ABSTRACT
We describe 2 cases of 6-year-old twin girls presenting with acute carpal tunnel syndrome (CTS) associated with human parvovirus B19 (HPV-B19) infection, as evidenced by serological data and detection of HPV-B19 DNA in blood with use of polymerase chain reaction (PCR). To our knowledge, this is the first time that HPV-B19 infection has been suggested as the causal agent of simultaneous acute bilateral CTS in twins, thus presenting the possibility that similar immunologic responses can be observed in twins during viral infections.
Subject(s)
Carpal Tunnel Syndrome/diagnosis , Carpal Tunnel Syndrome/drug therapy , Erythema Infectiosum/drug therapy , Parvovirus B19, Human , Acute Disease , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Carpal Tunnel Syndrome/virology , Child , Female , Humans , Naproxen/therapeutic use , Polymerase Chain Reaction , Twins , Vitamin B Complex/therapeutic useABSTRACT
OBJECTIVE: To explore the relationship between human immunodeficiency virus (HIV) infection and soft tissue rheumatic lesions in HIV-positive black Zambians. METHODS: We performed a prospective study of all patients over 18 years of age attending a rheumatic clinic in a teaching hospital. All patients underwent routine blood tests, and radiographs were performed when indicated. HIV status was determined by ELISA, and clinical staging was determined by World Health Organization criteria. Patients with isolated sacroiliac pain, enthesitis, or a soft tissue lesion were selected for analysis. For HIV-positive patients, only those in clinical stage 1 (asymptomatic or persistent generalized lymphadenopathy) were selected. RESULTS: Our study cohort comprised 120 patients (41 men, 79 women, age 23-70 yrs). Diagnosis and number (% HIV positive) were distributed as follows: sacroiliitis, 14 (100%); heel pain, 14 (100%); costochondritis, 3 (100%); polyenthesitis (> or = 4 sites), 20 (100%); carpal tunnel syndrome, 8 (63%); rotator cuff syndrome, 18 (30%); tendinitis, 8 (25%); sciatica/cervical spondylosis, 12 (16%); sacroiliac strain, 7 (0%); and de Quervain's tenosynovitis, 16 (0%). HIV seroprevalence was 54% overall, 74% in those under 45 years of age, and 17% in those over 45 years of age. Population prevalence of HIV in Lusaka is about 30% in the 30-40-year age range. Mean erythrocyte sedimentation rate (ESR) in 65 patients positive for HIV was 80 mm/h and in 55 patients negative for HIV, 18 mm/h. Within each subgroup the mean ESR was significantly higher in HIV-positive patients. CONCLUSION: A young age and a raised ESR are both good indications of HIV infection in Zambian patients with soft tissue lesions. Enthesitis is a distinct HIV-related phenomenon, either an early form or a forme fruste of HIV-related spondyloarthropathy.
Subject(s)
HIV Infections/epidemiology , Joint Diseases/epidemiology , Adult , Blood Sedimentation , Carpal Tunnel Syndrome/blood , Carpal Tunnel Syndrome/epidemiology , Carpal Tunnel Syndrome/virology , Cohort Studies , Comorbidity , Enzyme-Linked Immunosorbent Assay , Female , HIV Infections/blood , HIV Infections/complications , HIV Seroprevalence , HIV-1/immunology , HIV-1/isolation & purification , Hospitals, University , Humans , Joint Diseases/blood , Joint Diseases/virology , Male , Middle Aged , Outpatients , Prospective Studies , Seroepidemiologic Studies , Spondylarthropathies/blood , Spondylarthropathies/epidemiology , Spondylarthropathies/virology , Tendinopathy/blood , Tendinopathy/epidemiology , Tendinopathy/virology , Zambia/epidemiologyABSTRACT
Human parvovirus B19 has been described as a causative agent of erythema infectiosum (a disease common in children), aplastic crisis in patients with hemolytic disorders, and arthralgias and arthritis. Joint involvement may be a prominent clinical feature of parvovirus B19 infection and may last for several weeks. We describe three cases of acute bilateral carpal tunnel syndrome associated with parvovirus B19 infection as evidenced by serological data and, in one case, by detection of parvovirus B19 DNA in blood with use of PCR.
