SELECTED PARVOVIRUS B19 MEDICAL ABSTRACTS
Rheumatol Int. 2007 Jun;27(8):747-51. Epub 2007 Mar 31. Outcome of patients with arthritis and parvovirus B19 DNA in synovial membranes. Schmid S, Bossart W, Michel BA, Brühlmann P. Department of Rheumatology and Physical Medicine, University Hospital of Zurich, Gloria-strasse 25, 8091 Zurich, Switzerland.
To investigate the follow-up of the 17 patients during the period of 1995-2001 of the outpatient Clinic for Rheumatology at the University Hospital of Zurich with arthritis and the presence of parvovirus B19 DNA demonstrated by PCR in synovial biopsies. Seventeen patients of 163 with arthritis, which were routinely examined by needle arthroscopy during 1995-2001 with a positive parvovirus B19 DNA by PCR of synovial biopsy were reevaluated.
Investigations included medical history, clinical examination and blood tests. Joint fluid was taken on patients with joint effusion. The observation period of the 17 patients (F:M = 11:6) was 2-8 years (Ø = 6.5 years). In 8 of 17 patients the arthritis could not be classified neither at entry nor during the follow up of the study.
The arthritis could be diagnosed in six patients early in the onset of the disease and included three cases of lyme arthritis of the knee joint, two cases with arthritis following a gastrointestinal infection (one with Salmonella typhimurium--positive faecal test--and the other one with a culture negative agent), one patient probably had an infection-associated arthritis after a gastrointestinal infection with Entamöeba histolytica (Schirmer et al. in Rheumatol Int 18:37-38, 1998; Kasliwal in Am J Proctol Gastroenterol Colon Rectal Surg 32:12, 16, 28, 1981; Haslock and Wright in J R Coll Phys Lond 8:1554-162, 1974; Than-Saw et al. in Trop Geogr Med 44:355-358, 1992) with remission after antibiotic therapy.
After a disease course of 9 months one patient could be classified as rheumatoid arthritis in the presence of anti-cyclic citrullinated antibodies but lack of rheumatoid factor. One patient with polyarthritis developed psoriasis of the skin 22 months later. From the nine patients with unclassified arthritis 4 (45%) got into complete remission with no symptoms or signs of joint inflammation after a disease course of 9-45 months, whereas 5 (55%) still demonstrate active non erosive arthritis (disease duration between 3 and 10 years).
The presence of parvovirus B19 DNA in synovial tissue of patients with joint inflammation does not allow the diagnosis of parvovirus induced arthritis. If the arthritis remains unclassified and without erosions over time a virus associated aetiology may be assumed. However, no definitive diagnosis is possible even in the presence of parvovirus B19 DNA in synovial tissue.
J Clin Virol. 2008 Oct;43(2):226-9. Epub 2008 Persistent parvovirus B19 infection and arthralgia in a patient mistakenly treated for Lyme disease. Dobec M, Kaeppeli F, Cassinotti P, Satz N. Medica, medizinische Laboratorien Dr. F. Kaeppeli, Wolfbachstrasse 17, CH-8024 Zurich, Switzerland.
We report a case of a 37-year-old woman with persistent parvovirus B19 infection and arthralgia mistakenly treated for Lyme disease. This case indicates that poor standardization of both screening and confirmatory assays for Lyme disease can lead to an incorrect diagnosis of Lyme disease. Before making a final diagnosis of Lyme arthritis in an endemic region, other causative agents of arthritis, such as parvovirus B19, should be excluded to avoid unnecessary treatment or to add appropriate therapy in the case of co-infections. Since parvovirus B19 is often associated with arthralgia and can mimic rheumatoid arthritis and autoimmune diseases, it should be included in the differential diagnosis of arthralgia. PMID: 18653379 [PubMed - in process]
J Gen Intern Med. 2007 Jun;22(6):877-8. Epub 2007 Mar 24. Secondary symptomatic parvovirus B19 infection in a healthy adult. Kaufmann J, Buccola JM, Stead W, Rowley C, Wong M, Bates CK. Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, E/CC-6, 330 Brookline Avenue, Boston, MA 02215, USA.
Parvovirus B19 is a common infection in adults and children. There are reports of secondary parvovirus infection in immunocompromised persons, but no reports of symptomatic secondary infection in healthy persons. We describe a healthy 39-year-old woman who presented with fever, rash, and arthralgia. Her symptoms were thought most compatible with parvovirus B19 infection, but she reported prior positive parvovirus antibody 2 years earlier during prenatal care. Tests were therefore also sent for HIV, streptococcal infection, hepatitis C, and Lyme disease. Testing revealed both elevated IgG and IgM antibodies for parvovirus B19; previously, the patient was positive only for IgG. On a subsequent visit she related that a community outbreak of parvovirus developed in her town and church group. We believe this case demonstrates that a symptomatic secondary infection with parvovirus can occur in healthy persons, and that prior positive antibody test does not preclude the development of acute infection. PMID: 17384979 [PubMed - indexed for MEDLINE]
Dermatology. 2008;216(4):341-6. Epub 2008 Feb 15. Chronic fatigue syndrome after human parvovirus B19 infection without persistent viremia. Seishima M, Mizutani Y, Shibuya Y, Arakawa C. Department of Dermatology, Ogaki Municipal Hospital, Ogaki City, Japan. marikoseishima@yahoo.co.jp
BACKGROUND: It is unclear how often chronic fatigue syndrome (CFS) appears after human parvovirus B19 (B19) infection and whether prolonged B19 viremia or some other factors cause CFS. OBJECTIVES: To determine how often CFS appears after B19 infection and whether prolonged B19 DNA presence, antibody production and persistently reduced complement levels occur in CFS patients after B19 infection. METHODS: Clinical findings were examined in 210 patients after B19 infection, and CH50, C3 and C4 levels were determined. B19 DNA and antibodies to B19 were also tested in 38 patients' sera including 3 with CFS. RESULTS: Serum B19 DNA disappeared after 4-5 months in all 18 patients tested. There are no differences in B19 DNA-positive period between patients with and without persistent symptoms. IgM antibody titers to B19 became reduced after 2 months in all 38 patients. Complement levels persistently decreased in a greater proportion of patients with persistent symptoms.
CONCLUSIONS: The present study suggests that we should consider the possibility of CFS after B19 infection and that CFS may be derived from several aspects other than prolonged B19 DNA presence in sera. PMID: 18277075 [PubMed - indexed for MEDLINE]
Possible transmission of parvovirus B19 from intravenous immune globulin Dean D. Erdman 1 *, Barbara C. Anderson 1, Thomas J. Török 1, Terri H. Finkel 2, Larry J. Anderson 1 J. Med. Virol. 53:233-236, 1997. Published 1997 Wiley-Liss, Inc.
Abstract- To look for genetic changes in human parvovirus B19 that might be associated with chronic infection, we sequenced B19 DNA obtained from serum specimens collected over an approximately 1-year period from a patient with systemic vasculitis. A comparison of the nucleotide sequences of the VP1/VP2 gene from four specimens revealed an abrupt change in the B19 genotype that coincided with initiation of intravenous immune globulin (IVIG) therapy. We suspect that one or more of the lots of IVIG administered to the patient were contaminated with B19. If true, this finding suggests that investigators must be careful in linking B19 infection to disease based on detection of B19 DNA in persons who have received multiple unit blood products.
J Med Virol. 2008 Nov;80(11):2005-11. Tissue persistence of parvovirus B19 genotypes in asymptomatic persons. Corcioli F, Zakrzewska K, Rinieri A, Fanci R, Innocenti M, Civinini R, De Giorgi V, Di Lollo S, Azzi A. Department of Public Health, University of Firenze, Italy.
Parvovirus B19 (B19V) can persist in immunocompetent symptomatic and non-symptomatic individuals, as demonstrated by the finding of viral DNA in different tissues, in absence of viremia and of anti-B19V IgM. The spread and the nature of this phenomenon have not been clearly determined. In order to investigate the frequency of persistence and the tissue distribution of the three genotypes of B19V, the viral load of the persistent virus and its expression in the affected tissues, 139 tissue samples and 102 sera from 139 asymptomatic individuals have been analyzed by consensus PCRs and genotype specific PCRs for B19V detection and genotyping. Viral load was measured by real time PCR and viral mRNAs were detected by RT-PCR. Altogether, 51% individuals carried B19V DNA, more frequently in solid tissues (65%) than in bone marrow (20%). Genotype 1 was found in 28% tissue samples, genotype 2 in 68% and genotype 3 in 3% only. Viral load ranged from less then 10 copies to 7 x 10(4) copies per 10(6) cells, with the exception of two samples of myocardium with about 10(6) copies per 10(6) cells. mRNA of capsid proteins was present in two bone marrow samples only.
In conclusion, in asymptomatic individuals B19V persistence is more common in solid tissues than in bone marrow, and genotype 2 persists more frequently than genotype 1. The results suggest that the virus persists without replicating, at sub-immunogenic levels. PMID: 18814251 [PubMed - in process]
Indian J Med Res. 2000 Nov;112:149-64. Erythrovirus B19 infection in humans. Kishore J, Kapoor A.
Department of Microbiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow.
Erythrovirus B19 (B19) previously called parvovirus B19 is the only human pathogen in the family Parvoviridae. B19 is an autonomously replicating small single stranded non-enveloped DNA of 5.5 Kb with hairpin termini through which it replicates, when the cells are in the S-phase. Virus host interactions are mediated through the capsid protein VP2 attaching to P antigen receptor expressed on certain host cells, which imparts narrow host and tissue tropism. It affects the progenitor red cells, megakaryoblast, endothelial cells and a few organs like the kidney and the heart. VP1 antibodies are neutralizing, non-structural protein NS-1 exert cell cytotoxicity while NS-2 regulates replication. The virus is present world-wide. Most infections are asymptomatic but individuals with red cell defect, immune system defects or immunosuppression manifest disease, which may be persistent. In the immunocompetent host it causes erythema infectiosum in children, arthralgia or chronic polyarthritis especially in females, nonimmune hydrops foetalis, several haematological disorders and recently fulminant hepatitis in children. The virus is transmitted through the upper respiratory tract by droplets, transfusion of blood or its components (factor VIII) and transplacentally. The incubation period is 6-11 days after intranasal inoculation, in human volunteers. Detection of IgM antibodies is most important in serological diagnosis. Viral DNA can be detected by polymerase chain reaction (PCR) or hybridization procedures in patients sera or infected tissues. Intravenous immunoglobulin can be used in the treatment as well as in prophylaxis. In view of its increasing association with a wide variety of clinical diseases, a closer look in its biology, host virus interactions and evaluation of VP1 and VP2 recombinant proteins as B19 vaccines are areas which need the urgent attention of parvovirologists, epidemiologists and clinicians.
PMID: 12452123 [PubMed - indexed for MEDLINE]
J Med Virol. 2002 Feb;66(2):246-52. Baculovirus expression of erythrovirus V9 capsids and screening by ELISA: serologic cross-reactivity with erythrovirus B19. Heegaard ED, Qvortrup K, Christensen J. Department of Clinical Microbiology, University State Hospital, Rigshospitalet, Denmark. e.heegaard@immi.ku.dk Diagnosis of erythrovirus B19 (B19) relies on serology and the detection of viral DNA.
Recently, a distinct erythrovirus isolate termed V9, markedly different from erythrovirus B19 (> 11% nucleotide disparity), was isolated. Standard B19 PCR assays were inconclusive and serologic tests failed to categorize V9 as an acute B19-like infection. Sequencing, combined with PCR studies, have since demonstrated the need for specific and differentiated techniques when examining samples for possible B19 or V9 viremia. The antigenic properties of the V9 capsid proteins have not been characterized previously. To address this question, V9 VP1 and VP2 open reading frames were cloned and expressed in insect cells using a baculovirus vector. Large quantities of purified recombinant V9 capsid protein were produced and electron micrographs revealed self-assembly of V9 VP1/VP2 and VP2 capsids into empty icosahedral erythrovirus-like particles with a diameter of approximately 23 nm.
Screening of a panel of 270 clinical samples for the presence of V9 IgM and IgG antibodies in ELISA showed 100% serologic cross-reactivity between B19 and V9 when comparing V9 VP2 capsids to a commercial B19 VP2 assay. This suggests that both a V9 and a B19 antibody response may be diagnosed equally well by ELISA using either V9 or B19 recombinant capsids as antigen source. Retrospectively, translation of the V9 sequence indicates that despite a significant genetic variation on the DNA level, the majority of the discrepant DNA sequence represents silent mutations leading to an amino acid sequence very similar to the known B19 strains (96-97% homology). PMID: 11782935 [PubMed - indexed for MEDLINE]
J.Clin Rheumatol 2001 Oct;7(5):350-3; discussion 353. Coexistent Lyme disease and parvovirus infection in a child. Fisher JR, Ostrov BE. Penn State University College of Medicine, Rheumatology and Pediatric Rheumatology, Hershey, PA 17033, USA.
Infectious diseases commonly cause illnesses that mimic rheumatic diseases. Both Lyme disease and Parvovirus B19 infections produce arthritis, rashes, and a systemic illness that may be thought to represent a chronic rheumatic disease. In the case presented, a child with both infections simultaneously exhibited arthralgias, aseptic meningitis, and a facial rash. The features of Lyme disease and Parvovirus B19 infection that may mimic systemic lupus erythematosus include a facial rash, often in a malar distribution, hematologic abnormalities, arthritis, neurologic disorders, and autoantibody positivity. Given the proper season and geographical location, one must consider the possibility of co-infection with these two organisms, especially in those with atypical rheumatic complaints. PMID: 17039169 [PubMed]
Potentially misleading Western blot results in Lyme disease diagnosis Br J Biomed Sci 2006; 63(3); 142 A W L JOSS†, D HO-YEN*, K APPLEYARD‡, R EVANS*, S MAVIN* *Scottish Toxoplasma Reference Laboratory, Raigmore Hospital, Highland Acute Hospitals Trust, Inverness †Microbiology Department, Raigmore Hospital, Old Perth Road, Inverness IV2 3UJ ‡Virology/Serology Section, Medical Microbiology, Ninewells Hospital, Dundee DD1 9SY, UK
The laboratory diagnosis of Lyme disease is complex1 and serology remains the technique of choice. Recommended practice is a two-step process involving a sensitive screening enzyme immunoassay (EIA) followed by a more specific confirmatory Western blot for all EIA-positive and equivocal samples and for EIA-negative samples with a high clinical suspicion of Lyme disease (e.g., tick bite and erythema migrans).1,2 However, Western blot results require careful interpretation. The National Lyme Disease Testing Service Laboratory, Raigmore Hospital, Inverness, tests over 3000 samples annually from across Scotland, many of which are from complex clinical cases. It was noted recently that serum from a patient with confirmed parvovirus B19 infection crossreacted with the in-house Borrelia burgdorferi IgG Western blot. This could lead to the wrong interpretation of Western blot results. This study aims to discover if other viral infections produce similar results with the B. burgdorferi IgG Western blot. [Contd]
Chronic Fatigue Syndrome and Arthralgia Following Parvovirus B19 Infection JONATHAN R. KERR, JANICE BRACEWELL, IAN LAING, DEREK L. MATTEY, ROBERTM. BERNSTEIN, IAN N. BRUCE, and DAVID A.J. TYRRELL
ABSTRACT. Objective. To determine the incidence of arthralgia and fatigue complicating B19 infection, along with associated B19 markers and autoantibodies. Methods. We studied patients with acute B19 infection (n = 51), patients followed from the time of acute B19 infection (mean 22.5 mo) (n = 39), and healthy controls (n = 50). Clinical details were collected using a questionnaire and blood was tested for B19 markers and autoantibodies.
Results. Acute B19 arthralgia occurred in 31 patients and was associated with female sex (p = 0.007) and age > 20 years (p = 0.02). Acute B19 fatigue occurred in 8 patients and was not significantly associated with any marker. At followup, symptoms consisted of arthralgia (n = 5), arthralgia and fatigue(n = 6), fatigue (n = 7), lymphadenopathy (n = 1), and purpura due to thrombocytopenia (n = 2). Chronic B19 arthralgia was associated with persistent B19 viremia (p = 0.029). Comparison of the B19 followup group with the controls revealed a significantly increased prevalence of arthralgia (p = 0.0002), fatigue (p < 0.0001), and all other markers. Chronic B19 arthralgia was associated with both acute B19 arthralgia (p = 0.0168) and positive ANAat acute infection (p = 0.0043).
Chronic B19 fatigue was associated with acute B19 fatigue (p = 0.011). Five patients fulfilled the Centers for Disease Control criteria for a diagnosis of chronic fatigue syndrome (CFS) and one of these was negative for serum anti-B19 IgG at followup by both Western blot and immunofluorescence. However, there was no characteristic pattern of B19 markers/autoantibodies in patients with B19 associated chronic fatigue.
Conclusion. CFS may follow acute parvovirus B19 infection; however, attribution of a case of CFS to B19 infection may be extremely difficult in the absence of serological confirmation of acute infection at fatigue onset. (J Rheumatol 2002;29:595–602)
Parvovirus B19 infection as the cause of muscle twitching. http://tinyurl.com/69t9ck
Parvovirus B19 infection as the cause of paresthesia (numbness and tingling). The study showed that 50% of the patients with serologically confirmed Parvovirus B19 infection experienced neurological symptoms such as tingling and numbness in fingers and toes; and mild slowing of nerve conduction velocities. http://www.ncbi.nlm.nih.gov/pubmed/2153742
The Parvovirus B19 patients in the study below complained with dizziness. After they were treated with IVIG their symptoms improved significantly. http://tinyurl.com/5qjmol
The neurological manifestations caused by Parvovirus B19 are just beginning to be recognized. http://www.ncbi.nlm.nih.gov/pubmed/12740833
MISDIAGNOSIS OF PARVOVIRUS B19 INFECTION AS LYME DISEASE : A SERIES OF PATIENTS WITH FALSELY POSITIVE LYME SEROLOGY http://cat.inist.fr/?aModele=afficheN&cpsidt=10044373
According to this article- there is a gender difference when it comes to how severely a person's symptoms will be when infected with Parvovirus B19. Parvovirus B19 may cause more severe symptoms in females than it does in males.