1
|
Kagan KO, Hoopmann M, Geipel A, Sonek J, Enders M. Prenatal parvovirus B19 infection. Arch Gynecol Obstet 2024:10.1007/s00404-024-07644-6. [PMID: 39073431 DOI: 10.1007/s00404-024-07644-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2024] [Accepted: 07/09/2024] [Indexed: 07/30/2024]
Abstract
Parvovirus B19 (B19V) causes erythema infectiosum, a.k.a., fifth disease. This disease primarily affects children. It is generally self-limiting and subsides after 1-2 weeks. In pregnancy, the virus can cross the placenta and result in a fetal infection. This may lead to severe fetal anemia, hydrops fetalis, a miscarriage, or intrauterine fetal death. The risk of long-term sequelae also appears to be increased. About one-third of pregnant women are not immune to B19V and, therefore, are at risk to contract a primary infection. The seroconversion rate during pregnancy is generally around 1-2%. During a primary infection, maternal-fetal transplacental transmission of B19V occurs in about 30-50% of the cases and the risk of fetal infection increases with advancing gestational age. The risk of severe fetal anemia or hydrops is around 3-4% overall and is around 6-7% if the primary infection occurs before 20 weeks' gestation. Fetal monitoring in women with a primary B19V infection includes regular ultrasound examinations looking for evidence of hydrops fetalis and Doppler measurements of the middle cerebral artery peak velocity. Fetal blood sampling is performed if a significant anemia is suspected and, if such is found, an intrauterine blood transfusion is needed. This article provides an overview of the epidemiology, pathogenesis, clinical manifestations, diagnostic methods, and management of B19V infection during pregnancy.
Collapse
Affiliation(s)
- Karl Oliver Kagan
- Department of Obstetrics and Gynaecology, University Hospital Tuebingen, Calwerstrasse 7, 72076, Tuebingen, Germany.
| | - Markus Hoopmann
- Department of Obstetrics and Gynaecology, University Hospital Tuebingen, Calwerstrasse 7, 72076, Tuebingen, Germany
| | - Annegret Geipel
- Department of Obstetrics and Prenatal Medicine, University Hospital of Bonn, Bonn, Germany
| | - Jiri Sonek
- Division of Maternal Fetal Medicine, Boonshoft School of Medicine, Wright State University, Dayton, USA
| | - Martin Enders
- Laboratory Prof. Gisela Enders and Colleagues, Stuttgart, Germany, & German Consulting Laboratory for Parvoviruses, Stuttgart, Germany
| |
Collapse
|
2
|
De Paschale M, Ceriani C, Cerulli T, Cagnin D, Cavallari S, Zaongo D, Diombo K, Priuli G, Viganò P, Finazzi S, Clerici P. Prevalence of parvovirus B19 antibodies in pregnant women in northern Benin. Trop Med Int Health 2023; 28:226-231. [PMID: 36647788 DOI: 10.1111/tmi.13855] [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: 01/18/2023]
Abstract
OBJECTIVES Parvovirus B19 (B19V) infection in pregnancy is generally asymptomatic, but in about 3% it can cause complications, including miscarriage, severe foetal anaemia and foetal hydrops. The seroprevalence in pregnancy ranges from 20% to 82% in Africa, but there are no data for Benin. We therefore retrospectively assessed the seroprevalence of B19V in pregnant women attending the Saint Jean de Dieu Hospital in Tanguiéta, a rural district of Atacora, in northern Benin. METHODS We searched for anti-B19V immunoglobulin M (IgM) and immunoglobulin G (IgG) antibodies in 227 sequential sera from as many women (mean age 26.3 years, range: 16-41) of whom 30 were in the first trimester, 66 in the second and 131 in the third. Samples that tested positive for IgM were analysed with an immunoblot test and the viral genome (DNA-B19V) was searched for using a polymerase chain reaction. RESULTS Of the 227 women, 153 (67.4%) were positive for IgG anti-B19V, 7 (3.1%) for IgM and 73 (32.2%) were non-immune. Six IgM-positive women were also IgG positive. The difference in IgG seroprevalence between trimesters or ages was not statistically significant. Of the seven IgM-positive samples, three were confirmed positive by immunoblot (of which two were DNA-B19V positive), three were indeterminate (DNA-B19V negative) and one was negative (DNA-B19V negative). Of the three women with confirmed positive IgM, two were in the third trimester and one in the second trimester of pregnancy. CONCLUSIONS The seroprevalence of anti-B19V IgG among pregnant women in Benin is high and in line with those reported in some African countries. IgM seroprevalence is also similar to that described in some African countries in non-epidemic periods. The low viral load observed depicts non-acute infections, but it is difficult to establish the precise time of the infection, especially for women tested in the second or third trimester of pregnancy, when the observed viremia could be a sign of an acute infection that occurred in the previous trimester. Consequently, clinical follow-up and further investigations to highlight possible foetal consequences are indicated.
Collapse
Affiliation(s)
- Massimo De Paschale
- Microbiology Unit, ASST Ovest Milanese, Hospital of Legnano, Milan, Italy.,Laboratory Chimical Chemistry, ASST Ovest Milanese, Hospital of Legnano, Milan, Italy
| | - Cristina Ceriani
- Microbiology Unit, ASST Ovest Milanese, Hospital of Legnano, Milan, Italy.,Division of Microbiology and Immunology, Emory National Primate Research Center, Emory University, Atlanta, Georgia, USA
| | - Teresa Cerulli
- Microbiology Unit, ASST Ovest Milanese, Hospital of Legnano, Milan, Italy
| | - Debora Cagnin
- Microbiology Unit, ASST Ovest Milanese, Hospital of Legnano, Milan, Italy
| | | | | | | | | | | | - Sergio Finazzi
- Laboratory Chimical Chemistry, ASST Ovest Milanese, Hospital of Legnano, Milan, Italy
| | - Pierangelo Clerici
- Microbiology Unit, ASST Ovest Milanese, Hospital of Legnano, Milan, Italy
| |
Collapse
|
3
|
Di Paola N, Mesquita FS, Oliveira DBLD, Villabona-Arenas CJ, Zaki Pour S, de Sousa-Capra C, Lopes GP, Santana RAF, Pinho JRR, Balarini K, Pereira da Fonseca CRT, Zanotto PMDA. An Outbreak of Human Parvovirus B19 Hidden by Dengue Fever. Clin Infect Dis 2020; 68:810-817. [PMID: 30304533 DOI: 10.1093/cid/ciy630] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 08/01/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Seasonal outbreaks of dengue often result in hundreds of dengue-suspected cases where a clinical diagnosis cannot be confirmed. Usually, during large outbreaks of dengue and other pathogens that can cause acute febrile illnesses, the search for secondary pathogens with similar disease outcomes is rare. METHODS Using total RNA sequencing and targeted diagnostic assays, we discovered an outbreak of parvovirus B19 in dengue-suspected patients that occurred from November 2013 to February 2014. RESULTS Of the 182 cases investigated, 63% were viremic for the B19 virus. Moreover, we found that >43% of infected patients had no serological evidence of prior infection. Parvovirus B19 is a typical childhood infection, yet we observed that 82% of the infected patients were adults. Additionally, we perceived that infected adults had significantly higher presentations of myalgia than in children. We also obtained viral protein (VP) 1/VP2 gene nucleotide sequences from 43 patients. CONCLUSIONS Our results support the utility of next-generation sequencing for symptomatic patients with unknown etiologies during seasonal outbreaks of dengue and other arborviruses. Our findings could improve the vigilance of hospitals and laboratories by raising awareness of co-circulating pathogens such as parvovirus B19 that may be hidden in plain sight.
Collapse
Affiliation(s)
- Nicholas Di Paola
- Department of Microbiology, Institute of Biomedical Sciences, University of Sao Paulo, Brazil
| | - Flávio S Mesquita
- Department of Microbiology, Institute of Biomedical Sciences, University of Sao Paulo, Brazil
| | | | - Christian Julián Villabona-Arenas
- Recherches translationelles sur le virus de l'immunodéficience et les maladies infectieuses, Institut de Recherche pour le Développement, University of Montpellier, Institut national de la santé et de la recherche médicale, France
| | - Shahab Zaki Pour
- Department of Microbiology, Institute of Biomedical Sciences, University of Sao Paulo, Brazil
| | | | | | | | - João Renato Rebello Pinho
- Hospital Israelita Albert Einstein, Brazil.,Laboratório de Medicina Laboratorial/Laboratório de Gastroenterologia Clínica e Experimental Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Karime Balarini
- Itapema Laboratório de Análises Clínicas, Guarujá, São Paulo, Brazil
| | | | | |
Collapse
|
4
|
Barlinn R, Trogstad L, Rollag H, Frøen F, Magnus P, Dudman SG. Parvovirus B19 DNAemia in pregnant women in relation to perinatal death: A nested case-control study within a large population-based pregnancy cohort. Acta Obstet Gynecol Scand 2020; 99:856-864. [PMID: 31925774 DOI: 10.1111/aogs.13801] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 12/19/2019] [Accepted: 01/02/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Parvovirus B19 (B19V) is the infectious cause of exanthema infectiosum. In Europe around 40% of pregnant women are susceptible to infection. Having small children at home is the main risk factor for contracting an infection during pregnancy. The association between B19V-infection and perinatal death is not yet settled. The aims of the study were to estimate the association between maternal parvovirus B19 infection in pregnancy and perinatal death, and to assess the significance of a positive B19V PCR in pregnancy. MATERIAL AND METHODS The study population consists of women included in the Norwegian Mother and Child Cohort Study, a prospective population-based pregnancy cohort of nearly 100 000 women. Blood samples were obtained during weeks 17-18 in pregnancy (M1), at birth, and in umbilical cord blood. Within participants in the pregnancy cohort, 138 cases of perinatal death and 1350 controls with live-born children were included in a nested case-control study. Samples were analyzed with B19V serology and B19V PCR according to a predefined test algorithm. For cases, medical records and laboratory results from hospitals were combined with the results of B19V serology and PCR. The reported causes of perinatal death were categorized using the classification system: Causes Of Death and Associated Conditions (CODAC). RESULTS The B19V seroconversion rates were 9.8% for cases and 6.8% for control mothers. The odds ratio for maternal B19V infection in cases compared with controls was 1.28 (95% CI 0.35-4.70), adjusted for age, parity, body mass index and tobacco use. B19V-PCR-positive samples were detected at weeks 17-18 of gestation in both cases and controls. The proportion of positive samples was similar in cases and controls, 24% and 28.2%, respectively. Mothers with PCR-positive M1 samples transmitted B19V vertically in 9.1% of cases and in 11.9% of the controls. Of all perinatal deaths, 53% were attributed to placental pathology or unknown causes. CONCLUSIONS B19V PCR positivity was high and similar in both cases and controls. In our study B19V DNAemia was not seen to be associated with fatal outcome of pregnancy. The clinical significance of B19V DNA detection during pregnancy is uncertain. Caution is needed when diagnosing a B19V infection based only on B19V DNAemia.
Collapse
Affiliation(s)
- Regine Barlinn
- Department of Microbiology, Oslo University Hospital, Oslo, Norway
- Division for Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
- University of Oslo, Oslo, Norway
| | - Lill Trogstad
- Division for Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Halvor Rollag
- Department of Microbiology, Oslo University Hospital, Oslo, Norway
- University of Oslo, Oslo, Norway
| | - Fredrik Frøen
- Division for Health Care Services, Norwegian Institute of Public Health, Oslo, Norway
- University of Bergen, Bergen, Norway
| | - Per Magnus
- University of Oslo, Oslo, Norway
- Center for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Susanne G Dudman
- Department of Microbiology, Oslo University Hospital, Oslo, Norway
- University of Oslo, Oslo, Norway
| |
Collapse
|
5
|
Performance of Zika Assays in the Context of Toxoplasma gondii, Parvovirus B19, Rubella Virus, and Cytomegalovirus (TORCH) Diagnostic Assays. Clin Microbiol Rev 2019; 33:33/1/e00130-18. [PMID: 31826871 DOI: 10.1128/cmr.00130-18] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Infections during pregnancy that may cause congenital abnormalities have been recognized for decades, but their diagnosis is challenging. This was again illustrated with the emergence of Zika virus (ZIKV), highlighting the inherent difficulties in estimating the extent of pre- and postnatal ZIKV complications because of the difficulties in establishing definitive diagnoses. We reviewed the epidemiology, infection kinetics, and diagnostic methods used for Toxoplasma gondii, parvovirus B19, rubella virus, and cytomegalovirus (TORCH) infections and compared the results with current knowledge of ZIKV diagnostic assays to provide a basis for the inclusion of ZIKV in the TORCH complex evaluations. Similarities between TORCH pathogens and ZIKV support inclusion of ZIKV as an emerging TORCH infection. Our review evaluates the diagnostic performance of various TORCH diagnostic assays for maternal screening, fetal screening, and neonatal screening. We show that the sensitivity, specificity, and positive and negative predictive value of TORCH complex pathogens are widely variable, stressing the importance of confirmatory testing and the need for novel techniques for earlier and accurate diagnosis of maternal and congenital infections. In this context it is also important to acknowledge different needs and access to care for different geographic and resource settings.
Collapse
|
6
|
Abstract
Parvoviruses are structurally simple viruses with linear single-stranded DNA genomes and nonenveloped icosahedral capsids. They infect a wide range of animals from insects to humans. Parvovirus B19 is a long-known human pathogen, whereas adeno-associated viruses are nonpathogenic. Since 2005, many parvoviruses have been discovered in human-derived samples: bocaviruses 1-4, parvovirus 4, bufavirus, tusavirus, and cutavirus. Some human parvoviruses have already been shown to cause disease during acute infection, some are associated with chronic diseases, and others still remain to be proven clinically relevant-or harmless commensals, a distinction not as apparent as it might seem. One initially human-labeled parvovirus might not even be a human virus, whereas another was originally overlooked due to inadequate diagnostics. The intention of this review is to follow the rocky road of emerging human parvoviruses from discovery of a DNA sequence to current and future clinical status, highlighting the perils along the way.
Collapse
|
7
|
İnci A, Esmer AÇ. Investigation of Parvovirus B19 IgG and IgM antibodies with ELISA, distribution with regard to age groups and comparison with literature. JOURNAL OF CLINICAL AND EXPERIMENTAL INVESTIGATIONS 2018. [DOI: 10.5799/jcei.413067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
8
|
Bonvicini F, Bua G, Gallinella G. Parvovirus B19 infection in pregnancy-awareness and opportunities. Curr Opin Virol 2017; 27:8-14. [PMID: 29096233 DOI: 10.1016/j.coviro.2017.10.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 09/26/2017] [Accepted: 10/11/2017] [Indexed: 12/31/2022]
Abstract
Parvovirus B19 (B19V) is a human pathogenic virus associated with a wide range of clinical conditions. In pregnancy, B19V poses a potential hazard to the fetus as crossing the placental barrier and infecting erythroid progenitor cells in bone marrow and liver, it blocks fetal erythropoiesis leading to profound anemia, hydrops and/or fetal death. The virus is not regarded as a teratogen, however more scientific awareness is emerging on mechanisms and consequences of intrauterine infection and possible sequelae in the neonatal development. Reliable diagnostic procedures and fetal management strategies, including intrauterine transfusion, are established. In spite of being a recognized fetotropic agent possibly leading to fetal loss, testing for B19V is not routinely included in preconception or antenatal screenings, possibly delaying the management of B19V-complicated pregnancies. Continuous advances in B19V research will provide for better diagnostic methods and algorithms, as well as for the development of effective prophylactic interventions and novel therapeutic options.
Collapse
Affiliation(s)
- Francesca Bonvicini
- Department of Pharmacy and Biotechnology, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy.
| | - Gloria Bua
- Department of Pharmacy and Biotechnology, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy
| | - Giorgio Gallinella
- Department of Pharmacy and Biotechnology, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy; S.Orsola-Malpighi Hospital - Microbiology, Via Massarenti 9, 40138 Bologna, Italy
| |
Collapse
|
9
|
High incidence of maternal parvovirus B19 infection in a large unselected population-based pregnancy cohort in Norway. J Clin Virol 2017; 94:57-62. [DOI: 10.1016/j.jcv.2017.07.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 06/19/2017] [Accepted: 07/16/2017] [Indexed: 12/11/2022]
|
10
|
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.
Collapse
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
| |
Collapse
|
11
|
Hudson AC, Montegudo AE, Steele RW. Congenital human parvovirus b19 infection with persistent viremia. Clin Pediatr (Phila) 2015; 54:409-13. [PMID: 24807977 DOI: 10.1177/0009922814533412] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Anthony C Hudson
- Ochsner Children's Health Center, Tulane University School of Medicine, New Orleans, LA, USA University of Queensland School of Medicine, Ochsner Clinical Campus, New Orleans, LA, USA
| | - Anna E Montegudo
- Ochsner Children's Health Center, Tulane University School of Medicine, New Orleans, LA, USA University of Queensland School of Medicine, Ochsner Clinical Campus, New Orleans, LA, USA
| | - Russell W Steele
- Ochsner Children's Health Center, Tulane University School of Medicine, New Orleans, LA, USA University of Queensland School of Medicine, Ochsner Clinical Campus, New Orleans, LA, USA
| |
Collapse
|
12
|
Nadimpalli SS, Miller RS, Kamath VM, Farkouh CR, Nhan-Chang CL, Rathe JA, Collins A, Duchon JM, Neu N, Simpson LL, Ratner AJ. Congenital Parvovirus B19 Infection: Persistent Viremia and Red Blood Cell Aplasia. Open Forum Infect Dis 2015; 2:ofv049. [PMID: 26288800 PMCID: PMC4539735 DOI: 10.1093/ofid/ofv049] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 04/09/2015] [Indexed: 01/30/2023] Open
Abstract
We describe a case of fetal parvovirus B19 infection resulting in preterm birth and leading to hydrops fetalis requiring multiple in utero transfusions. The infant developed chronic postnatal anemia responsive to intravenous immunoglobulin therapy. Serum viral load decreased after immunoglobulin treatment but remained detectable for over 1 year.
Collapse
Affiliation(s)
| | - Russell S Miller
- Obstetrics and Gynecology, Columbia University Medical Center, New York, New York
| | | | | | - Chia-Ling Nhan-Chang
- Obstetrics and Gynecology, Columbia University Medical Center, New York, New York
| | | | | | | | | | - Lynn L Simpson
- Obstetrics and Gynecology, Columbia University Medical Center, New York, New York
| | | |
Collapse
|
13
|
Abstract
SUMMARYParvovirus B19 (B19V) infection during pregnancy may have serious consequences like fetal anaemia, hydrops fetalis, and fetal loss. Since epidemiological data on B19V infection are generally lacking in Sudan, the current study aimed to determine the seroprevalence of B19V in Sudanese pregnant women. Five hundred women, attending antenatal clinics in Khartoum state between November 2008 and March 2009, were enrolled and screened for B19V IgG and IgM antibodies by enzyme immunoassays. The study revealed a B19V IgG seroprevalence of 61·4%, with one subject positive for IgM. B19V DNA was not detected by PCR in any of the tested individuals. B19V IgG seroprevalence was significantly correlated with multigravidity (P = 0·046). Our data showed that B19V infection is prevalent in Sudan and we recommend further studies in Sudanese women, particularly in those with complications and adverse outcomes of pregnancy.
Collapse
|
14
|
Cooray M, Manolakos JJ, Wright DS, Haider S, Patel A. Parvovirus infection mimicking systemic lupus erythematosus. CMAJ 2013; 185:1342-4. [PMID: 23979870 DOI: 10.1503/cmaj.121565] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|
15
|
Dembinski J. Diagnosis of in utero Parvovirus B19 infection and maternal immune response - the relevance of linear epitopes and advanced serologic testing. ACTA ACUST UNITED AC 2013; 4:139-48. [PMID: 23484447 DOI: 10.1517/17530050903452190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
IMPORTANCE OF THE FIELD Parvovirus B19 (B19V) infection in utero causing fetal anemia and non-immune hydrops fetalis (NIHF) is a potentially life-threatening event for the fetus. Postexpositional non-invasive diagnosis is based on maternal IgG/IgM response and detection of viral genome in maternal blood. Serologic testing directs prenatal follow-up. Fetal infection is confirmed by polymerase chain reaction or in situ hybridization in fetal blood and/or amniotic fluid cells. The performance of serologic tests is significant in order to direct pre- and perinatal care at rational use of resources. Timing of diagnostic procedures and knowledge of the time course of infection in pregnant, asymptomatic women are critical. IgM negative testing in the presence of prolonged viremia may complicate individual risk analysis in pregnancy. Recently, advanced IgG avidity assays and epitope-type specific assays (IgG ETS EIA) have been re-evaluated. AREAS COVERED IN THIS REVIEW Epidemiology, clinical relevance and management of B19V infection in pregnancy. A review of the current literature (November 1984 - May 2009) and evaluation of current information on performance and predictive value of molecular and VP1/VP2 antigen-based IgG tests directed at the diagnosis of materno-fetal B19V infection and detection of past immunity. New aspects of B19V-associated fetal disease other than anemia/NIHF are also covered. WHAT THE READER WILL GAIN An overview of immunology and clinical relevance of B19V infection in pregnancy, of the potential value of advanced serologic testing and fields of future research. TAKE HOME MESSAGE In the absence of a commercially available vaccine, serologic tests remain important tools in individual risk analysis of pregnant women exposed to B19V. Sequential application of IgG avidity and IgG ETS EIAs may improve risk stratification and timing of invasive testing in B19V-exposed pregnancies, in particular with IgM-negativity and/or persistent DNAemia. Prospective evaluation of these test systems correlated to fetal outcome in order to reduce fetal morbidity and mortality as well as the overall burden of disease of B19V with regard to fetal malformation may be subject to future research.
Collapse
Affiliation(s)
- Jörg Dembinski
- Clinic of Pediatrics, Klinikum Itzehoe, Academic Teaching Hospital of Universitätsklinikum Hamburg Eppendorf UKE / Universitätsklinikum Schleswig-Holstein UKSH +49 0 4821 772 2201 ; +49 0 4821 772 2209 ;
| |
Collapse
|
16
|
Norja P, Lassila R, Makris M. Parvovirus transmission by blood products - a cause for concern? Br J Haematol 2012; 159:385-93. [PMID: 23025427 DOI: 10.1111/bjh.12060] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The introduction of dual viral inactivation of clotting factor concentrates has practically eliminated infections by viruses associated with significant pathogenicity over the last 20 years. Despite this, theoretical concerns about transmission of infection have remained, as it is known that currently available viral inactivation methods are unable to eliminate parvovirus B19 or prions from these products. Recently, concern has been raised following the identification of the new parvoviruses, human parvovirus 4 (PARV4) and new genotypes of parvovirus B19, in blood products. Parvoviruses do not cause chronic pathogenicity similar to human immunodeficiency virus or hepatitis C virus, but nevertheless may cause clinical manifestations, especially in immunosuppressed patients. Manufacturers should institute measures, such as minipool polymerase chain reaction testing, to ensure that their products contain no known viruses. So far, human bocavirus, another new genus of parvovirus, has not been detected in fractionated blood products, and unless their presence can be demonstrated, routine testing during manufacture is not essential. Continued surveillance of the patients and of the safety of blood products remains an important ongoing issue.
Collapse
Affiliation(s)
- Päivi Norja
- Department of Virology, Haartman Institute, Helsinki University, Helsinki, Finland
| | | | | |
Collapse
|
17
|
Puccetti C, Contoli M, Bonvicini F, Cervi F, Simonazzi G, Gallinella G, Murano P, Farina A, Guerra B, Zerbini M, Rizzo N. Parvovirus B19 in pregnancy: possible consequences of vertical transmission. Prenat Diagn 2012; 32:897-902. [PMID: 22777688 DOI: 10.1002/pd.3930] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Revised: 05/10/2012] [Accepted: 05/26/2012] [Indexed: 01/15/2023]
Abstract
OBJECTIVE The aim was to determine the outcome of pregnancies complicated by maternal Parvovirus B19 (B19) infection. METHOD Among 175 pregnant women referred to our clinic because of suspicion of a B19 infection, 63 with confirmed laboratory diagnosis of acute/recent B19 infection were followed up by ultrasound and Doppler measurement of the middle cerebral artery peak systolic velocity. RESULTS The vertical transmission rate was 31.7% (20/63). Of the 20 infected, 8 had hydrops, 1 had signs suggestive of meconium peritonitis and 1 had an isolated hydrothorax. Three fetuses presenting with hydrops were treated with intrauterine blood transfusion. Two of them died while the last showed resolution of anemia. Among the five untreated hydropic fetuses, one presented with mild signs that resolved spontaneously, two died at 16 and 17 weeks of gestation and two had also cardiomegaly and the parents opted for elective termination of pregnancy. All the anemic fetuses had middle cerebral artery peak systolic velocity values more than 1.8 multiples of the median. No stillbirth occurred. CONCLUSIONS The outcome of uncomplicated cases with B19 infection is good. In the presence of hydrops prognosis was very poor. It seems therefore logical to attempt to pick up this ominous signs early.
Collapse
Affiliation(s)
- C Puccetti
- Department of Obstetrics and Gynecology, Division of Prenatal Medicine, University of Bologna, Bologna, Italy.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Goncé A, Marcos MA, Borrell A, López M, Nadal A, Figueras F, Gratacós E. Maternal IgM antibody status in confirmed fetal cytomegalovirus infection detected by sonographic signs. Prenat Diagn 2012; 32:817-21. [PMID: 22639067 DOI: 10.1002/pd.3907] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To evaluate the value of maternal IgM to cytomegalovirus (CMV) as a predictive factor of fetal infection in fetuses with sonographic markers. METHODS Observational study (2006-2011) including a consecutive series of 19 fetuses with sonographic markers of fetal infection and confirmed infection by positive CMV-DNA in amniotic fluid or fetal blood. We evaluated the status of maternal CMV IgM at the time of sonographic suspicion. RESULTS During this 6-year study period, CMV infection was diagnosed in 19 fetuses from 18 pregnancies, including 16 singletons, both twins of a monochorionic diamniotic pregnancy and one twin of a dichorionic pregnancy. Sonographic suspicion was established on the basis of one or more of the following: brain abnormalities (14), fetal hydrops (4), hyperechogenic bowel (4), pericardial effusion (1), cardiomegaly (1), oligoanhydramnios (4), and placentomegaly (2). Maternal IgG antibodies were positive in all cases but maternal IgM antibodies were negative in 56% of pregnancies. Five of the 10 pregnancies with negative maternal IgM were diagnosed in the second trimester and five in the third trimester. CONCLUSION In around half of fetuses with confirmed CMV infection ascertained by sonographic markers, maternal IgM antibodies are negative and should therefore not be used as a diagnostic parameter.
Collapse
Affiliation(s)
- Anna Goncé
- Department of Maternal-Fetal Medicine, Institut Clinic de Ginecologia, Obstetricia i Neonatologia, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain.
| | | | | | | | | | | | | |
Collapse
|
19
|
|
20
|
Schiesser M, Sergi C, Enders M, Maul H, Schnitzler P. Discordant Outcomes in a Case of Parvovirus B19 Transmission Into Both Dichorionic Twins. Twin Res Hum Genet 2012; 12:175-9. [DOI: 10.1375/twin.12.2.175] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
AbstractMaternal infection with parvovirus B19 during pregnancy can cause aplastic anemia in the fetus and may lead to nonimmune fetal hydrops and fetal demise. Twin pregnancies complicated by infection due to parvovirus B19 are very rare clinical events. We present a dichorionic, diamniotic, dizygotic twin pregnancy after in vitro fertilization with parvovirus B19 infection and viral transmission to both twins, but different outcomes. At 19 weeks gestation, hydrops fetalis was diagnosed for male twin A, female twin B did not show any abnormalities. At 22 weeks gestation an acute parvovirus B19 infection was detected and twin A was diagnosed with intrauterine fetal death (IUFD) by ultrasound at 23 weeks gestation. Viral DNA was detected in maternal blood as well as in placenta and liver tissue of this twin. Twin B was born at 35 weeks gestation asymptomatically and no signs of hydrops or other congenital anomalies but viral DNA was detected by PCR in serum. At the age of 2 years, both IgG titres against B19 and parvovirus DNA amplification copies were still positive in plasma of the surviving twin, but no clinical signs were detectable. It is remarkable that both twins were infected with parvovirus B19 early in pregnancy but showed a discordant clinical outcome. Our case report describes the rare occurrence of an intrauterine fetal death (IUFD) of one twin and the asymptomatic infection of the other in a twin pregnancy.
Collapse
|
21
|
Weiffenbach J, Bald R, Gloning KP, Minderer S, Gärtner BC, Weidner A, Hanke M, Enders M. Serological and Virological Analysis of Maternal and Fetal Blood Samples in Prenatal Human Parvovirus B19 Infection. J Infect Dis 2012; 205:782-8. [DOI: 10.1093/infdis/jir855] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
|
22
|
Laboratory Diagnosis of Infection Due to Viruses, Chlamydia, Chlamydophila, and Mycoplasma. PRINCIPLES AND PRACTICE OF PEDIATRIC INFECTIOUS DISEASES 2012. [PMCID: PMC7152074 DOI: 10.1016/b978-1-4377-2702-9.00289-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
23
|
Plentz A, Modrow S. Diagnosis, management and possibilities to prevent parvovirus B19 infection in pregnancy. Future Virol 2011. [DOI: 10.2217/fvl.11.120] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Human parvovirus B19 (B19V) infection in pregnancy can cause severe fetal anemia and nonimmune hydrops fetalis, which may be associated with spontaneous abortion and fetal death. Approximately 30–40% of women of child-bearing age are not immune to B19V infection. The risk to fetal life is particularly high if maternal infection occurs during the first 20 weeks of gestation. In this article we intend to give an overview on the molecular biology, epidemiology and management of B19V infection during pregnancy. These data will be combined with an assessment of the clinical situation of the infected fetus and the possibilities for avoiding and/or preventing B19V infection in pregnant women. Currently B19V infection is the causative agent of one of the most frequently occurring infectious complications in pregnancy that endangers fetal life, and so the necessity to develop a preventive vaccine is discussed.
Collapse
Affiliation(s)
- Annelie Plentz
- Institut für Medizinische Mikrobiologie und Hygiene, Universität Regensburg, Franz-Josef-Strauß Allee 11, 93053 Regensburg, Germany
| | | |
Collapse
|
24
|
False-negative serology in patients with acute parvovirus B19 infection. J Clin Virol 2011; 51:115-20. [PMID: 21530386 DOI: 10.1016/j.jcv.2011.03.012] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Revised: 03/18/2011] [Accepted: 03/30/2011] [Indexed: 12/21/2022]
Abstract
BACKGROUND Acute parvovirus B19 (B19V) infection is characterized by high-level viremia. Antibodies against the capsid proteins VP1 and VP2 may complex with B19V-particles thereby becoming undetectable in diagnostic tests. OBJECTIVES We intended to obtain data on the frequency of false-negative serology in acute B19V-infection. STUDY DESIGN 129 plasma or serum samples of healthy blood donors and of patients with suspected B19V-infection were analyzed for B19V-DNA by qPCR and VP1/VP2-specific IgG and IgM by ELISA. Eleven of these samples were derived from four pregnant women with previous contact to B19V-infected individuals. Using acidic conditions virus/antibody-complexes were disrupted and detected by WesternLine and ELISA. RESULTS 83/118 samples were derived from acutely infected individuals displaying viremia (10(3)-10(12)geq/mL). In 24/83 viremic samples (28.9%) VP1/VP2-specific IgM and IgG were undetectable in ELISA, but could be demonstrated to be complexed with B19V-particles. Each 7/83 (8.4%) was IgM-positive/IgG-negative and IgM-negative/IgG-positive, in 45/83 samples (54.2%) IgG and IgM could be detected. 35 samples did not contain B19V-DNA; five of these were from seronegative persons. Analyzing consecutive sera derived from four pregnant women, B19V-DNA was demonstrated in 10/11 samples, B19V-specific IgG- and IgM-antibodies were detectable in 10/11 and 4/11 samples, respectively. In 2/4 women seroconversion was observed, but IgM was not detected in 50% of the samples. B19V-specific IgG but not IgM was detectable in 2/4 women. CONCLUSION Acute B19V-infection cannot be diagnosed by exclusive analysis of B19V-specific antibodies. Only the combination of assays for detection of B19V-DNA and antibodies enables correct serodiagnosis.
Collapse
|
25
|
de Jong EP, Walther FJ, Kroes ACM, Oepkes D. Parvovirus B19 infection in pregnancy: new insights and management. Prenat Diagn 2011; 31:419-25. [PMID: 21351281 DOI: 10.1002/pd.2714] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Revised: 12/23/2010] [Accepted: 01/09/2011] [Indexed: 11/07/2022]
Abstract
In this article, we review the virology, pathology, epidemiology and clinical spectrum of intrauterine human parvovirus B19 (B19V) infection, including intrauterine fetal death, non-immune hydrops fetalis, thrombocytopenia and neurological manifestations such as pediatric stroke and perivascular calcifications. In addition, we discuss the new insights into the neurodevelopmental outcome of intrauterine B19V infection. Current diagnosis and management of B19V infection is summarized, including a diagnostic and follow-up flowchart for practical clinical use.
Collapse
Affiliation(s)
- E P de Jong
- Department of Pediatrics, HAGA Hospital, Juliana's Childrens Hospital, The Hague, The Netherlands.
| | | | | | | |
Collapse
|
26
|
Lamont RF, Sobel J, Vaisbuch E, Kusanovic JP, Mazaki-Tovi S, Kim SK, Uldbjerg N, Romero R. Parvovirus B19 infection in human pregnancy. BJOG 2011; 118:175-86. [PMID: 21040396 PMCID: PMC3059196 DOI: 10.1111/j.1471-0528.2010.02749.x] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Human parvovirus B19 infection is widespread. Approximately 30-50% of pregnant women are nonimmune, and vertical transmission is common following maternal infection in pregnancy. Fetal infection may be associated with a normal outcome, but fetal death may also occur without ultrasound evidence of infectious sequelae. B19 infection should be considered in any case of nonimmune hydrops. Diagnosis is mainly through serology and polymerase chain reaction. Surveillance requires sequential ultrasound and Doppler screening for signs of fetal anaemia, heart failure and hydrops. Immunoglobulins, antiviral and vaccination are not yet available, but intrauterine transfusion in selected cases can be life saving.
Collapse
Affiliation(s)
- Ronald F. Lamont
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland and Detroit, Michigan, USA
- Wayne State University School of Medicine, Department of Obstetrics and Gynecology, Detroit, Michigan, USA
| | - Jack Sobel
- Wayne State University School of Medicine, Department of Infectious Diseases, Detroit, Michigan, USA
| | - Edi Vaisbuch
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland and Detroit, Michigan, USA
- Wayne State University School of Medicine, Department of Obstetrics and Gynecology, Detroit, Michigan, USA
| | - Juan Pedro Kusanovic
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland and Detroit, Michigan, USA
- Wayne State University School of Medicine, Department of Obstetrics and Gynecology, Detroit, Michigan, USA
| | - Shali Mazaki-Tovi
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland and Detroit, Michigan, USA
- Wayne State University School of Medicine, Department of Obstetrics and Gynecology, Detroit, Michigan, USA
| | - Sun Kwon Kim
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland and Detroit, Michigan, USA
| | - Niels Uldbjerg
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland and Detroit, Michigan, USA
| | - Roberto Romero
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland and Detroit, Michigan, USA
- Wayne State University School of Medicine, Department of Obstetrics and Gynecology, Detroit, Michigan, USA
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, Michigan, USA
| |
Collapse
|
27
|
Reed M, Sundberg B. Fetal Parvovirus B19 Infection Presenting With Nonimmune Hydrops Fetalis. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2011. [DOI: 10.1177/8756479310389046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Parvovirus B19 is an easily transmitted virus that is common in young children but can infect gravid women if they do not have immunity. If this virus crosses the placenta and becomes a fetal infection, it can be potentially fatal to the fetus. This case report depicts the diagnosis and subsequent treatment of a fetus infected with parvovirus B19.
Collapse
Affiliation(s)
| | - Brandy Sundberg
- Center for Genetics and Maternal Fetal Medicine, Eugene, OR, USA
| |
Collapse
|
28
|
Abstract
Parvovirus B19 is a single-stranded DNA virus which causes severe disease in immunocompromised patients and foetal loss in pregnant women. It is classified as an Erythrovirus and this genus also comprises two related viral genotypes (so-called LaLi/A6 (genotype 2) and V9 (genotype 3)) which appear to be immunologically indistinguishable from Parvovirus B19. Serological and nucleic acid test (NAT) systems to detect Parvovirus B19-mediated infection are commercially available; however, some NAT systems are genotype-specific. International standard preparations of Parvovirus B19 IgG and DNA have been produced for assay standardisation purposes, and to ensure consistency of assay manufacture and performance. Immunological assays, such as B-cell ELISpot, T-cell stimulation, and cytokine detection can also be used to confirm exposure to Parvovirus B19. Immunohistochemical techniques, employing commercially available monoclonal antibodies, are used to localise the virus in infected tissue and Parvovirus B19 viral antigen can also be detected in serum and plasma using antigen-specific ELISA. NAT systems have also been described to detect newly identified parvoviruses such as human bocavirus (HBoV), PARV4, and PARV5, although absolute confirmation of clinical diseases associated with these agents is required. This chapter describes the current status of detection systems for all the aforementioned parvoviruses, with particular emphasis on Erythrovirus detection by serological, NAT, and immunological approaches.
Collapse
Affiliation(s)
- Sean Doyle
- Department of Biology, National University Ireland, Maynooth, Ireland.
| |
Collapse
|
29
|
Facial rash in a pregnant woman. J Clin Virol 2009; 46:105-6. [PMID: 19716763 DOI: 10.1016/j.jcv.2009.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
30
|
Enders M, Lindner J, Wenzel JJ, Baisch C, Schalasta G, Enders G, Modrow S. No detection of human bocavirus in amniotic fluid samples from fetuses with hydrops or isolated effusions. J Clin Virol 2009; 45:300-3. [DOI: 10.1016/j.jcv.2009.04.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2008] [Revised: 04/16/2009] [Accepted: 04/20/2009] [Indexed: 11/29/2022]
|
31
|
Abstract
Human parvovirus B19 (B19) is common in society. Among adults, more than 50% have contracted the infection and immunity is believed to last lifelong. Infection occurs in a few percent of pregnancies, and albeit rare it can then cause fetal anemia, non-immune fetal hydrops and fetal death. Among cases with fetal demise, B19 is found in significant numbers, especially in the second and third trimesters of pregnancy. There is no specific treatment or prophylaxis available against B19 infection, but counseling of non-immune mothers and active monitoring of confirmed maternal infections with intervention to correct fetal anemia is likely to decrease mortality. Passive immunization also has potential to resolve fetal complications, but needs further study.
Collapse
Affiliation(s)
- Thomas Tolfvenstam
- Department of Medicine, Solna, Unit of Infectious Diseases, Center for Molecular Medicine, Karolinska Institutet, Karolinska University Hospital, B2:00, SE-17176 Stockholm, Sweden.
| | | |
Collapse
|