for B19 DNA in the B19 antibody positive samples, with the positive rate at 1.6%(3/185). Conclusion Although the prevalence of B19 infection in Suzhou was lower than that in other areas and was mostly past infection, there was still a certain proportion of persistent infection and acute infection, which posed the potential risk of blood transfusion transmission. Therefore, attention should be paid to blood transfusions, especially for the high-risk and susceptible groups.

Influencing factors and outcomes of acute rejection within one year after pediatric kidney transplantation / 中华器官移植杂志

Objective:To explore the influencing factors of acute rejection (AR) within one year after pediatric kidney transplantation (KT) and the effect of AR onset time on prognosis.Methods:From January 2011 to October 2021, a total of 112 patients aged under 18 years at the time of transplantation were selected.After excluding 6 of them with early renal non-function caused by non-rejection, 106 cases were examined.There were 63 males and 43 females with the age of 15(12, 16) years.The donors were living related (n=26) and deceased (n=80).According to the presence/absence and onset time of AR, they were assigned into three groups of AR within one year, AR after one year and non-AR.The relevant clinical data of donor/recipient, influencing factors of AR and therapeutic outcomes of AR were retrospectively compared.One-way ANOVA or Kruskal-Wallis test was utilized for comparing 1-year renal function after the occurrence of AR among three groups.With graft-function loss as an end-point event of follow-up, the effects of AR within one year and AR after one year on survival rate and function of graft-kidney were analyzed by Kaplan-Meier survival curve.Results:The median follow-up period of 106 pediatric KT recipients was 35 months.During follow-ups, 19 episodes of AR occurred in 17(16.0%) patients and 89 recipients exhibited no AR episode by the end of follow-up (non-AR group).As for initial AR, 9 episodes of AR occurred within one year (AR within one year group) and 8 episodes of AR after one year (AR after one year group).After anti-rejection treatment, 8 patients (47.1%) achieved full recovery and 6 patients (35.3%) failed to completely normalize and 3 patients (17.6%) developed graft failure.Univariate analysis indicated that, as compared with non-AR group, female recipients, donors aged under 8 years and early postoperative infection with parvovirus B19 were risk factors of AR within one year ( P=0.032, P=0.039, P=0.047).Kaplan-Meier survival analysis revealed that the incidence rates of AR within one year in patients with donors aged under 8 years and early postoperative parvoviral infection were 14.5%(8/55) and 30.0%(3/10) respectively.They were significantly higher than 2.0%(1/51) and 6.3%(6/96) of patients with donors aged above 8 years and those without parvoviral infection ( P=0.012, P=0.004).With graft-function loss as an end-point event of follow-up, Kaplan-Meier survival analysis showed that 10-year kidney graft survival rate in AR within one year and AR after one year groups were 88.9% and 65.6%.Both were significantly lower than that in non-AR group (98.9%).And the inter-group differences were statistically significant ( χ2=4.286, P=0.038; χ2=7.787, P=0.005).However, no significant difference existed in survival rate between AR within one year and AR after one year groups ( P=0.689).One-way ANOVA and Kruskal-Wallis test indicated that estimated glomerular filtration rates at 3/6/12 months after an onset of AR in AR within one year group were (76.8±51.6), (80.6±56.6) and (85.6±40.2) ml·min -1·1.73 m -2.The values of 3/6 months were lower than (125.3±39.2) and (124.7±38.2) ml·min -1·1.73 m -2 in AR after one year group.And the inter-group differences were statistically significant ( P=0.021, P=0.039).The values of 3/6/12 months were lower than (112.2±34.2), (115.3±33.2) and (117.4±30.2) ml·min -1·1.73 m -2 in non-AR group.And the inter-group differences were also statistically significant ( P=0.019, P=0.020, P=0.020). Conclusions:Female recipients, donors aged under 8 years and early postoperative infection with parvovirus B19 may elevate the risks of AR in children within one year of KT.AR within one year affects the survival rate of graft-kidney and renal function.

Síndrome purpúrico de distribución atípica por parvovirus B19 en una adolescente / Atypical involvement of purpuric syndrome caused by parvovirus B19: case report in a 12-year-old female

Resumen El parvovirus B19 es causante de una variedad de enfermedades exantemáticas durante la infancia y adolescencia, como el eritema infeccioso y el síndrome papular purpúrico en guante y calcetín. Este último es una acrodermatitis aguda, inusual y benigna, que puede asociarse a aftas orales, fiebre y otros síntomas constitucionales. Existen casos atípicos como la púrpura febril en otras localizaciones, sin cumplir la distribución característica en guante y calcetín de forma simétrica o con un mayor componente de eritrodermia. Presentamos el caso de una adolescente de 12 años con un síndrome papular purpúrico de distribución atípica por parvovirus B19.

Abstract Parvovirus B19 is the cause of a variety of exanthematous diseases during childhood and adolescence, such as erythema infectiosum and papular purpuric gloves and socks syndrome. This is an unusual, benign and acute acrodermatitis. Aphtous stomatitis, fever and other systemic symptoms can be associated with the eruption of the purpuric rash. Uncommon patterns such as asymmetrical distribution or erythematous involvement llave recently been described as additional features of PVB19-associated purpuric petechial eruption. This is a case report of a 12-year-old female with an atypical involvement of a papular-purpuric syndrome caused by human parvovirus B19.

Technical specification for clinical diagnosis and treatment of human parvovirus B19 infection in kidney transplant recipients (2022 edition) / 器官移植

Long-term use of immunosuppressant in kidney transplant recipients leads to poor immune function and infection with various pathogens. In recent years, along with the advancement of detection technique of human parvovirus B19 (HPV-B19) infection and the increasing quantity of kidney transplantation, the infection rate of HPV-B19 after kidney transplantation has been elevated year by year, becoming one of the major causes of pure red cell aplasia (PRCA), affecting the recovery of renal allograft function, and even leading to the injury or poor prognosis of renal allograft. To further standardize the diagnosis and treatment of HPV-B19 infection in kidney transplant recipients, Branch of Organ Transplantation of Chinese Medical Association and National Kidney Transplantation Quality Control Center jointly organized experts to formulate the clinical diagnosis and treatment specification for HPV-B19 infection after kidney transplantation from the perspectives of etiology, epidemiological characteristics, clinical manifestations, diagnosis, prevention, treatment, existing problems and prospects of HPV-B19, aiming to provide guidance for standardized prevention and treatment of HPV-B19 infection post-kidney transplantation in China.

Human parvovirus B19 infection in blood donors: a meta-analysis / 中国输血杂志

【Objective】 To analyze the current situation of human parvovirus B19 infection in blood donors in different regions of China, so as to provide basis for formulating reasonable screening programs of B19 virus for blood donors in various cities and regions. 【Methods】 The literatures related to human parvovirus B19 infection in whole blood and plasma donors published from 1998 to 2021 were searched in the database, and meta-analysis of literatures that satisfied the inclusion criteria was conducted by R4.1.0 software. 【Results】 A total of 35 literatures were obtained, 20 literatures involving 56 846 blood donor samples and 8 literatures involving 1 608 pooled raw plasma samples were subjected to Meta analysis of the positive rates of B19 DNA; 17 literatures involving 12 308 blood sample were subjected to the Meta analysis of the positive rate of B19 IgG antibody.The positive rates of B19 DNA in blood donors(I2=96%, τ2=0.026 0, P<0.01)and pooled raw plasma (I2=98%, τ2=0.124 5, P<0.01), as well as the positive rate of B19 IgG antibod (I2=98%, τ 2 =0.021 0, P < 0.01) presented significant heterogeneity between regions. The combined positive rate of B19 DNA was estimated to be 2.0% (95%-CI: 0.007~0.039), that of pooled raw plasma for production was 66.6% (95%-CI: 0.476~0.832), and that of B19 IgG antibody was 30.2% (95%-CI: 0.246~0.357). 【Conclusion】 Low HPV B19 infection rate and high positive rate of IgG antibody were found in blood donors. Therefore, the risk of B19 virus infection due to blood transfusion is low, but B19 infections in blood donors varied significantly between regions. Domestic cities and regions should reasonably evaluate their own B19 virus infection status to formulate appropriate B19 virus screening programs for blood donors, so as to reduce blood transfusion transmitted risk of B19 virus. In addition, the infection rate of B19 virus in pooled plasma for production is somewhat high. Recipients should be screened for B19 virus antibodies, and appropriate blood transfusion schemes should be formulated for blood recipients lacking neutralizing B19 IgG antibodies to reduce the exposure of B19 virus.

Epidemiological analysis and prevention and control of human parvovirus B19 infection in 39 recipients of renal transplantation / 中华器官移植杂志

Objective:To explore the epidemiological characteristics, risk factors, preventions and treatments of recent human parvovirus B19 (HPV-B19) infections in recipients of renal transplantation (RT).Methods:From May 2020 to June 2021, retrospective review was conducted for epidemiological characteristics, treatment protocols, preventions and outcomes of HPV-B19 infected recipients after RT.Risk factors were analyzed using uninfected recipients after RT in the same period as controls.And 78 recipients who were not infected after RT with similar operation time were used as a control group for risk factor analysis.The infection rates of the four liver transplant recipients infected with HPV-B19 during the same period were calculated and compared with those of the kidney transplant recipients.Chi-square test and Fisher's exact test were used for statistical analysis.Results:During the observation period, HPV-B19 infection occurred in 39/368 recipients after RT with an overall infection rate of 10.60%(39/368). In terms of clinical symptoms, all 39 recipients presented with pure red cell aplasia (PRCA). In terms of season of infection, HPV-B19 infections occurred predominantly in autumn and winter [74.3% (29/39) of infections in autumn and winter, including 48.7% (19/39) in autumn]. Comparing the infection rates of different transplant recipients, 4 out of 123 liver transplant recipients were infected with HPV-B19 during the same period.The rate of infection was lower in liver transplant recipients than in RT counterparts (3.25% vs.10.60%, χ2=6.225, P=0.013). Analysis of OR values showed that transfusion of blood products was a risk factor for recent postoperative infection ( χ2=4.806, P=0.028, OR=2.418, 95% CI=1.088-5.373). Conclusions:HPV-B19 infection in renal transplant patients is mainly manifested as PRCA and is more likely than in liver transplant patients.Autumn and winter may be susceptible seasons for HPV-B19 and protection should be increased to prevent infection.Transfusion of blood products is a risk factor for recent HPV-B19 infection after RT, therefore donors should be routinely examined and it is imperative to test the safety of blood products in patients after RT.Thus HPV-B19 infection is well-controlled so that further spread may be prevented to avoid an epidemic outbreak.

Síndrome Baboon-like asociado a Parvovirus B19: A propósito de un caso en edad pediátrica / Baboon-like syndrome induced by Parvovirus B19: report of a pediatric case

Resumen El Parvovirus B19 constituye un agente viral frecuente como causa de exantemas en edad pediátrica. Responsable clásicamente del eritema infeccioso, en los últimos años se lo asoció también a erupciones cutáneas atípicas. Recientemente se ha descrito una forma de exantema periflexural asociado a distintos agentes virales, conocido como síndrome Baboon-like. Presentamos el caso de una niña de 9 años con evidencia serológica de infección aguda por Parvovirus 19 que desarrolló una erupción máculo-pápulo-petequial con lesiones acentuadas en grandes pliegues. Se realiza búsqueda de la literatura disponible en relación a los exantemas inusuales por Parvovirus y se describe el caso como síndrome simil Baboon, una manifestación cutánea de esta infección viral.

Abstract Parvovirus B19 is a common viral cause of exanthem in pediatric patients. Classically responsible for infectious erythema, in the last few years it has also been associated with atypical rashes. A form of periflexural eruption associated with viral agents has been recently described as Baboon-like syndrome. We present the case of a 9-years-old girl with serological evidence of acute Parvovirus B19 infection that developed a maculopapular-petechial rash with lesions in large folds. A review of the available literature in relation to unusual Parvovirus exanthem is performed and the case is described as Baboon - like syndrome, a cutaneous manifestation of this viral infection.

Infección por parvovirus humano B19 en pacientes con enfermedad de células falciformes: a propósito de dos hermanos / Human parvovirus B19 infection in sickle cell disease patients: a two siblings report

Resumen La infección por parvovirus humano B19 es una de las complicaciones comunes en pacientes diagnosticados de enfermedad de células falciformes (ECF). Se caracteriza por una anemia grave con reticulocitopenia, pudiendo estar acompañada de otras manifestaciones clínicas. En ocasiones, la infección puede ocurrir de modo simultáneo en contactos intrafamiliares de un paciente también con ECF. Es fundamental el reconocimiento temprano de esta complicación y el diagnóstico diferencial con otras patologías para su correcto manejo y tratamiento. Presentamos el caso de dos hermanos con ECF e infección por parvovirus humano B19.

Abstract Human parvovirus B19 infection is one of the common complications of patients diagnosed with Sickle cell disease (SCD). Parvovirus infections are characterized by a severe anemia with reticulocytopenia, sometimes presenting with other clinical manifestations. The infection can occur simultaneously in patient's cohabitants also diagnosed with SCD. Early recognition and differential diagnosis are essential for a proper disease management and treatment. We present two siblings with SCD and human parvovirus B19 infection.

Human parvovirus B19 infection-associated anemia after liver transplantation: three case reports with a literature review / 中华器官移植杂志

Objective:To explore the diagnosis and treatment of pure red cell aplastic anemia (PRCA) caused by parvovirus B19 (HPV-B19)infection after liver transplantation (LT).Methods:Three adult PRCA patients caused by parvovirus B19 infection after LT were reviewed retrospectively.The relevant literatures were collected to sort out the detection methods and treatment of parvovirus B19 infection after LT.Results:All three patients received liver transplantation due to end-stage liver disease with massive intraoperative blood transfusion and smooth postoperative recovery.Severe anemia occurred at 1-2 Months after discharge.Hemorrhagic anemia was excluded after re-admission and PRCA was diagnosed by bone marrow aspiration and next generation sequencing (NGS). After tapering the intensity of immunosuppressive therapy, intravenous immunoglobulin (IVIG) was administered for 7-10 days and hemoglobin soon normalized.A review of 15 recent literatures on HPV-B19 infection after LT revealed that the diagnosis and treatment of parvovirus B19 infection after LT gradually were became same.Conclusions:HPV-B19 infection causes PRCA after LT in adults.Diagnosing with NGS, intravenous injection of immunoglobulin and modification of immunosuppressant regimen may achieve excellent therapeutic efficacies.

Mechanism of intravenous immunoglobulin and its application in renal transplantation / 器官移植

Intravenous immunoglobulin (IVIG) is an immunoglobulin (Ig) isolated from the plasma of healthy human, and its main component is IgG. The mechanism of IVIG is complex, which may play a role via multiple pathways. For example, the combination of Fc fragment of IgG with various Fc gamma receptor (FcγR) regulates inflammatory response and autoantibody metabolism, and Fab fragment of IgG neutralizes multiple antigens and other molecules. IVIG may also inhibit complement activation and affect the balance of anti-inflammation and proinflammation among immune cells. In the treatment of diseases, IVIG constantly plays a role through multiple mechanisms simultaneously, primarily via one certain mechanism in different diseases. IVIG is commonly applied in the desensitization treatment of sensitized patients, ABO incompatible renal transplantation, antibody-mediated rejection and several infectious diseases. In this article, the mechanism of IVIG and its application in renal transplantation were reviewed.

Hiperplasia eritroblástica secundaria a infección aguda por parvovirus B19

Resumen La infección aguda por parvovirus B19 es una enfermedad autolimitada en pacientes sin trastornos inmunitarios. Sin embargo, en pacientes con discrasias sanguíneas pueden manifestarse con una crisis aplásica. Presentamos el caso de un varón de 48 años, con una esferocitosis hereditaria no diagnosticada previamente, la cual debutó con una crisis aplásica inducida por una infección aguda de parvovirus B19. La sospecha clínica se planteó luego del análisis histopatológico de la médula ósea, en el que se observó una hiperplasia eritroblástica, con precursores eritroides gigantes e inclusiones nucleares virales, y cuyo análisis inmunohistoquímico fue positivo para la proteína de la cápside viral VP1 y VP2 de parvovirus B19 en células infectadas. Se confirmó la sospecha diagnóstica con la detección de anticuerpos IgM de parvovirus B19. De acuerdo a nuestra revisión, este es el primer reporte de un adulto en Latinoamérica que debutó con una crisis aplásica inducida por una infección aguda por parvovirus B19, como primera manifestación de una esferocitosis hereditaria.

Abstract Acute parvovirus B19 infection is a self-limiting disease in patients with normal immune response. However, in patients with blood dyscrasias, it is possible to present with an aplastic crisis. We present the case of a 48-year-old man who had developed an aplastic crisis as a result of an acute parvovirus B19 infection with an undiagnosed hereditary spherocytosis. Suspicions of the parvovirus infection began to arise after a routine bone marrow histopathological analysis which showed erythroblastic hyperplasia with giant erythroid precursor and viral inclusions. A subsequent immunohistochemical analysis tested positive for VP1 and VP2 capsid proteins of parvovirus B19 in infected cells. The diagnostic suspicion was later confirmed with the presence of anti-parvovirus B19 IgM. According to our review, this is the first published case in Latin America that documents an adult patient with normal immune response whose first symptom of hereditary spherocytosis was an aplastic crisis induced by an acute parvovirus B19 infection.

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.

Viral metagenomics performed in patients with acute febrile syndrome during Toxoplasma gondii outbreak in south Brazil

ABSTRACT Toxoplasmosis is a zoonotic infection caused by the protozoan parasite Toxoplasma gondii. The infection is widely disseminated in the human population and is usually benign or asymptomatic. Systemic T. gondii infection presents risks for pregnant women and AIDS patients. Although rare, T. gondii can cause outbreaks in urban centers. The origin of these outbreaks is not completely understood but probably results from introduction of zoonotic T. gondii strains in the population. During such outbreaks other pathogens which mimic T. gondii acute febrile syndrome may also circulate; therefore, detailed investigation of the outbreak is of extreme importance. In this study we performed viral metagenomics next-generation sequencing (mNGS) in patient samples obtained during T. gondii outbreak in Santa Maria city, South Brazil. Specific bioinformatics pipelines specialized in virus discovery were applied in order to identify co-circulating vial agents. Epstein Barr virus and Parvovirus B19 contigs were assembled and these viruses can cause symptoms similar to toxoplasmosis. In conclusion, our findings show the importance of Metagenomics next generation sequencing (mNGS) use to help characterize the outbreak more completely and in the management of the affected patients.

Parvovirus B19: un nuevo patógeno emergente en pacientes con SIDA. Presentación de 3 casos / PARVOVIRUS B19: HUMAN PARVOVIRUS B19: A NEW EMERGING DISEASE IN PATIENTS WITH AIDS. REPORT OF THREE PATIENTS

El Parvovirus humano B19 puede presentarse con una amplia variedad de manifestaciones clínicas, con distinto compromiso y evolución según el huésped afectado. En pacientes inmunocomprometidos se asocia con cuadros hematológicos prolongados y graves. Se describen 3 casos de pacientes con antecedentes de infección por virus de la inmunodeficiencia humana (VIH) que desarrollaron infecciones agudas por Parvovirus B19 que se presentaron con síndrome febril, citopenias (anemia, plaquetopenia y disminución de reticulocitos) y esplenomegalia. En todos los casos el diagnóstico se confirmó por la serología específica. Todos recibieron tratamiento con inmunoglobulina humana (Ig) intravenosa (IV); 2 pacientes tuvieron buena respuesta clínica y mejoría de citopenias mientras que el restante falleció. La infección por Parvovirus B19 debe incluirse en el diagnóstico diferencial de los pacientes VIH positivos con fiebre y citopenias, principalmente anemia persistente y compromiso linfoganglionar con esplenomegalia

Human Parvovirus B 19 is presented as a variety of diseases with different compromise and evolution according to the affected host. In immunocompromised patients the acute infection due to Parvovirus B19 is associated with severe and prolonged hematological clinical pictures. Three cases of patients with a history of infection with human immunodeficiency virus (HIV) co-infected with Human Parvovirus B19 are presented. All of they presented with febrile syndrome, cytopenias (anemia, platelet count and reticulocyte reduction) and lymphadenopathy and splenomegaly. In all cases the diagnosis was confirmed by serology. All were treated with intravenous human immunoglobulin (IVI G; 2 patients had good clinical response and better cytopenias while the other died. We consider thinking about Parvovirus B19 infection in HIV immunocompromised hosts with haematological involvement, mainly persistent anemia and lymph node involvement with splenomegaly

Advances in molecular biology research on human parvovirus B19 / 生物工程学报

Human parvovirus B19 (B19 virus) is one of the two parvoviruses that cause human diseases. As an important pathogen to humans, it causes infectious erythema in children, acute aplastic anemia, fetal edema and death. In this review, we focus on the recent advances in the molecular virology of B19V, such as viral genotypes, viral receptor, genomic features and viral replication, viral transcription and post-transcription regulation, viral nonstructural and structural protein features and functions, viral diagnosis and antiviral agents, to provide reference for further study of B19 pathogenesis mechanisms, treatment and diagnostic strategies.

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.