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Sarkar R, Yadav A, Maheshwari A. Fever with Rash in a Child: Revisited. Indian J Dermatol 2024; 69:282. [PMID: 39119300 PMCID: PMC11305486 DOI: 10.4103/ijd.ijd_913_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2024] Open
Abstract
Rash and fever are some of the most common chief complaints present in paediatric dermatology emergencies. The spectrum of differential diagnosis is broad, including many different infectious and some non-infectious agents. A systematic approach involving detailed history taking, careful clinical examination along with particular attention to epidemiological features are the most important factors to make a diagnosis. This article reviews the morphological patterns of various causes of fever with rash in children, including infectious as well as non-infectious causes, with special emphasis on the Indian scenario. We intend to highlight the clinical characteristics of each cause, which will not only help make a clinical diagnosis but also distinguish benign versus life-threatening causes of skin rash in febrile paediatric patients and provide early medical intervention.
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Affiliation(s)
- Rashmi Sarkar
- From the Department of Dermatology, Lady Hardinge Medical College, New Delhi, India
| | - Anukriti Yadav
- From the Department of Dermatology, Lady Hardinge Medical College, New Delhi, India
| | - Apoorva Maheshwari
- From the Department of Dermatology, Lady Hardinge Medical College, New Delhi, India
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Leung AKC, Lam JM, Barankin B, Leong KF, Hon KL. Erythema Infectiosum: A Narrative Review. Curr Pediatr Rev 2024; 20:462-471. [PMID: 37132144 DOI: 10.2174/1573396320666230428104619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 02/27/2023] [Accepted: 02/28/2023] [Indexed: 05/04/2023]
Abstract
BACKGROUND Erythema infectiosum occurs worldwide. School-aged children are most often affected. Since the diagnosis is mainly clinical, physicians should be well-versed in the clinical manifestations of erythema infectiosum to avoid misdiagnosis, unnecessary investigations, and mismanagement of the disease. OBJECTIVES The purpose of this article is to familiarize physicians with the wide spectrum of clinical manifestations and complications of erythema infectiosum associated with parvovirus B19 infection. METHODS A search was conducted in July 2022 in PubMed Clinical Queries using the key terms "Erythema infectiosum" OR "Fifth disease" OR "Slapped cheek disease" OR "Parvovirus B19". The search strategy included all clinical trials, observational studies, and reviews published within the past 10 years. Only papers published in the English literature were included in this review. The information retrieved from the above search was used in the compilation of the present article. RESULTS Erythema infectiosum is a common exanthematous illness of childhood caused by parvovirus B19. Parvovirus B19 spreads mainly by respiratory tract secretions and, to a lesser extent, the saliva of infected individuals. Children between 4 and 10 years of age are most often affected. The incubation period is usually 4 to 14 days. Prodromal symptoms are usually mild and consist of lowgrade fever, headache, malaise, and myalgia. The rash typically evolves in 3 stages. The initial stage is an erythematous rash on the cheeks, with a characteristic "slapped cheek" appearance. In the second stage, the rash spreads concurrently or quickly to the trunk, extremities, and buttocks as diffuse macular erythema. The rash tends to be more intense on extensor surfaces. The palms and soles are typically spared. Central clearing of the rash results in a characteristic lacy or reticulated appearance. The rash usually resolves spontaneously within three weeks without sequelae. The third stage is characterized by evanescence and recrudescence. In adults, the rash is less pronounced than that in children and is often atypical. Only approximately 20% of affected adults have an erythematous rash on the face. In adults, the rash is more frequently found on the legs, followed by the trunk, and arms. A reticulated or lacy erythema is noted in 80% of cases which helps to distinguish erythema infectiosum from other exanthems. Pruritus is noted in approximately 50% of cases. The diagnosis is mainly clinical. The many manifestations of parvovirus B19 infection can pose a diagnostic challenge even to the best diagnostician. Complications include arthritis, arthralgia, and transient aplastic crisis. In most cases, treatment is symptomatic and supportive. When parvovirus B19 infection occurs in pregnant women, hydrops fetalis becomes a real concern. CONCLUSION Erythema infectiosum, the most common clinical manifestation of parvovirus B19 infection, is characterized by a "slapped cheek" appearance on the face and lacy exanthem on the trunk and extremities. Parvovirus B19 infection is associated with a wide spectrum of clinical manifestations. Physicians should be aware of potential complications and conditions associated with parvovirus B19 infection, especially in individuals who are immunocompromised, chronically anemic, or pregnant.
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Affiliation(s)
- Alexander K C Leung
- Department of Pediatrics, The University of Calgary, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Joseph M Lam
- Department of Pediatrics and Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Benjamin Barankin
- Department of Dermatology, Toronto Dermatology Centre, Toronto, Ontario, Canada
| | - Kin Fon Leong
- Pediatric Institute, Kuala Lumpur General Hospital, Kuala Lumpur, Malaysia
| | - Kam Lun Hon
- Department of Paediatrics, The Chinese University of Hong Kong, China
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong, China
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Patalon T, Saciuk Y, Trotzky D, Pachys G, Ben-Tov A, Segal Y, Gazit S. An Outbreak of Parvovirus B19 in Israel. Viruses 2023; 15:2261. [PMID: 38005937 PMCID: PMC10674631 DOI: 10.3390/v15112261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 11/12/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023] Open
Abstract
Human parvovirus B19 (B19V) has a wide clinical spectrum, ranging from an asymptomatic infection to a life threatening one. During pregnancy, it can lead to fetal loss and hydrops fetalis. This retrospective study examined the incidence rates of B19V in Israel, analyzing anonymized electronic medical records of 2.7 million individuals between January 2015 and September 2023. A generalized linear model with a Poisson distribution was fit to the data, adjusting for potential confounders. A marked increase in B19V was observed in 2023, with an adjusted incidence rate ratio (IRR) of 6.6 (95% CI 6.33-6.89) when comparing 2023 to previous years. When specifically comparing 2023 to COVID-19 years (2020-2022), adjusted IRR climbs to 9.21 (8.66-9.80). Moreover, in 2023, previously existing seasonality has largely disappeared. High SES characterized most infected individuals with a marked discrepancy in social sectors; the Arab population was significantly less likely to be found B19V positive, even when adjusting for SES. Most infections occurred in school-aged children (6-11 years old). Pregnant women experienced the most significant rise in B19V, with an adjusted IRR of 11.47 (9.44-13.97) in 2023 compared to previous years; most cases were diagnosed in the first trimester. This study demonstrates that Israel is currently experiencing the largest and longest reported outbreak of B19V to date. Policymakers should consider setting screening policies in place, at least for populations at risk, while specifically studying and potentially targeting low socioeconomic populations and specific social sectors to avoid health inequalities.
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Affiliation(s)
- Tal Patalon
- Kahn Sagol Maccabi (KSM) Research & Innovation Center, Maccabi Healthcare Services, Tel Aviv 68125, Israel
- Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv 68125, Israel
| | - Yaki Saciuk
- Kahn Sagol Maccabi (KSM) Research & Innovation Center, Maccabi Healthcare Services, Tel Aviv 68125, Israel
| | - Daniel Trotzky
- Shamir Medical Center (Assaf Harofeh Medical Center), Zerifin 70300, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Gal Pachys
- Shamir Medical Center (Assaf Harofeh Medical Center), Zerifin 70300, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Amir Ben-Tov
- Kahn Sagol Maccabi (KSM) Research & Innovation Center, Maccabi Healthcare Services, Tel Aviv 68125, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Yaakov Segal
- Maccabi Healthcare Services, Tel Aviv 68125, Israel
| | - Sivan Gazit
- Kahn Sagol Maccabi (KSM) Research & Innovation Center, Maccabi Healthcare Services, Tel Aviv 68125, Israel
- Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv 68125, Israel
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Xiang C, Wu X, Wei Y, Li T, Tang X, Wang Y, Zhang X, Huang X, Wang Y. First report on severe septic shock associated with human Parvovirus B19 infection after cardiac surgery. Front Cell Infect Microbiol 2023; 13:1064760. [PMID: 37091672 PMCID: PMC10115160 DOI: 10.3389/fcimb.2023.1064760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 03/17/2023] [Indexed: 04/08/2023] Open
Abstract
BackgroundHuman Parvovirus B19 (PB19) is a single-stranded DNA virus. Septic shock from viremia is rare with PB19; however, this infection can progress to life-threatening conditions. We report the first case of severe septic shock associated with a PB19 infection after cardiac surgery.Case PresentationA 50-year-old Chinese woman received elective double metal valve replacement, including the aortic valve and the mitral valve, under cardiopulmonary bypass (CPB) and suffered severe septic shock on postoperative day (PD) 30. Through the detection of PB19-specific nucleic acids in blister fluid and serum samples via metagenomic next-generation sequencing (mNGS), positive serum PB19 IgM and no other proven infection, acute PB19 infection was confirmed. After five days of combined treatment, no further fever or abdominal discomfort was noted, and the patient’s circulation gradually became stable without vasoactive medications.ConclusionPB19 may be an unrecognized cause of septic shock, rash, fever of unknown origin or multiple systemic signs and symptoms, especially in immunosuppressed and immunocompetent critically ill patients. Investigations for viral aetiology are needed.
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Mohammed T, Deshmukh A, Kochhar T, Patlola A. Parvovirus B19 infection in a patient of juvenile arthritis: A case report. MGM JOURNAL OF MEDICAL SCIENCES 2023. [DOI: 10.4103/mgmj.mgmj_64_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
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Simunov B, Mrzljak A, Jurekovic Z, Zidovec Lepej S, Bainrauch A, Pavicic Saric J, Hruskar Z, Radmanic L, Vilibic-Cavlek T. Parvovirus B19 status in liver, kidney and pancreas transplant candidates: A single center experience. World J Transplant 2022; 12:378-387. [PMID: 36437842 PMCID: PMC9693899 DOI: 10.5500/wjt.v12.i11.378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 09/05/2022] [Accepted: 09/22/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Parvovirus B19 (B19V) is associated with a wide range of clinical manifestations. The major presentation is erythema infectiosum. However, a persistent infection may cause pure red cell aplasia and chronic anemia in immunocompromized patients. The B19V seroprevalence varies with age and geographical location.
AIM To determine the B19V serological status and DNAemia in kidney, liver, and pancreas transplant candidates.
METHODS Patients who underwent kidney, liver, or simultaneous kidney and pancreas/liver transplantation between January 2021 and May 2022 were included in the study. The serum samples were collected before transplantation. For detection of B19V DNA, a LightMix Kit B19V EC (TIB MOLBIOL, Berlin, Germany) was used. B19V IgM and IgG antibodies were detected using a commercial ELISA test (Euroimmun, Lübeck, Germany).
RESULTS One hundred and thirty-one transplant candidates were included in the study, 71.0% male, with an average age of 53.27 years ± 12.71 years. There were 68.7% liver, 27.5% kidney, 3.0% simultaneous pancreas/kidney transplant (SPKT), and 0.8% simultaneous liver/kidney transplant recipients. No patients had detectable B19V DNA. B19V IgG seroprevalence was 77.1%. No acute or recent infections were detected (IgM antibodies). There was no difference in the mean age of seronegative and seropositive patients (51.8 years ± 12.9 years vs 53.7 years ± 12.7 years, t = -0.603; P = 0.548). Although seropositivity was lower in patients aged less than 30 years (66.6%) compared to the patients aged 30-59 years and > 60 years (80.4% and 78.1%, respectively), this difference was not significant. In addition, there was no difference in seropositivity between male and female transplant candidates, 76.3% and 78.9% (χ2 = 0.104; P = 0.748). The seroprevalence did not differ among organ recipients, with 77.8%, 80.6%, and 50.0% for liver, kidney, and SPKT, respectively, (χ2 = 5.297; P = 0.151). No significant difference was found in the seroprevalence in kidney transplant patients according to dialysis modality. Seroprevalence was 71.1% in hemodialysis patients, and 100% in peritoneal dialysis patients (χ2 = 0.799; P = 0.372).
CONCLUSION The B19V seroprevalence is expectedly high among kidney, liver, and pancreas transplant candidates, but there are still 22.9% of seronegative individuals who remain at risk for primary disease and severe manifestations. Further research should elucidate the necessity of B19V screening in peri-transplant management.
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Affiliation(s)
- Bojana Simunov
- Department of Nephrology, Merkur University Hospital, Zagreb 10000, Croatia
| | - Anna Mrzljak
- Department of Gastroenterology and Hepatology, University Clinical Hospital Zagreb, Zagreb 10000, Croatia
- School of Medicine, University of Zagreb, Zagreb 10000, Croatia
| | - Zeljka Jurekovic
- Department of Nephrology, Merkur University Hospital, Zagreb 10000, Croatia
| | - Snjezana Zidovec Lepej
- Department of Immunological and Molecular Diagnostics, University Hospital for Infectious Diseases “Dr. Fran Mihaljevic”, Zagreb 10000, Croatia
| | - Ana Bainrauch
- Department of Medicine, Merkur University Hospital, Zagreb 10000, Croatia
| | | | - Zeljka Hruskar
- Department of Virology, Croatian Institute of Public Health, Zagreb 10000, Croatia
| | - Leona Radmanic
- Department of Immunological and Molecular Diagnostics, University Hospital for Infectious Diseases “Dr. Fran Mihaljevic”, Zagreb 10000, Croatia
| | - Tatjana Vilibic-Cavlek
- School of Medicine, University of Zagreb, Zagreb 10000, Croatia
- Department of Virology, Croatian Institute of Public Health, Zagreb 10000, Croatia
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Jacquot R, Gerfaud-Valentin M, Mekki Y, Billaud G, Jamilloux Y, Sève P. [Parvovirus B19 infections in adults]. Rev Med Interne 2022; 43:713-726. [PMID: 36088203 DOI: 10.1016/j.revmed.2022.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/29/2022] [Accepted: 08/21/2022] [Indexed: 12/11/2022]
Abstract
Acute Parvovirus B19 (PVB19) infection is responsible for erythema infectiosum in children and non-specific polyarthralgias in immunocompetent adults associated with skin lesions and rarer manifestations (hepatic, neurological, cardiac or nephrological). In immunocompromised patients, cytopenias are more frequent and in some cases, viremia persists and is responsible for PVB19 chronic infection. PVB19 is responsible for pure red cell aplasia during chronic hemolytic diseases. Acute PVB19 infection is a differential diagnosis of some autoimmune diseases and has been suspected to be a trigger for some autoimmune diseases because of its ability to promote the emergence of autoimmune markers. Mechanisms of molecular mimicry, induction of apoptosis and activation of enzymes have been demonstrated, explaining in part the production of autoantibodies during infection. However, the demonstration of a causal relationship in the triggering of autoimmune disease remains to be done. This review provides a synthesis of the PVB19 infection clinical data in adults with a particular focus on these links with autoimmunity.
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Affiliation(s)
- R Jacquot
- Service de médecine interne, hospices civils de Lyon, hôpital de la Croix-Rousse, 103, Grande-Rue de la Croix-Rousse, 69317 Lyon cedex 04, France; Université de Lyon, Lyon, France.
| | - M Gerfaud-Valentin
- Service de médecine interne, hospices civils de Lyon, hôpital de la Croix-Rousse, 103, Grande-Rue de la Croix-Rousse, 69317 Lyon cedex 04, France; Université de Lyon, Lyon, France
| | - Y Mekki
- Université de Lyon, Lyon, France
| | | | - Y Jamilloux
- Service de médecine interne, hospices civils de Lyon, hôpital de la Croix-Rousse, 103, Grande-Rue de la Croix-Rousse, 69317 Lyon cedex 04, France; Université de Lyon, Lyon, France
| | - P Sève
- Service de médecine interne, hospices civils de Lyon, hôpital de la Croix-Rousse, 103, Grande-Rue de la Croix-Rousse, 69317 Lyon cedex 04, France; Université de Lyon, Lyon, France; Université Claude-Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), Inserm U1290, Lyon, France; Laboratoire de virologie, hospices civils de Lyon, centre de biologie et de pathologie, hôpital de la Croix-Rousse, 103, Grande-Rue de la Croix-Rousse, 69317 Lyon cedex 04, France
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Wang F, Zhan Q, Yu SP, Feng HT, Hu P, Zhong ZF, Qu TT. Environmental Monitoring of Parvovirus B19 in the Kidney Transplantation Ward of a Chinese Teaching Hospital. Infect Drug Resist 2022; 15:1903-1910. [PMID: 35465250 PMCID: PMC9030386 DOI: 10.2147/idr.s356174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/26/2022] [Indexed: 01/04/2023] Open
Abstract
Purpose Parvovirus B19 (B19V) infection is a viral threat after kidney transplantation. It is mainly transmitted by close-contact inhalation of aerosolized viral particles. The risk of nosocomial spread of B19V in the transplantation ward is quite high. This study aimed to evaluate the quality of routine disinfection and the effectiveness of isolation measures in the wards of B19V-infected kidney transplant recipients. Patients and Methods Throat swab samples of 19 kidney transplant recipients admitted to the isolation ward and three healthcare workers (HCWs) were collected for viral DNA detection. Routine disinfection procedures were performed twice a day in general and B19V isolation wards. Environmental surface and air samples were collected for viral DNA detection before and after disinfection. Results A total of four patients were diagnosed with B19V infection and transferred to the B19V isolation ward, of which only two had positive throat swab samples. The other 15 patients and all HCWs tested negative for B19V. A total of 88 environmental surface and air samples were collected. Eight of the environmental samples collected in the B19V isolation ward before disinfection tested positive for B19V, while one sample tested positive after disinfection. In the general wards, all environmental samples collected before disinfection tested negative for B19V. All 24 samples collected from ambient air, whether in B19V isolation or general wards, before or after disinfection, tested negative for B19V. Conclusion Existing methods of routine or terminal disinfection for air and object surfaces were effective in eliminating B19V from object surfaces and ambient air in the isolation and general wards. Material surfaces that are exposed to high frequency and easily contaminated by blood, body fluids, and indoor air were the focus of cleaning and disinfection. Nosocomial cross-infection of other immunocompromised patients and HCWs can be avoided if appropriate prevention and control measures are taken.
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Affiliation(s)
- Fang Wang
- Infection Control Department, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, People’s Republic of China
| | - Qing Zhan
- Infection Control Department, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, People’s Republic of China
| | - Shi-Ping Yu
- Kidney Disease Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, People’s Republic of China
| | - Hai-Ting Feng
- Infection Control Department, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, People’s Republic of China
| | - Ping Hu
- Kidney Disease Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, People’s Republic of China
| | - Zi-Feng Zhong
- Infection Control Department, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, People’s Republic of China
| | - Ting-Ting Qu
- Infection Control Department, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, People’s Republic of China
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, People’s Republic of China
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Fölster-Holst R. Infectious exanthemas in childhood. J Dtsch Dermatol Ges 2021; 18:1128-1155. [PMID: 33112060 DOI: 10.1111/ddg.14301] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 05/09/2020] [Indexed: 12/15/2022]
Abstract
Most childhood exanthemas are harmless. However, recognizing serious diseases with life-threatening complications at an early stage is important for the timely initiation of adequate therapy. This requires knowledge of the specific patterns of the exanthema, obtained from the medical history and the clinic, including the patient's general condition and physical examination. In unclear cases, additional diagnostic measures are undertaken, such as blood tests and smears (cutaneous, mucocutaneous). Viruses are the most common cause of childhood exanthemas. New variants of infectious agents, improved diagnostics and stays in tropical and subtropical countries have expanded the spectrum of infectious exanthemas.
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Affiliation(s)
- Regina Fölster-Holst
- Dermatology, Venereology, Allergology, University Hospital Schleswig-Holstein (UKSH), Campus Kiel, Kiel, Germany
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Koliou M, Tryfonos A, Charalambous M. Purpuric rash in an adolescent with fever, pancytopenia, and an hemophagocytic lymphohistiocytosis-like syndrome due to parvovirus B19. Clin Case Rep 2020; 8:3093-3097. [PMID: 33363887 PMCID: PMC7752404 DOI: 10.1002/ccr3.3335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 06/22/2020] [Accepted: 08/17/2020] [Indexed: 11/29/2022] Open
Abstract
A rare case of parvovirus B19 infection associated with fever, hemorrhagic rash, and a clinical course resembling an incomplete HLH syndrome is presented. Parvovirus B19 should be included in the evaluation of febrile purpura and HLH-like syndrome.
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Affiliation(s)
- Maria Koliou
- Department of PaediatricsArchbishop Makarios HospitalNicosiaCyprus
- Medical SchoolUniversity of CyprusNicosiaCyprus
| | - Anna Tryfonos
- Department of PaediatricsArchbishop Makarios HospitalNicosiaCyprus
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Garduño-Soto M, Choreño-Parra JA, Cazarin-Barrientos J. Dermatological aspects of SARS-CoV-2 infection: mechanisms and manifestations. Arch Dermatol Res 2020; 313:611-622. [PMID: 33159236 PMCID: PMC7646711 DOI: 10.1007/s00403-020-02156-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 10/11/2020] [Accepted: 10/17/2020] [Indexed: 02/08/2023]
Abstract
The human infection caused by the novel SARS-CoV-2 is a public health emergency of international concern. Although the disease associated to this virus, named COVID-19, mainly affects the lungs, the infection can spread to extrapulmonary tissues, causing multiorgan involvement in severely ill patients. The broad infective capacity of SARS-CoV-2 is related to the pattern of expression of the viral entry factors ACE2 and TMPRSS2 in human tissues. As such, the respiratory and gastrointestinal tracts are at high risk for SARS-CoV-2 infection due to their high expression of ACE2 and TMPRSS2, which explains the clinical phenotype described in the vast majority of infected patients that includes pneumonia and diarrhea. Recently, preoccupation about the potential of the virus to infect the skin has been raised by dermatologists due to the increasing observations of cutaneous manifestations in patients with SARS-CoV-2 infection. Although there is little evidence of the expression of ACE2 and TMPRSS2 in the normal skin, the dermatological findings observed among COVID-19 patients warrants further investigation to delineate the mechanisms of skin affection after SARS-CoV-2 infection. Here, we provide a summary of the dermatological findings observed among patients with laboratory-confirmed SARS-CoV-2 infection based on recent reports. In addition, we analyze possible mechanisms of skin injury in COVID-19 patients and discuss about the risk of individuals with chronic skin conditions for SARS-CoV-2 infection. The present review constitutes a useful informative tool to improve our understanding of the pathophysiological mechanisms of COVID-19 and the possible implications of the current pandemic in dermatology.
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Affiliation(s)
- Myriam Garduño-Soto
- Department of Dermatology, Hospital General de México "Dr. Eduardo Liceaga", Dr. Balmis 148, Doctores, Cuauhtémoc, 06720, Mexico City, Mexico.
| | | | - Jorge Cazarin-Barrientos
- Department of Dermatology, Hospital General de México "Dr. Eduardo Liceaga", Dr. Balmis 148, Doctores, Cuauhtémoc, 06720, Mexico City, Mexico
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12
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Fölster-Holst R. Infektiöse Exantheme im Kindesalter. J Dtsch Dermatol Ges 2020; 18:1128-1157. [PMID: 33112074 DOI: 10.1111/ddg.14301_g] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 08/10/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Regina Fölster-Holst
- Dermatologie, Venerologie, Allergologie, Universitätsklinikum Schleswig-Holstein (UKSH), Campus Kiel, Kiel
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13
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Tomás-Velázquez A, Escribano Á, Rodríguez-Garijo N, Estenaga Pérez de Álbeniz Á, Reina G, España A. Primoinfección por parvovirus B19: análisis de 46 pacientes. Med Clin (Barc) 2020; 155:26-29. [DOI: 10.1016/j.medcli.2019.12.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 12/08/2019] [Accepted: 12/19/2019] [Indexed: 02/09/2023]
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Tidman ASM, Fatima R. An unusual cutaneous manifestation of parvovirus B19 infection: papular-purpuric gloves-and-socks syndrome and petechial bathing trunk eruption. Clin Exp Dermatol 2020; 45:341-342. [PMID: 31400151 DOI: 10.1111/ced.14070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2019] [Indexed: 11/28/2022]
Affiliation(s)
- A S M Tidman
- Department of Dermatology, University Hospital Crosshouse, Kilmarnock Road, Kilmarnock, KA2 0BE, UK
| | - R Fatima
- Department of Dermatology, University Hospital Crosshouse, Kilmarnock Road, Kilmarnock, KA2 0BE, UK
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Manaresi E, Gallinella G. Advances in the Development of Antiviral Strategies against Parvovirus B19. Viruses 2019; 11:v11070659. [PMID: 31323869 PMCID: PMC6669595 DOI: 10.3390/v11070659] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 07/16/2019] [Accepted: 07/17/2019] [Indexed: 12/11/2022] Open
Abstract
Parvovirus B19 (B19V) is a human pathogenic virus, responsible for an ample range of clinical manifestations. Infections are usually mild, self-limiting, and controlled by the development of a specific immune response, but in many cases clinical situations can be more complex and require therapy. Presently available treatments are only supportive, symptomatic, or unspecific, such as administration of intravenous immunoglobulins, and often of limited efficacy. The development of antiviral strategies against B19V should be considered of highest relevance for increasing the available options for more specific and effective therapeutic treatments. This field of research has been explored in recent years, registering some achievements as well as interesting future perspectives. In addition to immunoglobulins, some compounds have been shown to possess inhibitory activity against B19V. Hydroxyurea is an antiproliferative drug used in the treatment of sickle-cell disease that also possesses inhibitory activity against B19V. The nucleotide analogues Cidofovir and its lipid conjugate Brincidofovir are broad-range antivirals mostly active against dsDNA viruses, which showed an antiviral activity also against B19V. Newly synthesized coumarin derivatives offer possibilities for the development of molecules with antiviral activity. Identification of some flavonoid molecules, with direct inhibitory activity against the viral non-structural (NS) protein, indicates a possible line of development for direct antiviral agents. Continuing research in the field, leading to better knowledge of the viral lifecycle and a precise understanding of virus–cell interactions, will offer novel opportunities for developing more efficient, targeted antiviral agents, which can be translated into available therapeutic options.
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Affiliation(s)
- Elisabetta Manaresi
- Department of Pharmacy and Biotechnology, University of Bologna, I-40138 Bologna, Italy
| | - Giorgio Gallinella
- Department of Pharmacy and Biotechnology, University of Bologna, I-40138 Bologna, Italy.
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16
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Kishore J, Kishore D. Clinical impact & pathogenic mechanisms of human parvovirus B19: A multiorgan disease inflictor incognito. Indian J Med Res 2019; 148:373-384. [PMID: 30666000 PMCID: PMC6362725 DOI: 10.4103/ijmr.ijmr_533_18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Human parvovirus B19 (B19V) causes myriads of clinical diseases; however, owing to lack of awareness and undetermined clinical impact, it has failed to become a virus pathogen of global concern. Cryptically, B19V causes significant morbidity and mortality. Half of the world population and 60 per cent of Indians are known to be serologically naive and are at risk of acquiring B19V infections. Cumulatively, our data showed 21.3 per cent B19V-infected patients with juvenile chronic arthropathy, recurrent abortions, multi-transfused thalassaemia and leukaemia. In addition, B19V-infected cases that ended fatally included patients with pure red cell aplasia, fulminant hepatitis and haemophagocytic syndrome. Novel clinical associations of B19V observed were amegakaryocytic thrombocytopaenia, myositis and non-occlusive ischaemic gangrene of bowel. B19V possesses multiple receptors which are distributed widely in human tissues. Vascular endothelial cell infection by B19V causes endothelialitis and vasculitic injuries besides antibody-dependent enhancement which empowered B19V to cause multiorgan diseases. Owing to lack of suitable animal model for B19V, true causal role remains to be determined, but numerous reports on B19V infections substantiate a causal role in multiorgan diseases. Hence, B19V infections need to be recognized, investigated and treated besides making efforts on vaccine developments.
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Affiliation(s)
- Janak Kishore
- Division of Virology, Department of Microbiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Divya Kishore
- Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, India
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17
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Knöpfel N, Noguera-Morel L, Latour I, Torrelo A. Viral exanthems in children: A great imitator. Clin Dermatol 2019; 37:213-226. [PMID: 31178104 DOI: 10.1016/j.clindermatol.2019.01.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Viral exanthems are frequent in children and are mostly self-limited. Early recognition and differentiation from other childhood illnesses are important to direct further investigations and treatment initiation. The clinical presentation of viral exanthems in children includes a polymorphic spectrum of skin eruptions ranging from classic viral exanthems to "atypical" presentations that can mimic nonviral diseases; thus, viral exanthems of childhood can be readily diagnosed on clinical grounds, but not rarely do they represent a diagnostic challenge. In this review, we focus on viral diseases in children that may be difficult to diagnose due to their clinical similarities with nonviral diseases, and we offer clues for the differential diagnosis and proper diagnostic testing in such cases.
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Affiliation(s)
- Nicole Knöpfel
- Department of Pediatric Dermatology, University Children's Hospital Zurich, Zurich, Switzerland; Department of Dermatology, University Children's Hospital Niño Jesús, Madrid, Spain
| | - Lucero Noguera-Morel
- Department of Dermatology, University Children's Hospital Niño Jesús, Madrid, Spain
| | - Irene Latour
- Department of Dermatology, University Children's Hospital Niño Jesús, Madrid, Spain
| | - Antonio Torrelo
- Department of Dermatology, University Children's Hospital Niño Jesús, Madrid, Spain.
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18
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Ferrari B, Díaz MS, López M, Larralde M. Unusual skin manifestations associated with parvovirus B19 primary infection in children. Pediatr Dermatol 2018; 35:e341-e344. [PMID: 30230024 DOI: 10.1111/pde.13623] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Parvovirus B19 is a DNA virus of the Parvoviridae family. We present four children with unusual exanthems associated with parvovirus infection: a purpuric periflexural pattern, a purpuric vasculitic pattern, and a combination of the two.
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Affiliation(s)
- Bruno Ferrari
- Dermatology Service, Hospital Ramos Mejía, Buenos Aires, Argentina
| | - María Sol Díaz
- Dermatology Service, Hospital Ramos Mejía, Buenos Aires, Argentina
| | - Micaela López
- Dermatology Service, Hospital Ramos Mejía, Buenos Aires, Argentina
| | - Margarita Larralde
- Dermatology Service, Hospital Ramos Mejía, Buenos Aires, Argentina.,Dermatology Service, Hospital Alemán, Buenos Aires, Argentina
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19
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Kreuter A, Koushk Jalali B, Tigges C, Silling S, Lehmann P, Wieland U. Juvenile Spring Eruption Associated With Parvovirus B19 Infection. JAMA Dermatol 2018; 154:1356-1357. [DOI: 10.1001/jamadermatol.2018.2932] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Alexander Kreuter
- Department of Dermatology, Venerology, and Allergology, HELIOS St Elisabeth Hospital Oberhausen, University Witten/Herdecke, Oberhausen, Germany
| | - Bijan Koushk Jalali
- Department of Dermatology, Venerology, and Allergology, HELIOS St Elisabeth Hospital Oberhausen, University Witten/Herdecke, Oberhausen, Germany
| | - Christian Tigges
- Department of Dermatology, Venerology, and Allergology, HELIOS St Elisabeth Hospital Oberhausen, University Witten/Herdecke, Oberhausen, Germany
| | - Steffi Silling
- Institute of Virology, University of Cologne, Cologne, Germany
| | - Percy Lehmann
- Department of Dermatology, Allergology, and Dermatosurgery, HELIOS University Hospital Wuppertal, University of Witten/Herdecke, Wuppertal, Germany
| | - Ulrike Wieland
- Institute of Virology, University of Cologne, Cologne, Germany
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20
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Dollat M, Chaigne B, Cormier G, Costedoat-Chalumeau N, Lifermann F, Deroux A, Berthoux E, Dernis E, Sené T, Blaison G, Lambotte O, Terrier B, Sellam J, De Saint-Martin L, Chiche L, Dupin N, Mouthon L. Extra-haematological manifestations related to human parvovirus B19 infection: retrospective study in 25 adults. BMC Infect Dis 2018; 18:302. [PMID: 29973155 PMCID: PMC6033229 DOI: 10.1186/s12879-018-3227-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 06/29/2018] [Indexed: 01/19/2023] Open
Abstract
Background To describe extra-haematological manifestations associated with human parvovirus B19 (HPV-B19) infection. Methods We conducted a nationwide multicentre study to retrospectively describe the characteristics and outcome of extra-haematological manifestations in French adults. Results Data from 25 patients followed from 2001 to 2016 were analysed. Median age was 37.9 years (range: 22.7–83.4), with a female predominance (sex ratio: 4/1). Only 3 patients had an underlying predisposing condition (hemoglobinopathy or pregnancy). The most common manifestations were joint (80%) and skin (60%) involvement. Four patients (16%) had renal involvement (endocapillary proliferative or membranoproliferative glomerulonephritis, focal segmental glomerulosclerosis). Three patients (12%) had peripheral nervous system involvement (mononeuritis, mononeuritis multiplex, Guillain-Barré syndrome) and 2 (8%) presented muscle involvement. Other manifestations included hemophagocytic lymphohistiocytosis (n = 1), myopericarditis and pleural effusion (n = 1), and lymphadenopathy and splenomegaly mimicking lymphoma with spleen infarcts (n = 1). Immunological abnormalities were frequent (56.5%). At 6 months, all patients were alive, and 54.2% were in complete remission. In 2 patients, joint involvement evolved into rheumatoid arthritis. Six patients (24%) received intravenous immunoglobulin (IVIg), with a good response in the 3 patients with peripheral nervous system involvement. Conclusions HPV-B19 infection should be considered in a wide range of clinical manifestations. Although the prognosis is good, IVIg therapy should be discussed in patients with peripheral nerve involvement. However, its efficacy should be further investigated in prospective studies.
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Affiliation(s)
- Marion Dollat
- Service de Médecine Interne, Centre de Référence Maladies Systémiques Autoimmunes Rares d'Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Descartes, Paris, France
| | - Benjamin Chaigne
- Service de Médecine Interne, Centre de Référence Maladies Systémiques Autoimmunes Rares d'Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Descartes, Paris, France
| | - Grégoire Cormier
- Service de Rhumatologie, Centre Hospitalier Départemental Vendée, La Roche-sur-Yon, France
| | - Nathalie Costedoat-Chalumeau
- Service de Médecine Interne, Centre de Référence Maladies Systémiques Autoimmunes Rares d'Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Descartes, Paris, France
| | - François Lifermann
- Service de Médecine Interne, Centre Hospitalier de Dax - Côte d'Argent, Dax, France
| | - Alban Deroux
- Service de Médecine Interne, Centre Hospitalier Universitaire Grenoble Alpes, Université Grenoble Alpes, Grenoble, France
| | - Emilie Berthoux
- Service de Médecine Interne, Centre Hospitalier Saint-Joseph Saint-Luc, Lyon, France
| | - Emmanuelle Dernis
- Service de Rhumatologie, Centre Hospitalier - Le Mans, Le Mans, France
| | - Thomas Sené
- Service de Médecine Interne, Hôpital Foch, Suresnes, France
| | - Gilles Blaison
- Service de Médecine Interne, Centre Hospitalier Louis Pasteur, Colmar, France
| | - Olivier Lambotte
- Service de Médecine Interne et Immunologie, Hôpital Bicêtre, AP-HP, Université Paris-Sud, Le Kremlin-Bicêtre, France
| | - Benjamin Terrier
- Service de Médecine Interne, Centre de Référence Maladies Systémiques Autoimmunes Rares d'Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Descartes, Paris, France
| | - Jérémie Sellam
- Service de Rhumatologie, Hôpital Saint-Antoine, AP-HP, Université Pierre et Marie Curie, Paris, France
| | - Luc De Saint-Martin
- Service de Médecine Interne, Centre de Référence Maladies Systémiques Autoimmunes Rares Nord et Ouest, Centre Hospitalier Régional et Universitaire de Brest, Université de Bretagne Occidentale, Brest, France
| | - Laurent Chiche
- Service de Médecine Interne, Hôpital Européen, Marseille, France
| | - Nicolas Dupin
- Service de Dermatologie, Hôpital Cochin, AP-HP, Université Paris Descartes, Paris, France
| | - Luc Mouthon
- Service de Médecine Interne, Centre de Référence Maladies Systémiques Autoimmunes Rares d'Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Descartes, Paris, France. .,Service de médecine interne, Hôpital Cochin, 27, rue du faubourg Saint-Jacques, 75679, Paris Cedex 14, France.
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21
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Kappers W, Stevens G, Bruynseels P, van den Akker M. Papular Purpuric Gloves and Socks Syndrome because of a Mycoplasma Infection. J Pediatr 2018; 194:258-258.e2. [PMID: 29217102 DOI: 10.1016/j.jpeds.2017.10.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Revised: 10/22/2017] [Accepted: 10/24/2017] [Indexed: 01/02/2023]
Affiliation(s)
- Willemijn Kappers
- Department of Pediatrics Queen Paola Children's Hospital Antwerp, Belgium
| | - Greet Stevens
- Department of Pediatrics Queen Paola Children's Hospital Antwerp, Belgium
| | | | - Machiel van den Akker
- Department of Pediatrics Queen Paola Children's Hospital Antwerp, Belgium; Department of Pediatric Hematology Oncology UZ Brussel Brussels, Belgium
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22
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Immunohistochemical Demonstration of Parvovirus B19 Viral Protein 2 in Periflexural Exanthema in an Adult, Supporting Antibody-Dependent Enhancement as Means of Endothelial Uptake of the Virus. Am J Dermatopathol 2018; 40:e19-e24. [DOI: 10.1097/dad.0000000000000946] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Santonja C, Santos-Briz A, Palmedo G, Kutzner H, Requena L. Detection of human parvovirus B19 DNA in 22% of 1815 cutaneous biopsies of a wide variety of dermatological conditions suggests viral persistence after primary infection and casts doubts on its pathogenic significance. Br J Dermatol 2017; 177:1060-1065. [DOI: 10.1111/bjd.15382] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2017] [Indexed: 12/21/2022]
Affiliation(s)
- C. Santonja
- Department of Pathology; Hospital Universitario Fundación Jiménez Díaz; Madrid Spain
| | - A. Santos-Briz
- Departments of Pathology and Dermatology; Hospital Universitario de Salamanca; Salamanca Spain
| | - G. Palmedo
- Dermatopathologie Friedrichshafen; Friedrichshafen Germany
| | - H. Kutzner
- Dermatopathologie Friedrichshafen; Friedrichshafen Germany
| | - L. Requena
- Department of Dermatology; Hospital Universitario Fundación Jiménez Díaz/Universidad Autónoma de Madrid; Madrid Spain
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24
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Warris A, Kroon FP. Viral Exanthems. Infect Dis (Lond) 2017. [DOI: 10.1016/b978-0-7020-6285-8.00009-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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25
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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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26
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Vázquez-Osorio I, Mallo-García S, Rodríguez-Díaz E, Gonzalvo-Rodríguez P, Requena L. Parvovirus B19 infection presenting concurrently as papular-purpuric gloves-and-socks syndrome and bathing-trunk eruption. Clin Exp Dermatol 2016; 42:58-60. [DOI: 10.1111/ced.13013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2016] [Indexed: 11/29/2022]
Affiliation(s)
- I. Vázquez-Osorio
- Dermatology Service; Hospital Universtario de Cabueñes; Gijón Asturias Spain
| | - S. Mallo-García
- Dermatology Service; Hospital Universtario de Cabueñes; Gijón Asturias Spain
| | - E. Rodríguez-Díaz
- Dermatology Service; Hospital Universtario de Cabueñes; Gijón Asturias Spain
| | - P. Gonzalvo-Rodríguez
- Anatomy and Pathology Service; Hospital Universtario de Cabueñes; Gijón Asturias Spain
| | - L. Requena
- Dermatology Service; Fundación Jiménez Díaz; Madrid Spain
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27
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Viral exanthems: An update on laboratory testing of the adult patient. J Am Acad Dermatol 2016; 76:538-550. [PMID: 28413059 DOI: 10.1016/j.jaad.2016.08.034] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 08/16/2016] [Accepted: 08/17/2016] [Indexed: 12/24/2022]
Abstract
Although classic viral exanthems of childhood are well described, they are rarely differentiated in adults. Laboratory techniques for viral identification have advanced without substantial literature to suggest how a dermatologist ought to conduct a cost-effective and diagnostic viral panel. Certain clinical features such as petechiae, vesicles, and dusky macular or morbilliform exanthems point strongly toward a viral exanthem. Differentiation of drug and viral causes of morbilliform eruptions has proven difficult. It is possible that with further diagnostic refinement that unnecessary and fruitless workups of an exanthem and unneeded discontinuation of drugs can be avoided. We review viral exanthems based on clinical features and discuss the available and optimal laboratory techniques to assist the dermatologist in a targeted workup.
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28
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Neri I, Bassi A, Patrizi A. Cellulitis-Like Lesions: An Unusual Manifestation of a Parvovirus B19 Infection. J Pediatr 2016; 175:239. [PMID: 27266966 DOI: 10.1016/j.jpeds.2016.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Accepted: 05/05/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Iria Neri
- Division of Dermatology, Department of Specialized, Experimental, and Diagnostic Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Andrea Bassi
- Department of Health Sciences, University of Florence, Department of Pediatric Medicine, Anna Meyer Children's University Hospital, Florence, Italy
| | - Annalisa Patrizi
- Division of Dermatology, Department of Specialized, Experimental, and Diagnostic Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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29
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Hirai Y, Takeda Y. Atypical rashes in adult human Parvovirus B19 infection; atypical is typical. IDCases 2016; 5:32-3. [PMID: 27419073 PMCID: PMC4941584 DOI: 10.1016/j.idcr.2016.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 05/27/2016] [Accepted: 05/31/2016] [Indexed: 11/25/2022] Open
Affiliation(s)
- Yuji Hirai
- Juntendo University, Faculty of Medicine, Department of General Medicine, Japan
- Tokyo Women's Medical University, Department of Infectious Diseases, Japan
- Tokyo Metropolitan Health and Medical Treatment Corporation, Tama-Hokubu Medical Centre, Internal Medicine, Japan
- Ginza Hospital, Internal Medicine, Japan
- Corresponding author at: Juntendo University, Faculty of Medicine, Department of General Medicine, 2-1-1 Hongo, Bunkyo, Japan.Juntendo UniversityFaculty of MedicineDepartment of General MedicineJapan
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30
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Abstract
ABSTRACT
Primary parvovirus B19 infection is an infrequent, but serious and treatable, cause of chronic anemia in immunocompromised hosts. Many compromised hosts have preexisting antibody to B19 and are not at risk. However, upon primary infection, some patients may be able to mount a sufficient immune response to terminate active parvovirus B19 infection of erythroid precursors. The most common consequence of B19 infection in the compromised host is pure red-cell aplasia, resulting in chronic or recurrent anemia with reticulocytopenia. Anemia persists until neutralizing antibody is either produced by the host or passively administered. Parvovirus B19 should be suspected in compromised hosts with unexplained or severe anemia and reticulocytopenia, or when bone-marrow examination shows either giant pronormoblasts or absence of red-cell precursors. Diagnosis is established by detection of B19 DNA in serum in the absence of IgG antibody to B19. In some cases, IgG antibody is detected but is not neutralizing. Anti-B19 IgM may or may not be present. Therapy includes any or all of the following: red-cell transfusion, adjustment in medications to restore or improve the patient’s immune system, and administration of intravenous immunoglobulin (IVIG). Following treatment, patients should be closely monitored, especially if immunosuppression is unchanged or increased. Should hematocrit trend downward and parvovirus DNA trend upward, the therapeutic options above should be revisited. In a few instances, monthly maintenance IVIG may be indicated. Caregivers should be aware that B19 variants, though rarely encountered, can be missed or under-quantitated by some real-time polymerase-chain reaction methods.
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31
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Samanta D, Willis E. Focal seizure associated with human parvovirus B19 infection in a non-encephalopathic child. World J Pediatr 2016; 12:118-20. [PMID: 26684306 DOI: 10.1007/s12519-015-0060-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 12/12/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND The incidence of acute symptomatic (at the time of documented brain insult) seizures and single unprovoked seizures are 29-39 and 23-61 per 100 000 per year, respectively. After stabilization of the patient, finding the etiology of the seizure is of paramount importance. A careful history and physical examination may allow a diagnosis without need for further evaluation. METHODS In the literature, severe central nervous system involvement has been reported from human parvovirus B19 infection. We reported a previously healthy 7-year-old girl who presented after an episode of focal seizure. She was afebrile and didn't have any focal neurological abnormalities. She had erythematous malar rash along with reticulating pattern of rash over her both upper extremities. RESULTS Parvovirus infection was suspected due to the characteristic erythematous malar rash. Serum human parvovirus B19 DNA polymerase chain reaction was positive which was consistent with acute parvovirus infection. Further confirmation of current infection was done with Sandwich enzyme immunoassays showing positive anti-B19 IgM Index (>1.1). IgG index was equivocal (0.9-1.1). CONCLUSIONS We report an extremely rare presentation of non-febrile seizure from acute parvovirus infection in a child without encephalopathy who had an excellent recovery. Timely diagnosis can provide counselling regarding future seizure recurrence risk, curtail expenditure from expensive diagnostic work up and provide additional recommendations about potential risks to a pregnant caregiver.
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Affiliation(s)
- Debopam Samanta
- Division of Child Neurology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
| | - Erin Willis
- Division of Child Neurology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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33
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Kechaou I, Cherif E, Boukhris I, Azzabi S, Kaouech Z. Pseudo-erysipelas: A new atypical cutaneous manifestation of parvovirus B19 primary infection. Med Mal Infect 2016; 46:107-8. [PMID: 26791960 DOI: 10.1016/j.medmal.2015.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 11/11/2015] [Accepted: 12/07/2015] [Indexed: 11/16/2022]
Affiliation(s)
- I Kechaou
- Service de médecine interne B, hôpital Charles-Nicolle, faculté de médecine de Tunis, boulevard du 9-Avril-1938, El Manar, Tunisia.
| | - E Cherif
- Service de médecine interne B, hôpital Charles-Nicolle, faculté de médecine de Tunis, boulevard du 9-Avril-1938, El Manar, Tunisia
| | - I Boukhris
- Service de médecine interne B, hôpital Charles-Nicolle, faculté de médecine de Tunis, boulevard du 9-Avril-1938, El Manar, Tunisia
| | - S Azzabi
- Service de médecine interne B, hôpital Charles-Nicolle, faculté de médecine de Tunis, boulevard du 9-Avril-1938, El Manar, Tunisia
| | - Z Kaouech
- Service de médecine interne B, hôpital Charles-Nicolle, faculté de médecine de Tunis, boulevard du 9-Avril-1938, El Manar, Tunisia
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34
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Abstract
Dermatoses have been better characterized as hypochromic vitiligo in subjects with dark skin or the acquired racquet nails associated with hyperparathyroidism. The innate immunity has a central role in the new classification of auto inflammatory diseases, neutrophilic dermatoses, neutrophilic urticaria or pseudo-neutrophilic urticaria. Comorbidities have been studied e.g. cardiovascular co morbidities for psoriasis, IBD associated with hidradenitis suppurativa or neurological disorders associated with pemphigoid. Bullous pemphigoid could be renamed as cutaneous pemphigoid, it can be induced by drugs especially gliptins. Genetic predispositions are analyzed in auto inflammatory diseases, psoriasis (HLA), drug eruptions (HLA or cytokines). Telaprevir often induces rashes, which can be severe but other treatments against hepatitis C as interferon can also induce debilitating rashes, some eligible for drug tolerance induction. European guidelines for the definition, classification, diagnosis of chronic spontaneous urticaria have been published. Severe cutaneous adverse drug reactions may be associated with severe systemic symptoms such as organ involvement in AGEP or the occurrence of a shock in DRESS. Allover Europe, there is now an epidemic of contact allergies to methylisothiazolinone (MIT), contained in cosmetics, wet wipes but also in paints. MIT should be tested at 2.000 ppm in water, included in the standard series for patch tests. Its role has to be evoked in any case localized on the face or hand, airborne or generalized eczema. Among infectious diseases, skin manifestations due to Parvovirus have been specified, a febrile rash can be related to dengue infection or to Zika virus.
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Affiliation(s)
- A Barbaud
- Département de dermatologie et allergologie, bâtiment des spécialités médicales, hôpitaux de Brabois, centre hospitalo-universitaire de Nancy, 54500 Vandœuvre-les-Nancy, France.
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Drago F, Ciccarese G, Broccolo F, Javor S, Parodi A. Atypical exanthems associated with Parvovirus B19 (B19V) infection in children and adults. J Med Virol 2015; 87:1981-4. [DOI: 10.1002/jmv.24246] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2015] [Indexed: 11/10/2022]
Affiliation(s)
- Francesco Drago
- IRCCS A.O.U. San Martino-IST DISSAL; Department of Dermatology; Genoa Italy
| | - Giulia Ciccarese
- IRCCS A.O.U. San Martino-IST DISSAL; Department of Dermatology; Genoa Italy
| | - Francesco Broccolo
- Department of Health Sciences; University of Milano-Bicocca; Monza Italy
| | - Sanja Javor
- IRCCS A.O.U. San Martino-IST DISSAL; Department of Dermatology; Genoa Italy
| | - Aurora Parodi
- IRCCS A.O.U. San Martino-IST DISSAL; Department of Dermatology; Genoa Italy
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36
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Wolfromm A, Rodriguez C, Michel M, Habibi A, Audard V, Benayoun E, Rogier O, Challine D, Chosidow O, Lelièvre JD, Chevalier X, Le Bras F, Pautas C, Imbert M, Pawlotsky JM, Wagner-Ballon O. Spectrum of adult Parvovirus B19 infection according to the underlying predisposing condition and proposals for clinical practice. Br J Haematol 2015; 170:192-9. [PMID: 25920561 DOI: 10.1111/bjh.13421] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 02/21/2015] [Indexed: 12/22/2022]
Abstract
The virological diagnosis of Parvovirus B19 (PvB19) infection is currently based on sero-diagnosis, molecular methods or both, yet without clear recommendations. We retrospectively identified patients with polymerase chain reaction-positive PvB19 and/or positive serological assay between 2007 and 2013. Eighty-two adults with at least one diagnostic criterion of recent PvB19 infection (IgM antibodies, viral DNA in blood and/or in marrow) were included and classified into three homogeneous groups: 30 patients had no underlying predisposing condition, 25 a hereditary haemolytic anaemia, 27 an underlying immunodeficiency. The classical PvB19-related manifestations were less frequent in immunocompromised than in immunocompetent patients (arthromyalgia: 5 vs. 14; erythema: 4 vs. 17, respectively). Only 41·4% of patients with no underlying disease were anaemic. Bicytopenia and pancytopenia were observed mainly in immunocompromised patients. Classical pure red cell aplasia was observed in only 9 of the 27 marrow smears performed. Specific IgM were found in 93% of immunocompetent patients, whereas only 58% had detectable viral DNA in blood. IgM and DNA were present alone or together in all patients with hereditary haemolytic anaemia. In immunocompromised patients, the diagnosis was confirmed by marrow analysis in 91% of cases. We make some proposals based on this large series of PvB19-infected patients.
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Affiliation(s)
- Alice Wolfromm
- Département d'Hématologie et d'Immunologie Biologiques, Hôpital Henri Mondor, APHP, UPEC, Créteil, France
| | - Christophe Rodriguez
- Département de Virologie, Bactériologie-Hygiène, Mycologie-Parasitologie, Hôpital Henri Mondor, APHP, UPEC, Créteil, France.,INSERM U955, Créteil, France
| | - Marc Michel
- Service de Médecine interne, National Referral Centre For Adult Immune Cytopenias, Hôpital Henri Mondor, APHP, UPEC, Créteil, France
| | - Anoosha Habibi
- Unité des Maladies Génétiques du Globule Rouge, Hôpital Henri Mondor, APHP, UPEC, Créteil, France
| | - Vincent Audard
- INSERM U955, Créteil, France.,Service de Néphrologie et de Transplantation, Hôpital Henri Mondor, APHP, UPEC, Créteil, France
| | - Emmanuel Benayoun
- Département d'Hématologie et d'Immunologie Biologiques, Hôpital Henri Mondor, APHP, UPEC, Créteil, France
| | - Olivier Rogier
- Département de Virologie, Bactériologie-Hygiène, Mycologie-Parasitologie, Hôpital Henri Mondor, APHP, UPEC, Créteil, France
| | - Dominique Challine
- Département de Virologie, Bactériologie-Hygiène, Mycologie-Parasitologie, Hôpital Henri Mondor, APHP, UPEC, Créteil, France
| | - Olivier Chosidow
- Service de Dermatologie, Hôpital Henri Mondor, APHP, UPEC, Créteil, France.,French satellite of the Cochrane Skin Group, Créteil, France.,Centre d'Investigation Clinique 006, INSERM, Créteil, France
| | - Jean-Daniel Lelièvre
- INSERM U955, Créteil, France.,Service d'Immunologie clinique et Maladies infectieuses, Hôpital Henri Mondor, APHP, UPEC, Créteil, France
| | - Xavier Chevalier
- Service de Rhumatologie, Hôpital Henri Mondor, APHP, UPEC, Créteil, France
| | - Fabien Le Bras
- Unité Fonctionnelle d'Hémopathies lymphoïdes, Hôpital Henri Mondor, APHP, UPEC, Créteil, France
| | - Cécile Pautas
- Service d'Hématologie clinique, Hôpital Henri Mondor, APHP, UPEC, Créteil, France
| | - Michèle Imbert
- Département d'Hématologie et d'Immunologie Biologiques, Hôpital Henri Mondor, APHP, UPEC, Créteil, France
| | - Jean-Michel Pawlotsky
- Département de Virologie, Bactériologie-Hygiène, Mycologie-Parasitologie, Hôpital Henri Mondor, APHP, UPEC, Créteil, France.,INSERM U955, Créteil, France
| | - Orianne Wagner-Ballon
- Département d'Hématologie et d'Immunologie Biologiques, Hôpital Henri Mondor, APHP, UPEC, Créteil, France.,INSERM U955, Créteil, France
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38
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Drago F, Ciccarese G, Rebora A. Exanthems associated with parvovirus B19 infection in adults. J Am Acad Dermatol 2014; 71:1256. [DOI: 10.1016/j.jaad.2014.07.063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 07/16/2014] [Indexed: 10/24/2022]
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