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parvovirus B19
parvovirus B19, human
Pathology:
1) arthritis
- virus may be present in synovial tissue cells by PCR
2) hypoplastic anemia & pancytopenia may occur in adults
a) infects erythrocyte precursors (giant, abnormal proerythroblasts)
b) transient aplasia, reversing spontaneously in a week or two
c) generally becomes apparent only in individuals with underlying chronic hemolytic anemia (sickle cell anemia), dependent upon increased erythrocyte production
3) erythema infectiousum in children
4) hydrops fetalis
5) generally does not harm fetus
- can cause fetal anemia, cardiac failure, hydrops fetalis
- risk greatest 9-20 weeks of gestation & 2-4 weeks after maternal infection [10]
Clinical manifestations:
- nonspecific, flulike symptoms may precede rash
- fever, myalgia, headache
- facial rash
- erythematous malar rash (slapped-cheek rash, erythema infectiousum)
- facial rash often followed by a generalized reticular or maculopapular rash
- faint maculopapular rash on chest & arms
- case with no facial rash [10]
- systemic symptoms have usually resolved with appearance of generalized maculpapular rash [6,8,9]
- rheumatoid arthritis-like syndrome in adults
a) acute symmetric inflammatory polyarthritis
b) rash may be absent in adults
c) hands, wrists & knees most commonly affected
- small joints of the hands most often affected
- MCP joints affected
d) median duration is 10 days; however a few cases may last for years
Laboratory:
- parvovirus B19 IgM
- test in pregnant woman 2-4 weeks after maternal infection [10]
- PCR/RT-PCR for parvovirus B19
- parvovirus B19 DNA
- parvovirus B19 RNA
- see ARUP consult [3]
Complications:
- pure red cell aplasia
- direct antiglobulin test (DAT) would rule out pure red cell aplasia (even in patients with CLL known for positive DAT in some patients) [7]
Differential diagnosis:
- disseminated gonorrhea
- no flu-like syndrome of headache, fever, myalgia preceding rash
- symptoms of fever, chills & malaise may precede migratory arthritis & rash by a week or two
- asymmetric arthritis, oligoarthritis or monoarthritis favors gonorrhea
- a positive history of sexual activity increases likelihood of gonorrhea
- purulent conjunctivitis not a feature of parvovirus B19
- migratory arthritis not a feature of parvovirus B19
Management:
- NSAID for symptomatic treatment
- intravenous immunoglobulin
General
parvovirus
Properties
KINGDOM: virus
GENOME-TYPE: deoxyribonucleic acid (DNA)
SINGLE-STRANDED
GENOME-SIZE: 5 kB
ENVELOPE: NONE
CAPSID-SYMMETRY: ICOSAHEDRAL
References
- Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed)
Lippincott-Raven, Philadelphia, 1998, pg 455
- Medical Knowledge Self Assessment Program (MKSAP) 11,16,17,18.
American College of Physicians, Philadelphia 1998,2012,2015,2018,
- ARUP Consult: Parvovirus B19
The Physician's Guide to Laboratory Test Selection & Interpretation
https://www.arupconsult.com/content/parvovirus-b19
- Servey JT, Reamy BV, Hodge J.
Clinical presentations of parvovirus B19 infection.
Am Fam Physician. 2007 Feb 1;75(3):373-6.
PMID: 17304869
- Young NS, Brown KE.
Parvovirus B19.
N Engl J Med. 2004 Feb 5;350(6):586-97.
PMID: 14762186
- NEJM Knowledge+ May 12, 2015
- Geriatric Review Syllabus, 11th edition (GRS11)
Harper GM, Lyons WL, Potter JF (eds)
American Geriatrics Society, 2022
- Page C, Francois C, Goeb V, Duverlie G.
Human parvovirus B19 and autoimmune diseases. Review of the literature
and pathophysiological hypotheses.
J Clin Virol. 2015 Nov;72:69-74.
PMID: 26433772 Review.
- Soderlund-Venermo M
Emerging Human Parvoviruses: The Rocky Road to Fame.
Annu Rev Virol. 2019 Sep 29;6(1):71-91.
PMID: 31283445
- NEJM Knowledge+