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Alves AD, Melgaço JG, Cássia Nc Garcia RD, Raposo JV, de Paula VS, Araújo CC, Pinto MA, Amado LA. Persistence of Parvovirus B19 in liver from transplanted patients with acute liver failure. Future Microbiol 2021; 15:307-317. [PMID: 32286103 DOI: 10.2217/fmb-2019-0224] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Aim: In this study, we investigated the presence of B19V in liver tissues from patients with acute liver failure (ALF) and evaluated the viral activity in infected liver. Methods: Serum and liver samples from 30 patients who underwent liver transplantation for ALF were investigated for B19V infection by real-time PCR, serological tests and examination of B19V mRNA (transcript) expression in the liver. Results: The serum and liver samples from seven patients were B19V DNA positive (103-105 copies/ml). Most of them presented detectable anti-B19V IgG, indicating persistent infection. B19V mRNA was detected in all patients, demonstrating intra-hepatic replication. Conclusion: B19V infection of the liver during the course of non-A-E ALF suggested a role of B19V, which produced the worst outcome in co-infected patients and in patients with cryptogenic ALF, in liver damage.
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Affiliation(s)
- Arthur Dr Alves
- Laboratório de Desenvolvimento Tecnológico em Virologia, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil
| | - Juliana G Melgaço
- Laboratório de Desenvolvimento Tecnológico em Virologia, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil
| | - Rita de Cássia Nc Garcia
- Departamento de Microbiologia e Parasitologia, Instituto Biomédico, Universidade Federal Fluminense, Niterói, RJ, Brasil
| | - Jessica V Raposo
- Laboratório de Virologia Molecular, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil
| | - Vanessa S de Paula
- Laboratório de Virologia Molecular, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil
| | | | - Marcelo A Pinto
- Laboratório de Desenvolvimento Tecnológico em Virologia, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil
| | - Luciane A Amado
- Laboratório de Desenvolvimento Tecnológico em Virologia, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil
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2
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Cnc Garcia RD, Leon LA. Human parvovirus B19: a review of clinical and epidemiological aspects in Brazil. Future Microbiol 2021; 16:37-50. [PMID: 33438475 DOI: 10.2217/fmb-2020-0123] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Since the first evidence of human parvovirus B19 (B19V) infection in late 80s, several studies have been conducted to clarify the spectrum of clinical diseases in Brazil. B19V infection is prevalent in the general population and has exhibited a cyclical pattern of occurrence every 4-5 years, with the predominance of genotype 1 over 3b. During epidemic periods the wide range of clinical conditions, such as ertythema infectiosum, arthropathy, transient aplastic crisis, nonimmune hydrops fetalis and B19V-hepatitis were diagnosed. However, many infections are likely asymptomatic or have a self-limiting clinical course and are not readly diagnosed. Besides, the similarity of the symptoms of ertythema infectiosum to other rash diseases and the broadly circulation of arboviruses makes differential diagnosis more difficult. In this article, we provide a historical comprehensive overview of the research on parvovirus B19 conducted in Brazil, with a focus on the clinical and epidemiological aspects of the infection.
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Affiliation(s)
- Rita de Cnc Garcia
- Departamento de Microbiologia e Parasitologia, Instituto Biomédico, Universidade Federal Fluminense (UFF), Rua Professor Hernani Melo 101, Niterói, RJ 22430 190, Brazil
| | - Luciane Aa Leon
- Laboratório de Desenvolvimento Tecnológico em Virologia, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Avenida Brasil 4365, Manguinhos, RJ 21040 360, Brazil
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3
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Nameki S, Maeda Y, Shibahara T, Fukui J, Shimizu T, Bessho K, Fujiwara H. Refractory liver dysfunction was remarkably improved with chelating agents of Wilson's disease, in a patient with systemic lupus erythematosus-like syndrome after a parvovirus B19 infection. Mod Rheumatol Case Rep 2020; 5:182-187. [PMID: 33019911 DOI: 10.1080/24725625.2020.1832754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Parvovirus B19 infection has been reported to be associated with systemic lupus erythematosus (SLE). Liver dysfunction is frequently observed in SLE patients. However, liver dysfunction caused by an aberrant copper metabolism is rarely seen in patients with parvovirus B19 infection. We report a rare case of SLE-like and Wilson's disease (WD) mimicking symptoms that were simultaneously triggered by parvovirus B19 infection. A 29-year-old man was admitted to our hospital with high-grade fever, arthralgia, and oral ulcers following a parvovirus B19 infection. Laboratory tests showed elevated transaminase levels, proteinuria, anti-double-stranded DNA antibody, high levels of serum ferritin, and leukocytopenia. He was suspected of having SLE with haemophagocytosis and was treated with high doses of prednisolone. Subsequently, the patient's arthritis symptoms improved and the proteinuria improved. Immunosuppressive therapies improved most of his symptoms except for the high titre of transaminases were alleviated. Laboratory findings indicated low serum levels of ceruloplasmin and copper along with elevated levels of 24-hour urinary copper. Liver biopsy detected copper in hepatocytes. Although the hepatic copper content was relatively low in this case, the dysregulation of copper metabolism was considered to be a main cause of his elevated levels of liver enzymes. Therefore, we started treatment with chelating agents used in WD treatment. At the 2-month follow-up, the liver dysfunction had significantly improved. Our case suggests that in patients with refractory liver dysfunction due to unknown reasons, it is necessary to exclude the possibility that an abnormal copper metabolism had caused an increase in the levels of liver enzymes.
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Affiliation(s)
- Shinichiro Nameki
- Division of Rheumatology and Allergy, Osaka General Medical Center, Osaka, Japan
| | - Yuichi Maeda
- Division of Rheumatology and Allergy, Osaka General Medical Center, Osaka, Japan
| | - Takayuki Shibahara
- Division of Rheumatology and Allergy, Osaka General Medical Center, Osaka, Japan
| | - Jun Fukui
- Division of Rheumatology and Allergy, Osaka General Medical Center, Osaka, Japan
| | - Takeshi Shimizu
- Division of Gastroenterology, Osaka General Medical Center, Osaka, Japan
| | - Kazuhiko Bessho
- Department of Pediatrics, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Hiroshi Fujiwara
- Division of Rheumatology and Allergy, Osaka General Medical Center, Osaka, Japan
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4
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Gille N, Roque-Afonso AM, Sebagh M, Rudler M, Thabut D, Duclos-Vallée JC, Samuel D, Coilly A. Parvovirus B19 infection: A challenging cause of fulminant hepatitis. Clin Res Hepatol Gastroenterol 2020; 44:e89-e91. [PMID: 31917176 DOI: 10.1016/j.clinre.2019.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 11/20/2019] [Accepted: 12/03/2019] [Indexed: 02/04/2023]
Affiliation(s)
- Nicolas Gille
- Paul Brousse Hospital, 12, avenue Paul-Vaillant Couturier, 94800 Villejuif, France.
| | | | - Mylène Sebagh
- Paul Brousse Hospital, 12, avenue Paul-Vaillant Couturier, 94800 Villejuif, France
| | - Marika Rudler
- Paul Brousse Hospital, 12, avenue Paul-Vaillant Couturier, 94800 Villejuif, France
| | - Dominique Thabut
- Paul Brousse Hospital, 12, avenue Paul-Vaillant Couturier, 94800 Villejuif, France
| | | | - Didier Samuel
- Paul Brousse Hospital, 12, avenue Paul-Vaillant Couturier, 94800 Villejuif, France
| | - Audrey Coilly
- Paul Brousse Hospital, 12, avenue Paul-Vaillant Couturier, 94800 Villejuif, France
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5
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Alves ADR, Cubel Garcia RDCN, Cruz OG, Pinto MA, Amado Leon LA. Quantitative real-time PCR for differential diagnostics of parvovirus B19 infection in acute liver failure patients. Expert Rev Mol Diagn 2019; 19:259-266. [DOI: 10.1080/14737159.2019.1582333] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Arthur Daniel Rocha Alves
- Laboratório de Desenvolvimento Tecnológico em Virologia, Instituto Oswaldo cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | | | | | - Marcelo Alves Pinto
- Laboratório de Desenvolvimento Tecnológico em Virologia, Instituto Oswaldo cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Luciane Almeida Amado Leon
- Laboratório de Desenvolvimento Tecnológico em Virologia, Instituto Oswaldo cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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6
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Abstract
Parvovirus B19 (B19V) and human bocavirus 1 (HBoV1), members of the large Parvoviridae family, are human pathogens responsible for a variety of diseases. For B19V in particular, host features determine disease manifestations. These viruses are prevalent worldwide and are culturable in vitro, and serological and molecular assays are available but require careful interpretation of results. Additional human parvoviruses, including HBoV2 to -4, human parvovirus 4 (PARV4), and human bufavirus (BuV) are also reviewed. The full spectrum of parvovirus disease in humans has yet to be established. Candidate recombinant B19V vaccines have been developed but may not be commercially feasible. We review relevant features of the molecular and cellular biology of these viruses, and the human immune response that they elicit, which have allowed a deep understanding of pathophysiology.
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Affiliation(s)
- Jianming Qiu
- Department of Microbiology, Molecular Genetics and Immunology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | | | - Neal S Young
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
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Bihari C, Rastogi A, Rangegowda D, Chowdhury A, Saxena P, Garg H, Sarin SK. Parvovirus B19 associated acute hepatitis and hepatosplenomegaly. Clin Res Hepatol Gastroenterol 2014; 38:e9-10. [PMID: 23886765 DOI: 10.1016/j.clinre.2013.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2013] [Revised: 06/19/2013] [Accepted: 06/26/2013] [Indexed: 02/04/2023]
Affiliation(s)
- Chhagan Bihari
- Department of Hematology, Institute of Liver and Biliary Sciences, Vasant Kunj, New Delhi 110070, India.
| | - Archana Rastogi
- Department of Pathology, Institute of Liver and Biliary Sciences, Vasant Kunj, New Delhi 110070, India
| | - Devraj Rangegowda
- Department of Hepatology, Institute of Liver and Biliary Sciences, Vasant Kunj, New Delhi 110070, India
| | - Ashok Chowdhury
- Department of Hepatology, Institute of Liver and Biliary Sciences, Vasant Kunj, New Delhi 110070, India
| | - Priyanka Saxena
- Department of Hematology, Institute of Liver and Biliary Sciences, Vasant Kunj, New Delhi 110070, India
| | - Hitendra Garg
- Department of Hepatology, Institute of Liver and Biliary Sciences, Vasant Kunj, New Delhi 110070, India
| | - Shiv Kumar Sarin
- Department of Hepatology, Institute of Liver and Biliary Sciences, Vasant Kunj, New Delhi 110070, India
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8
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Acute hepatitis and myositis associated with Erythema infectiosum by Parvovirus B19 in an adolescent. BMC Pediatr 2014; 14:6. [PMID: 24410941 PMCID: PMC3937157 DOI: 10.1186/1471-2431-14-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 12/14/2013] [Indexed: 12/19/2022] Open
Abstract
Background Erythema infectiosum is the most common clinical manifestation of Parvovirus B19 infection although it has also been associated with rheumatologic diseases and various types of systemic vasculitides. Acute hepatitis and benign myositis however are rarely reported in association with Parvovirus B19 infection. Case presentation Here we report a 14-year old male, who developed acute hepatitis and benign myositis associated with erythema infectiosum following Parvovirus B19 infection. Conclusion Parvovirus B19 infection has rarely been associated with acute hepatitis and exceptionally rarely with benign myositis. Parvovirus B19 should be considered in the differential diagnosis of acute non-A to E hepatitis and in the case of acute benign myositis presenting with a rash especially in children.
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9
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Parvovirus b19 associated hepatitis. HEPATITIS RESEARCH AND TREATMENT 2013; 2013:472027. [PMID: 24232179 PMCID: PMC3819764 DOI: 10.1155/2013/472027] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 08/10/2013] [Accepted: 09/04/2013] [Indexed: 12/21/2022]
Abstract
Parvovirus B19 infection can present with myriads of clinical diseases and syndromes; liver manifestations and hepatitis are examples of them. Parvovirus B19 hepatitis associated aplastic anemia and its coinfection with other hepatotropic viruses are relatively underrecognized, and there is sufficient evidence in the literature suggesting that B19 infections can cause a spectrum of liver diseases from elevation of transaminases to acute hepatitis to fulminant liver failure and even chronic hepatitis. It can also cause fatal macrophage activation syndrome and fibrosing cholestatic hepatitis. Parvovirus B19 is an erythrovirus that can only be replicate in pronormoblasts and hepatocytes, and other cells which have globosides and glycosphingolipids in their membrane can also be affected by direct virus injury due to nonstructural protein 1 persistence and indirectly by immune mediated injury. The virus infection is suspected in bone marrow aspiration in cases with sudden drop of hemoglobin and onset of transient aplastic anemia in immunosuppressed or immunocompetent patients and is confirmed either by IgM and IgG positive serology, PCR analysis, and in situ hybridization in biopsy specimens or by application of both. There is no specific treatment for parvovirus B19 related liver diseases, but triple therapy regimen may be effective consisting of immunoglobulin, dehydrohydrocortisone, and cyclosporine.
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10
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Thammasri K, Rauhamäki S, Wang L, Filippou A, Kivovich V, Marjomäki V, Naides SJ, Gilbert L. Human parvovirus B19 induced apoptotic bodies contain altered self-antigens that are phagocytosed by antigen presenting cells. PLoS One 2013; 8:e67179. [PMID: 23776709 PMCID: PMC3680405 DOI: 10.1371/journal.pone.0067179] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 05/15/2013] [Indexed: 12/03/2022] Open
Abstract
Human parvovirus B19 (B19V) from the erythrovirus genus is known to be a pathogenic virus in humans. Prevalence of B19V infection has been reported worldwide in all seasons, with a high incidence in the spring. B19V is responsible for erythema infectiosum (fifth disease) commonly seen in children. Its other clinical presentations include arthralgia, arthritis, transient aplastic crisis, chronic anemia, congenital anemia, and hydrops fetalis. In addition, B19V infection has been reported to trigger autoimmune diseases such as systemic lupus erythematosus and rheumatoid arthritis. However, the mechanisms of B19V participation in autoimmunity are not fully understood. B19V induced chronic disease and persistent infection suggests B19V can serve as a model for viral host interactions and the role of viruses in the pathogenesis of autoimmune diseases. Here we investigate the involvement of B19V in the breakdown of immune tolerance. Previously, we demonstrated that the non-structural protein 1 (NS 1) of B19V induces apoptosis in non-permissive cells lines and that this protein can cleave host DNA as well as form NS1-DNA adducts. Here we provide evidence that through programmed cell death, apoptotic bodies (ApoBods) are generated by B19V NS1 expression in a non-permissive cell line. Characterization of purified ApoBods identified potential self-antigens within them. In particular, signature self-antigens such as Smith, ApoH, DNA, histone H4 and phosphatidylserine associated with autoimmunity were present in these ApoBods. In addition, when purified ApoBods were introduced to differentiated macrophages, recognition, engulfment and uptake occurred. This suggests that B19V can produce a source of self-antigens for immune cell processing. The results support our hypothesis that B19V NS1-DNA adducts, and nucleosomal and lysosomal antigens present in ApoBods created in non-permissive cell lines, are a source of self-antigens.
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Affiliation(s)
- Kanoktip Thammasri
- Department of Biological and Environmental Sciences and Nanoscience Center, University of Jyväskylä, Jyväskylä, Finland
| | - Sanna Rauhamäki
- Department of Biological and Environmental Sciences and Nanoscience Center, University of Jyväskylä, Jyväskylä, Finland
| | - Liping Wang
- Department of Biological and Environmental Sciences and Nanoscience Center, University of Jyväskylä, Jyväskylä, Finland
| | - Artemis Filippou
- Department of Biological and Environmental Sciences and Nanoscience Center, University of Jyväskylä, Jyväskylä, Finland
| | - Violetta Kivovich
- Pennsylvania State College of Medicine/Milton S. Hershey Medical Center, Hershey, Pennsylvania, United States of America
| | - Varpu Marjomäki
- Department of Biological and Environmental Sciences and Nanoscience Center, University of Jyväskylä, Jyväskylä, Finland
| | - Stanley J. Naides
- Quest Diagnostics Nichols Institute, San Juan Capistrano, California, United States of America
| | - Leona Gilbert
- Department of Biological and Environmental Sciences and Nanoscience Center, University of Jyväskylä, Jyväskylä, Finland
- * E-mail:
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Acute fulminant hepatic failure associated with parvovirus B19 infection in an immunocompetent adult. Dig Dis Sci 2012; 57:2811-3. [PMID: 22395961 DOI: 10.1007/s10620-012-2110-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Accepted: 02/22/2012] [Indexed: 12/09/2022]
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Martínez González J, Senosiain Lalastra C, Mesonero Gismero F, Moreira Vicente V. [An exceptional cause of acute hepatitis in an adult: parvovirus B19]. GASTROENTEROLOGIA Y HEPATOLOGIA 2012; 35:697-9. [PMID: 22749503 DOI: 10.1016/j.gastrohep.2012.04.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Revised: 04/18/2012] [Accepted: 04/22/2012] [Indexed: 11/25/2022]
Abstract
There are multiple causes of hepatitis. The most frequent etiologies are viral, usually hepatitis A, B and C viruses. However, other, non-hepatotropic viruses can cause this disease, including parvovirus B19. We present a case of acute hepatitis due to parvovirus B19, as well as a review of the epidemiological, clinical, diagnostic and therapeutic features of this entity.
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Abstract
There are few reports in the literature of hepatitis as a manifestation of parvovirus B19 infection. We describe a case of parvovirus B19-associated acute hepatitis diagnosed based on a positive serologic test (IgM) and molecular detection of parvovirus B19 DNA in a liver biopsy specimen. Parvovirus B19 infection should be considered in the differential diagnosis of patients presenting with acute hepatitis.
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14
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Kivovich V, Gilbert L, Vuento M, Naides SJ. Parvovirus B19 genotype specific amino acid substitution in NS1 reduces the protein's cytotoxicity in culture. Int J Med Sci 2010; 7:110-9. [PMID: 20567611 PMCID: PMC2880839 DOI: 10.7150/ijms.7.110] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2010] [Accepted: 05/24/2010] [Indexed: 11/05/2022] Open
Abstract
A clinical association between idiopathic liver disease and parvovirus B19 infection has been observed. Fulminant liver failure, not associated with other liver-tropic viruses, has been attributed to B19 in numerous reports, suggesting a possible role for B19 components in the extensive hepatocyte cytotoxicity observed in this condition. A recent report by Abe and colleagues (Int J Med Sci. 2007;4:105-9) demonstrated a link between persistent parvovirus B19 genotype I and III infection and fulminant liver failure. The genetic analysis of isolates obtained from these patients demonstrated a conservation of key amino acids in the nonstructural protein 1 (NS1) of the disease-associated genotypes. In this report we examine a conserved residue identified by Abe and colleagues and show that substitution of isoleucine 181 for methionine, as occurs in B19 genotype II, results in the reduction of B19 NS1-induced cytotoxicity of liver cells. Our results support the hypothesis that in the setting of persistent B19 infection, direct B19 NS1-induced cytotoxicity may play a role in idiopathic fulminant liver failure.
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Krygier DS, Steinbrecher UP, Petric M, Erb SR, Chung SW, Scudamore CH, Buczkowski AK, Yoshida EM. Parvovirus B19 induced hepatic failure in an adult requiring liver transplantation. World J Gastroenterol 2009; 15:4067-9. [PMID: 19705505 PMCID: PMC2731960 DOI: 10.3748/wjg.15.4067] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Parvovirus B19 induced acute hepatitis and hepatic failure have been previously reported, mainly in children. Very few cases of parvovirus induced hepatic failure have been reported in adults and fewer still have required liver transplantation. We report the case of a 55-year-old immunocompetent woman who developed fulminant hepatic failure after acute infection with Parvovirus B19 who subsequently underwent orthotopic liver transplantation. This is believed to be the first reported case in the literature in which an adult patient with fulminant hepatic failure associated with acute parvovirus B19 infection and without hematologic abnormalities has been identified prior to undergoing liver transplantation. This case suggests that Parvovirus B19 induced liver disease can affect adults, can occur in the absence of hematologic abnormalities and can be severe enough to require liver transplantation.
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Abstract
Infection with parvovirus B19 causes several clinical syndromes (fifth disease, transient aplastic crisis, pure red cell aplasia, and hydrops fetalis) and may contribute to other illnesses. B19 has been linked to renal disease in three settings: As a cause of acute glomerulopathy and as a cause of anemia in ESRD and kidney transplantation. Case reports implicate parvovirus in the pathogenesis of proliferative glomerulonephritis and collapsing glomerulopathy, but a causal relationship has not been established. A proposed role for B19 infection is based on the temporal association of renal findings with viral infection, positive serology, and identification of the viral genome in the glomerulus. Mechanisms may include cytopathic effects on glomerular epithelial cells and/or endothelial cells and glomerular deposition of immune complexes. Patients who require dialysis may have increased susceptibility to acute and chronic anemia after parvoviral infection. Factors that predispose this population to complications of B19 infection include impaired immune response, deficient erythropoietin production, and possibly decreased erythrocyte survival. The clinical burden of parvovirus B19 infection in renal transplant recipients may be underestimated; these individuals may develop persistent viremia as a result of a dysfunctional immune response. Chronic anemia and pure red blood cell aplasia are the most common complications of parvovirus infection in this population; the diagnosis should be considered in transplant recipients with unexplained anemia or pancytopenia. Allograft rejection and dysfunction have been reported in association with infection, but a cause-effect relationship has not been proved. Further investigation of the relationship between B19 and kidney disease is warranted.
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Affiliation(s)
- Meryl Waldman
- Kidney Disease Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland 20892-1268, USA. merylw@.niddk.nih.gov
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Abstract
In the strictest sense, the term "viral hepatitis" includes a series of clinical conditions of infectious origin caused by five phylogenetically unrelated human viruses that have developed specific tropism to hepatocytes. In a broader sense, it also includes acute liver diseases due to infection by other viruses that do not display specific liver tropism, but may produce liver disease as a complication of the infection. Hepatitis B and C viruses have, in addition, developed strategies that allow them to establish long-lasting, chronic infections in some patients. Chronic viral hepatitis, liver cirrhosis and primary liver cancer are the main clinical outcomes of these phenomena of viral persistence, which respond to two main mechanisms: induction of immune tolerance in the host, and emergence and selection of viral mutants that are able to escape the immune response.
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Affiliation(s)
- José Manuel Echevarría-Mayo
- Servicio de Microbiología Diagnóstica, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain.
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Hsu TC, Chen TY, Lin MC, Tzang BS, Tsay GJ. Human parvovirus B19 infection in patients with chronic hepatitis B or hepatitis C infection. J Gastroenterol Hepatol 2005; 20:733-8. [PMID: 15853987 DOI: 10.1111/j.1440-1746.2005.03815.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM Parvovirus B19 has been reported to be detected in the sera of patients with acute or chronic hepatitis. The prevalence and clinical significance of B19 DNA in serum samples from patients with chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infection were investigated. METHODS Serum samples from 54 patients with HBV infection, 51 with HCV infection and 53 normal controls were examined for anti-B19 antibodies and B19 DNA by enzyme-linked immunosorbent assay (ELISA), the nested polymerase chain reaction (PCR), Southern blotting and direct nucleotide sequencing, respectively. RESULTS Anti-B19 IgM and IgG antibodies were detected in 19 (35.2%) and 46 (85.2%) of 54 serum samples from patients with HBV infection, and eight (15.7%) and 36 (70.6%) of 51 serum samples from patients with HCV infection. B19 DNA was detected in serum samples of 20 (37%) of 54 patients with HBV infection and 12 (23.5%) of 51 patients with HCV infection, but not in 53 serum samples from normal controls. The occurrence of liver dysfunction was not affected by B19 infection in patients with HBV and HCV infection (P > 0.05). All of the 20 serum samples with B19 DNA from patients with chronic HBV infection and all of the 12 serum samples with B19 DNA from patients with chronic HCV infection exhibited TW-3 subtype and TW-9 subtype, respectively. The variant subtypes of B19 were found to be distinctive in patients with HBV or HCV infection. CONCLUSIONS These data revealed that human parvovirus B19 infection was frequently found in patients with chronic HBV or HCV infection. The variant genotypes were present in patients with different chronic hepatitis. The coinfection of B19 with HBV or HCV did not increase the frequency of liver dysfunction in patients with chronic hepatitis. Long-term longitudinal studies are required to determine the natural course of parvovirus B19 infection and whether its coinfection affects the natural history of chronic hepatitis B or hepatitis C.
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MESH Headings
- Adolescent
- Adult
- Aged
- Antibodies, Viral/blood
- Case-Control Studies
- DNA, Viral/blood
- Female
- Hepatitis B, Chronic/blood
- Hepatitis B, Chronic/complications
- Hepatitis B, Chronic/virology
- Hepatitis C, Chronic/blood
- Hepatitis C, Chronic/complications
- Hepatitis C, Chronic/virology
- Humans
- Immunoglobulin G/blood
- Immunoglobulin M/blood
- Male
- Middle Aged
- Parvoviridae Infections/blood
- Parvoviridae Infections/complications
- Parvoviridae Infections/diagnosis
- Parvovirus B19, Human/immunology
- Parvovirus B19, Human/isolation & purification
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Affiliation(s)
- Tsai-Ching Hsu
- Department of Internal Medicine, Chung Shan Medical University, Taichung, Taiwan
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McGhee SA, Kaska B, Liebhaber M, Stiehm ER. Persistent parvovirus-associated chronic fatigue treated with high dose intravenous immunoglobulin. Pediatr Infect Dis J 2005; 24:272-4. [PMID: 15750469 DOI: 10.1097/01.inf.0000155194.66797.20] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We report a 16-year-old boy with no evidence of immunodeficiency who had a 2-year history of chronic fatigue, low grade fever and slapped-cheek rash associated with chronic parvovirus B19 viremia. Prolonged intravenous immunoglobulin therapy resulted in resolution of his symptoms and viremia. Intravenous immunoglobulin may be useful in the resolution of parvovirus viremia regardless of immune status.
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Affiliation(s)
- Sean A McGhee
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
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