Neurological aspects of human parvovirus B19 infection: a systematic review.

Parvovirus B19 has been linked with various clinical syndromes including neurological manifestations. However, its role in the latter remains not completely understood. Although the last 10 years witnessed a surge of case reports on B19-associated neurological aspects, the literature data remains scattered and heterogeneous, and epidemiological information on the incidence of B19-associated neurological aspects cannot be accurately extrapolated. The aim of this review is to identify the characteristics of cases of B19-associated neurological manifestations. A computerized systematic review of existing literature concerning cases of B19-related neurological aspects revealed 89 articles describing 129 patients; 79 (61.2%) were associated with CNS manifestations, 41 (31.8%) were associated with peripheral nervous system manifestations, and 9 (7.0%) were linked with myalgic encephalomyelitis. The majority of the cases (50/129) had encephalitis. Clinical characteristic features of these cases were analyzed, and possible pathological mechanisms were also described. In conclusion, B19 should be included in differential diagnosis of encephalitic syndromes of unknown etiology in all age groups. Diagnosis should rely on investigation of anti-B19 IgM antibodies and detection of B19 DNA in serum or CSF. Treatment of severe cases might benefit from a combined regime of intravenous immunoglobulins and steroids. To confirm these outcomes, goal-targeted studies are recommended to exactly identify epidemiological scenarios and explore potential pathogenic mechanisms of these complications. Performing retrospective and prospective and multicenter studies concerning B19 and neurological aspects in general, and B19 and encephalitic syndromes in particular, are required.

Prevalence of herpes simplex types 1 and 2, varicella zoster virus, cytomegalovirus, immunoglobulin G antibodies among female university students in Syria.

OBJECTIVE: To examine the current seroepidemiology of immunoglobulin (Ig)G for herpes simplex virus types 1 and 2 (HSV 1-2), varicella zoster virus (VZV), and cytomegalovirus (CMV) among university females of childbearing age in Syria. METHODS: A cross-sectional study was conducted to examine the female students of the Pharmacy College, Kalamoon University, Deratiah, Syria, where 316 sera were collected from October 2009 to November 2010, and subjected to HSV 1-2, VZV, and CMV IgG screening and titration using enzyme-linked immunosorbent assay-based techniques in the Microbiology Laboratory. RESULTS: A total of 164 participants were positive for HSV 1-2 IgG giving a prevalence of 52%, leaving a relatively high proportion of susceptibility among the tested group. For VZV, 91% of the participants (n=287) were positive for its specific IgG, while, regarding CMV, 74.5% (n=235) were positive, and 25.5% were negative for CMV specific IgG. CONCLUSION: Although most participants were seropositive for herpes viruses IgG, suggesting a natural virus circulation within the community, screening for protective immunity is suggested against HSV, since a relatively high proportion of tested females are still susceptible. In addition, and because of its nasty outcomes during pregnancy, IgG against CMV should also be tested. High percentage of positivity towards VZV could be explained due to introduction of the new vaccine program, and therefore, further analysis during pregnancy is not recommended.

A longitudinal investigation of depressive symptoms in undergraduate students of pharmacy in Syria.

This prospective longitudinal study investigated depressive symptoms and its association with students' demographic, academic, and health factors in undergraduate students of pharmacy in Syria. Students attending any year (1st to 5th year) were assessed in the first semester (time 1) and in the second semester (time 2). An academic year comprises two semesters of 16 weeks each. Data for 450 students were analyzed at time 1, and 262 students were assessed at the two time points. Our results showed that most of the students experienced depressive symptoms, with a substantial percentage presenting moderate to severe levels of symptoms (35% or 450 students at time 1; 23% or 262 students at time 2). Across the two semesters, a significant decrease in depressive symptoms was observed for students with complete data at the two time points. Depressive symptoms at time 2 increased significantly with increasing depressive scores at time 1 and decreasing students' expectations about their academic performance. Our results support the clear need for dynamic, full-time, and accessible psychological services at the university to promote and assess mental health and to deliver psychological interventions to students at need.

Prevalence of rubella IgG antibodies among Syrian females of childbearing age.

OBJECTIVE: To examine the current sero-epidemiology of rubella IgG among Syrian females of childbearing age that missed rubella vaccination. METHODS: A cross-sectional study examined healthy female students of the Pharmacy College, Kalamoon University, Deratiah, Syria. Ninety sera were collected between March and May 2008, and were subject to rubella specific IgG screening and titration using an enzyme-linked immunosorbent assay-based technique provided by Diamed Eurogen in the Microbiology Laboratory, Faculty of Pharmacy. RESULTS: The quantitative analysis for rubella IgG showed a noticeable variability in the values of antibodies that ranged between 0-363 IU/ml. A total of 77 participants were positive for rubella IgG giving a prevalence of 85.6%, and leaving a relatively high proportion of susceptibility (14.4%) among the tested group. CONCLUSION: Although most women tested were seropositive for rubella IgG, suggesting a natural virus circulation within the community, screening for protective immunity followed by vaccination to those who missed the regular vaccine program should be enforced to prevent possible rubella congenital syndrome. In addition, adding a second shot of rubella vaccine to those who were subject to the national program of vaccination is a must since the concentration of antibodies may drop below the recommended levels necessary for protection.

Neurological manifestations of human parvovirus B19 infection.

Since its discovery, human parvovirus B19 has been linked with a broad spectrum of clinical syndromes. An aetiological role for the virus has been confirmed in erythema infectiosum, transient aplastic crisis, persistent infection manifesting as pure red cell aplasia in immunocompromised persons, non-immune hydrops fetalis and arthritis. Less commonly recognised, but receiving increasing attention recently, are the neurological manifestations, a variety of which have been described in patients with either clinically diagnosed or laboratory confirmed B19 infection. The purpose of this review is to summarise present knowledge of B19, its known and potential pathogenic mechanisms and its association with human diseases, particularly those with neurological manifestations. The outcome of the review supports an aetiological role of the virus in neurological disease. However, the pathogenesis remains unknown and elucidating this is a priority.

Circulating tumour necrosis factor-alpha and interferon-gamma are detectable during acute and convalescent parvovirus B19 infection and are associated with prolonged and chronic fatigue.

To investigate whether cytokine responses may have a bearing on the symptoms and outcome of parvovirus B19 infection, circulating cytokines were measured during acute infection (n=51), follow-up of acute infection (n=39) and in normal healthy controls (n=50). At acute B19 virus infection (serum anti-B19 IgM-positive), patients ranged in age from 4 to 54 years, with a mean age of 28.2 years. The male:female ratio was 1:4.1 and symptoms were rash (n=15), arthralgia (n=31), fatigue (n=8), lymphadenopathy (n=4), foetal hydrops (n=3), transient aplastic crisis (n=2), neutropenia (n=2), myelodysplasia (n=1), thrombocytopenia (n=1) and pancytopenia (n=1). Of these patients, 39 were contacted after a follow-up period of 2-37 months (mean of 22.5 months). In comparison with normal controls, detectable IL-6 was associated with acute B19 virus infection (26%; P=0.0003), but not with follow-up (6%; P=0.16). Detection of interferon (IFN)-gamma was associated with acute B19 virus infection (67%; P<0.0001) and follow-up (67%; P<0.0001). Detection of tumour necrosis factor (TNF)-alpha was associated with acute B19 virus infection (49%; P<0.0001) and follow-up (56%; P<0.0001). IL-1beta was detected in acute infection (20%), but not at follow-up. At acute B19 virus infection, detection of serum/plasma IL-6 was associated with rheumatoid factor (P=0.038) and IFN-gamma (> or =7 pg/ml) was associated with fatigue in those patients of > or =15 years of age (P=0.022). At follow-up, fatigue was associated with IFN-gamma (> or =7 pg/ml) and/or TNF-alpha (> or =40 pg/ml) (P=0.0275). Prolonged upregulation of serum IFN-gamma and TNF-alpha appears to represent a consistent host response to symptomatic B19 virus infection.