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Jin H, Lee JW, Ju HY, Cho HW, Hyun JK, Sung KW, Koo HH, Kim HJ, Yoo KH. A Case of Hereditary Spherocytosis Initially Manifested as an Aplastic Crisis Caused by Parvovirus B19 Infection. CLINICAL PEDIATRIC HEMATOLOGY-ONCOLOGY 2020. [DOI: 10.15264/cpho.2020.27.2.120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Hyungsuk Jin
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Won Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hee Young Ju
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hee Won Cho
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ju Kyung Hyun
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ki Woong Sung
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hong Hoe Koo
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hee-Jin Kim
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Keon Hee Yoo
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Cilla N, Domitien L, Arrada N, Chiffre D, Mahe P, Vincent L, Aguilar-Martinez P, Foulongne V. Transient aplastic crisis triggered by parvovirus B19 in a family with hereditary spherocytosis. IDCases 2020; 21:e00802. [PMID: 32461906 PMCID: PMC7242858 DOI: 10.1016/j.idcr.2020.e00802] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/05/2020] [Accepted: 05/05/2020] [Indexed: 12/14/2022] Open
Abstract
Acute parvovirus B19 infection may lead to erythroblastopenia crisis in patients with underlying red blood cells disorders. We report herein an uncommon concomitant transient aplastic crisis in a mother and her daughter, both affected by hereditary spherocytosis. The diagnosis was confirmed by the detection of a very high parvovirus B19 DNA load in both the mother’s and daughter’s sera, associated with the presence of parvovirus B19 specific immunoglobulin-M antibodies. This rapid etiologic diagnosis allowed to save bone marrow sampling, although blood transfusion was required regarding the severe anemia associated with pancytopenia. Our observation illustrates first line parvovirus B19 hypothesis in the context of transient aplastic crisis and that contagiousness in household contacts should be considered in family with a medical history of red blood cell pathology.
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Affiliation(s)
- Nicolas Cilla
- Department of Clinical Hematology, Montpellier University Hospital, 34295, Montpellier, France
| | - Léa Domitien
- Division of Hematologic Diseases, Department of Pediatrics, Montpellier University Hospital, University Montpellier, Montpellier, France
| | - Neila Arrada
- Pathogenesis and Control of Chronic Infections, University of Montpellier, INSERM, EFS, Montpellier University Medical Centre, 34090, Montpellier, France
| | - Delphine Chiffre
- Department of Biological Hematology, Montpellier University Medical Centre & University of Montpellier, Montpellier, France
| | - Perrine Mahe
- Division of Hematologic Diseases, Department of Pediatrics, Montpellier University Hospital, University Montpellier, Montpellier, France.,Reference Center on Rare Red Cell Disorders, Montpellier University Medical Centre, Montpellier, France
| | - Laure Vincent
- Department of Clinical Hematology, Montpellier University Hospital, 34295, Montpellier, France
| | - Patricia Aguilar-Martinez
- Department of Biological Hematology, Montpellier University Medical Centre & University of Montpellier, Montpellier, France.,Reference Center on Rare Red Cell Disorders, Montpellier University Medical Centre, Montpellier, France
| | - Vincent Foulongne
- Pathogenesis and Control of Chronic Infections, University of Montpellier, INSERM, EFS, Montpellier University Medical Centre, 34090, Montpellier, France
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Kalmuk J, Matar S, Feng G, Kilb E, Lim MY. Parvovirus B19-induced hemophagocytic lymphohistiocytosis: Case report and review of the literature. Clin Case Rep 2019; 7:2076-2081. [PMID: 31788255 PMCID: PMC6878072 DOI: 10.1002/ccr3.2401] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 05/27/2019] [Accepted: 05/28/2019] [Indexed: 12/21/2022] Open
Abstract
HLH is a catastrophic and likely underdiagnosed pathology with multiple triggers including infection. PVB19 can cause persistent marrow infection leading to HLH despite negative acute serologic markers making timely diagnosis difficult. Increased awareness of PVB19-HLH is warranted given its potentially lethal nature and the careful interpretation required with serologic markers.
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Affiliation(s)
- James Kalmuk
- Department of Internal MedicineMedical University of South CarolinaCharlestonSCUSA
| | - Sara Matar
- Department of Hematology/OncologyMedical University of South CarolinaCharlestonSCUSA
| | - Gong Feng
- Department of Pathology and Laboratory MedicineMedical University of South CarolinaCharlestonSCUSA
| | - Edward Kilb
- Department of Pulmonary and Critical Care MedicineMedical University of South CarolinaCharlestonSCUSA
| | - Ming Y. Lim
- Department of Hematology/OncologyMedical University of South CarolinaCharlestonSCUSA
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Ishikawa A, Yoto Y, Tsugawa T, Tsutsumi H. Quantitation of human parvovirus B19 DNA in erythema infectiosum and aplastic crisis. J Med Virol 2014; 86:2102-6. [PMID: 24962467 DOI: 10.1002/jmv.23930] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2014] [Indexed: 11/10/2022]
Abstract
Several publications concerning the methods of real-time PCR for human parvovirus B19 (B19V) have appeared and some case reports mention B19V DNA loads. However, no large-scale study quantitating levels of B19V DNA in common or representative B19V manifestations such as erythema infectiosum and aplastic crisis has been performed. Consequently, using the TaqMan PCR assay, the B19V load in a large sample of subjects with erythema infectiosum or aplastic crisis was quantitated. Sixty-five subjects in the acute phase of erythema infectiosum were involved, and in addition 22 serum samples from seven subjects with B19V-associated aplastic crisis complicating chronic hemolytic anemia were also analyzed. In the acute phase of erythema infectiosum the median B19V DNA load in the serum samples from the acute phase of erythema infectiosum was 7.63 × 10(5) genomes/ml, (range from 4.48 × 10(3) to 8.31 × 10(6) genomes/ml). The serum B19V DNA load during the acute phase of aplastic crisis complicating chronic hemolytic anemia was extremely high, that is 10(10) -10(13) genomes/ml, and decreased gradually to around 10(5) genomes/ml over 1-2 months. Although all subjects followed an almost uniform and typical clinical course of erythema infectiosum, there was a large individual variation of B19V DNA loads, that is differences of over 1,000 times. Extremely high B19V loads were observed in subjects with aplastic crisis. This study is the first large scale report of studies of the B19V DNA loads in subjects with erythema infectiosum and aplastic crisis, the most common and significant clinical manifestations by B19V infections.
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Affiliation(s)
- Aki Ishikawa
- Department of Pediatrics, Sapporo Medical University School of Medicine, Sapporo, Japan
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[Acute erythroblastopenia due to Parvovirus B19 revealing hereditary spherocytosis]. Arch Pediatr 2011; 18:990-2. [PMID: 21820287 DOI: 10.1016/j.arcped.2011.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Revised: 04/04/2011] [Accepted: 06/15/2011] [Indexed: 11/24/2022]
Abstract
Acute Parvovirus B19 infection is responsible for blocking the erythroblastic line, usually with no consequences on hematopoiesis except in patients with chronic hemolytic anemia in whom it can evolve to potentially serious acute anemia. We report 2 observations of acute erythroblastopenia revealing hereditary spherocytosis in 2 children (1 boy and 1 girl) of non-consanguineous parents.
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Chehadeh W, Halim MA, Al-Nakib W. Antibody-mediated opsonization of red blood cells in parvovirus B19 infection. Virology 2009; 390:56-63. [PMID: 19450862 DOI: 10.1016/j.virol.2009.04.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2009] [Revised: 04/01/2009] [Accepted: 04/22/2009] [Indexed: 11/28/2022]
Abstract
Red blood cells (RBCs) express abundantly parvovirus B19 receptor, and their role in the dissemination or clearance of B19 infection is unknown. In this study, we report that in early, acute or persistent infection, B19 viremia is mostly associated with RBCs. The capacity of different patients' plasma or IgG to opsonize RBCs collected from patients with early B19 infection, was investigated. The highest opsonization activity was observed with plasma or IgG fractions from patients with past B19 infection. In contrast, IgG samples from patients with acute or persistent infection showed no or little opsonization activity. The depletion of antibodies specific to B19 VP1, but not VP2, from IgG samples, resulted in a significant suppression of opsonization. Furthermore, IgG samples preincubated with heated B19 particles exposing VP1-unique (VP1u) region were unable to opsonize RBCs. These observations clearly suggest a role for anti-VP1u IgG in the opsonization of RBC-bound B19 particles.
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Affiliation(s)
- Wassim Chehadeh
- Virology Unit, Department of Microbiology, Faculty of Medicine, Kuwait University, PO Box 24923, Safat 13310 Kuwait
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Yilmaz S, Oren H, Demircioğlu F, Firinci F, Korkmaz A, Irken G. Parvovirus B19: a cause for aplastic crisis and hemophagocytic lymphohistiocytosis. Pediatr Blood Cancer 2006; 47:861. [PMID: 16514614 DOI: 10.1002/pbc.20807] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
MESH Headings
- Adolescent
- Anemia, Aplastic/complications
- Anemia, Aplastic/pathology
- Anemia, Aplastic/therapy
- Antibodies, Viral/blood
- Erythrocyte Transfusion
- Female
- Fibrin Fibrinogen Degradation Products/analysis
- Humans
- Immunoglobulins/administration & dosage
- Immunoglobulins, Intravenous/therapeutic use
- Lymphohistiocytosis, Hemophagocytic/complications
- Lymphohistiocytosis, Hemophagocytic/pathology
- Lymphohistiocytosis, Hemophagocytic/therapy
- Male
- Parvoviridae Infections/blood
- Parvoviridae Infections/complications
- Parvoviridae Infections/diagnosis
- Parvovirus B19, Human/immunology
- Spherocytosis, Hereditary/complications
- Treatment Outcome
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Affiliation(s)
- S Yilmaz
- Department of Pediatric Hematology, Dokuz Eylül University Faculty of Medicine, Izmir, Turkey
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Abstract
Parvovirus B19 (B19) was discovered in 1974 and is the only member of the family Parvoviridae known to be pathogenic in humans. Despite the inability to propagate the virus in cell cultures, much has been learned about the pathophysiology of this virus, including the identification of the cellular receptor (P antigen), and the control of the virus by the immune system. B19 is widespread, and manifestations of infection vary with the immunologic and hematologic status of the host. In healthy immunocompetent individuals B19 is the cause of erythema infectiosum and, particularly in adults, acute symmetric polyarthropathy. Due to the tropism of B19 to erythroid progenitor cells, infection in individuals with an underlying hemolytic disorder causes transient aplastic crisis. In the immunocompromised host persistent B19 infection is manifested as pure red cell aplasia and chronic anemia. Likewise, the immature immune response of the fetus may render it susceptible to infection, leading to fetal death in utero, hydrops fetalis, or development of congenital anemia. B19 has also been suggested as the causative agent in a variety of clinical syndromes, but given the common nature, causality is often difficult to infer. Diagnosis is primarily based on detection of specific antibodies by enzyme-linked immunosorbent assay or detection of viral DNA by dot blot hybridization or PCR. Treatment of persistent infection with immunoglobulin reduces the viral load and results in a marked resolution of anemia. Vaccine phase I trials show promising results.
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Affiliation(s)
- Erik D Heegaard
- Department of Clinical Microbiology, University State Hospital, Rigshospitalet, Copenhagen, Denmark
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Granel B, Serratrice J, Rey J, David M, Pache X, Bernit E, Swiader L, Disdier P, Weiller PJ. [Acute transitory intrafamilial erythroblastopenia and hereditary spherocytosis: role of parvovirus B19]. Rev Med Interne 2001; 22:664-7. [PMID: 11508161 DOI: 10.1016/s0248-8663(01)00405-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Acute parvovirus B19 infection induces a transient inhibition of erythroid cell formation, which may induce an erythroblastopenia crisis in patients suffering from chronic hemolytic anemia. EXEGESIS We report here an exceptional observation of acute erythroblastopenia crisis with good outcome, occurring at the same time in a mother and her son, both suffering from hereditary spherocytosis. Diagnosis of parvovirus infection is based on detection of serum parvovirus B19-specific immunoglobulin M antibodies in the mother and her son and by the positivity of parvovirus B19 DNA detected by PCR in serum in the mother. Outcome was good, with the end of the erythroblastopenia crisis obtained 7 to 10 days later, but requiring blood transfusion in the mother. CONCLUSION Our observation is a reminder that the contagiosity of parvovirus B19 is high in household contacts and that protection of family members should rapidly be considered in hereditary spherocytosis.
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Affiliation(s)
- B Granel
- Service de médecine interne, hôpital de la Timone, 264, rue Saint-Pierre, 13385 Marseille, France
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