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Tambi P, Dave R, Kute V, Patel HV, Shah S, Yadav R. Parvovirus in Kidney Transplant Recipients: A Single-Center Experience. EXP CLIN TRANSPLANT 2023; 21:868-871. [PMID: 38140930 DOI: 10.6002/ect.2023.0127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Abstract
OBJECTIVES Parvovirus testing is not done in routine clinical practice; thus, it is possible that reported parvovirus cases are just the tip of the iceberg of total prevalence. We present a single-center retrospective analysis of 22 events of parvovirus B19 anemia in 20 renal transplant recipients, among which 2 patients had recurrence. MATERIALS AND METHODS For this descriptive analytical study, parvovirus B19 disease was defined as parvovirus infection (detection by real-time polymerase chain reaction) in the presence of anemia with clinical symptoms or bone marrow biopsy findings consistent with the diagnosis. Study duration was 18 months, from June 2021 through December 2022, and patients were enrolled from a single center. RESULTS All patients detected with the virus had received induction with thymocyte globulin and were on standard triple drug immunosuppression. Mean age was 32 ± 12 years with median time to diagnosis of 2 months after transplant. Anemia was observed in all patients with mean hemoglobin level at presentation of 6.02 ± 1.28 g/dL. Creatinine at presentation was 1.49 mg/dL (interquartile range, 0.92-2.69 mg/dL). The most common presentation was asymptomatic patient with evaluation for anemia. During therapy, the highest median creatinine level was 2.0 mg/dL (interquartile range, 1.38-3.2 mg/dL), which was significantly higher than that at presentation (P < .018). After therapy, median creatinine level was 1.3 mg/dL, which was not significantly higher than the baseline level, demonstrating a mostly transient graft dysfunction. CONCLUSIONS Parvovirus B19 is a relatively underreported disease in renal transplant recipients, with patients presenting with anemia and the disease causing transient graft dysfunction. Parvovirus B19 infection responds well to a decrease in immunosuppression and intravenous immunoglobulin therapy.
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Affiliation(s)
- Priyash Tambi
- From the Department of Nephrology and Transplantation, Institute of Kidney Disease and Research Center, Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, Gujarat, India
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Yaghoubi F, Dalil D, Tavakoli F, Hosseini SM. Relapsing anemia associated with parvovirus B19 infection in a kidney transplant recipient: A case report and review of the literature. Clin Case Rep 2023; 11:e7906. [PMID: 37692152 PMCID: PMC10485237 DOI: 10.1002/ccr3.7906] [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: 06/05/2023] [Revised: 08/25/2023] [Accepted: 08/28/2023] [Indexed: 09/12/2023] Open
Abstract
Key clinical message PB19 infection should be considered an uncommon cause of posttransplant anemia in renal transplant recipients, particularly those whose anemia is not associated with common etiologies. IVIG treatment and reduced immunosuppression could be beneficial. Abstract Parvovirus B19-associated relapsing anemia is rare in kidney transplant recipients. Herein, we report a case of relapsed anemia due to parvovirus B19 infection in a 53-year-old woman 18 months after kidney transplantation. The patient presented with palpitations, shortness of breath, dizziness, weakness, and lethargy. Early laboratory findings showed a WBC count of 6.000/μL, RBC count of 1.89/μL, hemoglobin (Hb) 3.5 g/dL, hematocrit (Hct) 15%, platelet count 266.000/μL, MCV 89, reticulocyte count 0.8%, and serum iron 221 μg/dL. Upon further evaluation, the RT-PCR test for BK polyomavirus and cytomegalovirus (CMV) was negative, while the parvovirus B19 RT-PCR was positive. The patient was treated with blood transfusion and IVIG 25 g daily for 5 days. Two months after discharge, the patient presented, complaining of palpitation, shortness of breath, and dizziness, with RBC 2.7/μL, Hb 6.5 g/dL, Hct 25%, and MCV 85. Again, the CMV RT-PCR was negative, while the parvovirus B19 RT-PCR was positive. Tacrolimus and mycophenolic acid were stopped, and IVIG 25 g daily for 5 days was administered. Consequently, her Hb level increased to 9 g/dL, and the patient was discharged with prednisolone 5 mg daily and cyclosporine 50 mg daily instead of tacrolimus. Viral infection, particularly PB19 infection, should be considered in the differential diagnosis of posttransplantation anemia in KTRs. IVIG treatment and modification of immunosuppressive medications are suggested standard therapies for such patients. The function of transplanted kidneys should be carefully monitored during treatment.
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Affiliation(s)
- Fatemeh Yaghoubi
- Nephrology Research Center, Shariati HospitalTehran University of Medical SciencesTehranIran
| | - Davood Dalil
- Student Research Committee, Faculty of MedicineShahed UniversityTehranIran
| | - Farnaz Tavakoli
- Nephrology Research Center, Shariati HospitalTehran University of Medical SciencesTehranIran
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Lindahl JP, Barlinn R, Abrahamsen IW, Spetalen S, Midtvedt K, Jenssen T. Case Report: Pure Red Cell Aplasia Caused by Refractory Parvovirus B19 Infection After Pancreas Transplantation Alone. Front Med (Lausanne) 2022; 9:849783. [PMID: 35372384 PMCID: PMC8966125 DOI: 10.3389/fmed.2022.849783] [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: 01/06/2022] [Accepted: 02/22/2022] [Indexed: 11/25/2022] Open
Abstract
A multidisciplinary team of doctors is in charge or is involved in the follow-up of patients who undergo solid organ transplantation (SOT). Immunosuppressive drugs are required after SOT, some potential unwanted side effects can be difficult to detect, and physicians must be aware of potential pitfalls. We report a case of a recipient with brittle type 1 diabetes who experienced severe and refractory anemia after pancreas transplantation alone (PTA). Despite a broad diagnostic approach for anemia, the diagnosis was delayed. The patient had normocytic normochromic anemia with severe reticulocytopenia and marked reduction or absence of erythroid precursors in the bone marrow, compatible with pure red cell aplasia (PRCA). Analyses of serological parvovirus B19 anti-IgM and anti-IgG antibodies, including PCR, were initially inconclusive/negative. The diagnosis of parvovirus B19 infection was confirmed after bone marrow biopsy with immunohistochemical staining for parvovirus B19. A retrospective analysis revealed an early post-transplant primary parvovirus B19 infection. The patient was successfully treated with intravenous immunoglobulin (IVIg) therapy. There is a risk of diagnostic delay for the less common types of anemia following SOT. Parvovirus B19 infection-associated PRCA is curable in SOT recipients and should be actively considered in patients with persistent anemia and low reticulocytes.
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Affiliation(s)
- Jørn Petter Lindahl
- Department of Transplantation Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Regine Barlinn
- Department of Microbiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | | | - Signe Spetalen
- Department of Pathology, Oslo University Hospital, Radiumhospitalet, Oslo, Norway
| | - Karsten Midtvedt
- Department of Transplantation Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Trond Jenssen
- Department of Transplantation Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Zhong Q, Zeng J, Lin T, Song T. The detection, treatment of parvovirus B19 infection induced anemia in solid organ transplants: a case series and literature review of 194 patients. Transfus Clin Biol 2022; 29:168-174. [PMID: 35007720 DOI: 10.1016/j.tracli.2021.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 12/15/2021] [Accepted: 12/26/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND There are no optimal diagnostic, treatment and post-infection surveillance strategies for parvovirus B19 infection in solid organ transplantation (SOT) recipients. METHODS We conducted a retrospective review of all PVB19 infected cases confirmed by qPCR among SOT recipients at our institution over a 3-year period and reviewed the literature from 1990 to 2021. RESULTS Eight kidney and two heart transplant patients with refractory anemia had PVB19 infection. The viral DNA load in peripheral blood ranged from 2.62 × 102 to 8.31 × 106 copies/mL. Two patients with the lowest PVB19 DNA load only reduced the use of immunosuppressants and anemia was relieved. Eight received intravenous immunoglobulin (IVIG) (ranging from 0.25 to 0.5 g/kg/day). The median time to anemia improvement (hemoglobulin>100g/L) was 16 days (8-70 days) after treatment. One patient had a PVB19 relapse and viral DNA load > 1.00 × 108 copies/mL at diagnosis. A total of 86 studies involving 194 SOTs were screened from the literature, and the most common symptom was anemia and low reticulocyte count. PVB19 DNA was detected in all cases. Of that, 91.4% of cases received IVIG, 53.8% received IVIG and immunosuppression reduction, 6.5% of cases showed reduced immunosuppression without IVIG, and 2.1% did not receive any special treatment. The recurrence rate was 17.5%. CONCLUSION PVB19 infection is a cause of anemia after SOT, and treatment mainly relies on IVIG and/or immunosuppression reduction.
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Affiliation(s)
- Qiang Zhong
- Urology Department, Urology research institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Organ transplantation center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jun Zeng
- Department of Transplantation Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Tao Lin
- Urology Department, Urology research institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Organ transplantation center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - TuRun Song
- Urology Department, Urology research institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Organ transplantation center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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Noriega-Salas L, Cruz-Santiago J, Lòpez-Lòpez B, Del Rosario Garcia-Ramirez C, Robledo-Melendez A. Aplastic anemia associated with parvovirus B19 in living donor kidney transplantation: experience of a reference center. Nefrologia 2021; 41:599-601. [PMID: 36165146 DOI: 10.1016/j.nefroe.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 11/15/2020] [Indexed: 06/16/2023] Open
Affiliation(s)
- Lorena Noriega-Salas
- Unidad de Trasplante Renal, Instituto Mexicano del Seguro Social Centro Médico Nacional La Raza, Hospital de Especialidades "Dr. Antonio Fraga Mouret", Centro Médico Nacional La Raza, Ciudad de México, Mexico.
| | - Jose Cruz-Santiago
- Unidad de Trasplante Renal, Instituto Mexicano del Seguro Social Centro Médico Nacional La Raza, Hospital de Especialidades "Dr. Antonio Fraga Mouret", Centro Médico Nacional La Raza, Ciudad de México, Mexico
| | - Bibiana Lòpez-Lòpez
- Unidad de Trasplante Renal, Instituto Mexicano del Seguro Social Centro Médico Nacional La Raza, Hospital de Especialidades "Dr. Antonio Fraga Mouret", Centro Médico Nacional La Raza, Ciudad de México, Mexico
| | - Catalina Del Rosario Garcia-Ramirez
- Unidad de Trasplante Renal, Instituto Mexicano del Seguro Social Centro Médico Nacional La Raza, Hospital de Especialidades "Dr. Antonio Fraga Mouret", Centro Médico Nacional La Raza, Ciudad de México, Mexico
| | - Arlette Robledo-Melendez
- Unidad de Trasplante Renal, Instituto Mexicano del Seguro Social Centro Médico Nacional La Raza, Hospital de Especialidades "Dr. Antonio Fraga Mouret", Centro Médico Nacional La Raza, Ciudad de México, Mexico
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Noriega-Salas L, Cruz-Santiago J, Lòpez-Lòpez B, Garcia-Ramirez CDR, Robledo-Melendez A. Aplastic anemia associated with parvovirus B19 in living donor kidney transplantation: Experience of a reference center. Nefrologia 2021. [PMID: 33812658 DOI: 10.1016/j.nefro.2020.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Lorena Noriega-Salas
- Unidad de Trasplante Renal, Instituto Mexicano del Seguro Social Centro Médico Nacional La Raza, Hospital de Especialidades «Dr. Antonio Fraga Mouret», Centro Médico Nacional La Raza, Ciudad de México, México.
| | - Jose Cruz-Santiago
- Unidad de Trasplante Renal, Instituto Mexicano del Seguro Social Centro Médico Nacional La Raza, Hospital de Especialidades «Dr. Antonio Fraga Mouret», Centro Médico Nacional La Raza, Ciudad de México, México
| | - Bibiana Lòpez-Lòpez
- Unidad de Trasplante Renal, Instituto Mexicano del Seguro Social Centro Médico Nacional La Raza, Hospital de Especialidades «Dr. Antonio Fraga Mouret», Centro Médico Nacional La Raza, Ciudad de México, México
| | - Catalina Del Rosario Garcia-Ramirez
- Unidad de Trasplante Renal, Instituto Mexicano del Seguro Social Centro Médico Nacional La Raza, Hospital de Especialidades «Dr. Antonio Fraga Mouret», Centro Médico Nacional La Raza, Ciudad de México, México
| | - Arlette Robledo-Melendez
- Unidad de Trasplante Renal, Instituto Mexicano del Seguro Social Centro Médico Nacional La Raza, Hospital de Especialidades «Dr. Antonio Fraga Mouret», Centro Médico Nacional La Raza, Ciudad de México, México
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Abstract
Parvovirus B19 infection is s new viral threat in post-kidney transplantation. It is a viral infection often acquired from the donor, occurring in young transplant patients during the first post-kidney transplantation months, and with a non-specific clinico-biological picture. The hallmark symptom is regenerative anaemia which may be severe, requiring blood transfusion. The C3 and C4 complement fractions are reduced and constitute an early and inexpensive diagnostic marker. Diagnosis is often delayed due to the non-specific clinico-biological picture. However, severe anaemia and hypocomplementemia are early and suggestive signs of parvovirus B19 infection. Levels of parvovirus B19 DNA, as determined by real time-polymerase chain reaction (RT-PCR), are often very high and tend to decrease slowly over several months. Treatment is based on adaptive reduction of immunosuppression, adequate in the forms with few symptoms, discontinuation of antiproliferative agents, or a switch to other molecules associated with intravenous immunoglobulins in the severe and highly symptomatic forms. Screening for other concomitant viral infections, particularly for cytomegalovirus, Epstein Barr virus, and BK virus is systematic. Relapses are quite frequent during the first-year post-transplantation. Clinical-biological follow-up aims to detect any recurrence of the parvovirus B19 infection, the occurrence of parvovirus B19-related glomerulopathy, and acute rejection. Parvovirus B19 infection is a new viral threat in post-kidney transplantation and requires broader and/or randomised studies to better establish the diagnostic and therapeutic approach.
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Affiliation(s)
- Yassamine Bentata
- Nephrology, Dialysis, and Kidney Transplantation Unit, University Hospital Mohammed VI, Oujda, University Mohammed First, Oujda, Morocco.,Laboratory of Epidemiology, Clinical Research, and Public Health, Medical School, University Mohammed Premier, Oujda, Morocco
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A case of recurrent anemia due to chronic parvovirus B19 infection in a kidney transplant recipient. Can everolimus make a difference? CEN Case Rep 2021; 10:388-392. [PMID: 33539009 DOI: 10.1007/s13730-021-00575-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 01/06/2021] [Indexed: 12/22/2022] Open
Abstract
Parvovirus B19 (PB19) is a common infection among solid transplant recipients. Usually, it is asymptomatic, but sometimes it can become a real therapeutic challenge. We report a case of a kidney transplant recipient with relapsing pure red cell aplasia due to PB19 infection. Our patient was initially managed with standard treatment consisting of intravenous immunoglobulins and minimization of immunosuppressive treatment. However, when this approach became ineffective, conversion from tacrolimus to everolimus was done, with favorable results. This paper explores infection by PB19 in kidney transplant recipients and the potential benefits of a calcineurin inhibitor-free immunosuppression and the antiviral properties of mTOR inhibitors.
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Gang S, Park S, Min SI, Hong J, Chang YH, Ha J, Yang J. Recurrent parvovirus B19 infection-associated pure red cell aplasia in a kidney transplant patient. KOREAN JOURNAL OF TRANSPLANTATION 2020; 34:199-203. [PMID: 35769066 PMCID: PMC9186813 DOI: 10.4285/kjt.2020.34.3.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 11/04/2022] Open
Affiliation(s)
- Sujin Gang
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
| | - Sooyong Park
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sang-il Min
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
- Transplantation Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Joonshik Hong
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Yoon Hwan Chang
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jongwon Ha
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
- Transplantation Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jaeseok Yang
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
- Transplantation Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Transplantation Center, Seoul National University Hospital, Seoul, Korea
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10
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High prevalence of parvovirus B19 infection in patients with chronic kidney disease under hemodialysis: A multicenter study. Int J Infect Dis 2020; 100:350-356. [PMID: 32927082 DOI: 10.1016/j.ijid.2020.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 09/01/2020] [Accepted: 09/04/2020] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVES Parvovirus B19 (B19V) infection is commonly acute and self-limited, but in chronic kidney disease (CKD) patients under dialysis treatment, this infection could increase susceptibility to acute and chronic anemia. The aim of this study was to evaluate the frequency and risk of B19V infection among Brazilian CKD patients under dialysis. METHODS A study was conducted among 221 CKD patients and a control group of 142 blood donors. B19V infection was evaluated in serum samples by real-time PCR, and ELISA (anti-B19V IgM and IgG). RESULTS B19V DNA was detected in 65% (145/221) of CKD patients, which was significantly higher (p < 0.001) than in the blood donors (6.3%). Simultaneous detection of B19V IgG and viremia was shown in 40.3% of CKD patients, which was indicative of persistent B19V infection. CKD patients showed an increased risk of developing B19V infection (OR = 28.1, CI = 13.5-58.5, p = 0.001). CONCLUSIONS Despite an absence of clinical signs of B19V infection, these data highlight the importance of B19V infection in this high-risk population, since a persistent B19V infection could become clinically significant after renal transplant. Moreover, the persistent viremia should be considered as a potential risk, mainly because of the contamination of dialysis equipment.
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11
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Escobar-Sevilla J, Bustos Merlo A, Garcia Martínez C, Mediavilla Garcia JD. Severe Refractory Anaemia and Fever of Unknow Origin: Human Parvovirus B19 Reactivation. Eur J Case Rep Intern Med 2020; 7:001596. [PMID: 32908820 DOI: 10.12890/2020_001596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 05/14/2020] [Indexed: 11/05/2022] Open
Abstract
Reactivation of human parvovirus B19 is exceptional and characteristic of immunosuppression, with anaemia being the predominant manifestation although pancytopenia and thrombotic microangiopathy may also occur. We describe a patient with a history of diffuse large B-cell lymphoma with pure erythrocyte aplasia due to reactivation of parvovirus B19, who was treated with corticosteroids and immunoglobulins. LEARNING POINTS Infection with human parvovirus B19 is identified by polymerase chain reaction (PCR) testing of blood and the presence of typical giant proerythroblasts in the bone marrow.Cytomegalovirus infection should be considered in immunosuppressed patients with fever and non-specific symptoms with haematological changes.The treatment of persistent infection in immunosuppressed patients is based on the administration of IV immunoglobulins at high doses.
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Thongprayoon C, Khoury NJ, Bathini T, Aeddula NR, Boonpheng B, Lertjitbanjong P, Watthanasuntorn K, Leeaphorn N, Chesdachai S, Torres-Ortiz A, Kaewput W, Bruminhent J, Mao MA, Cheungpasitporn W. Epidemiology of parvovirus B19 and anemia among kidney transplant recipients: A meta-analysis. Urol Ann 2020; 12:241-247. [PMID: 33100749 PMCID: PMC7546070 DOI: 10.4103/ua.ua_89_19] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 11/20/2019] [Indexed: 12/23/2022] Open
Abstract
Background Persistent anemia has been described in kidney transplant (KTx) recipients with parvovirus B19 virus infection. However, the epidemiology of parvovirus B19 and parvovirus B19-related anemia after KTx remains unclear. We conducted this systematic review (1) to investigate the incidence of parvovirus B19 infection after KTx and (2) to assess the incidence of parvovirus B19 among KTx patients with anemia. Materials and Methods A systematic review was conducted in EMBASE, MEDLINE, and Cochrane databases from inception to March 2019 to identify studies that reported the incidence rate of parvovirus B19 infection and/or seroprevalence of parvovirus B19 in KTx recipients. Effect estimates from the individual studies were extracted and combined using random-effects, generic inverse variance method of DerSimonian and Laird. The protocol for this systematic review is registered with PROSPERO (no. CRD42019125716). Results Nineteen observational studies with a total of 2108 KTx patients were enrolled. Overall, the pooled estimated seroprevalence of parvovirus B19 immunoglobulin G was 62.2% (95% confidence interval [CI]: 45.8%-76.1%). The pooled estimated incidence rate of positive parvovirus B19 DNA in the 1st year after KTx was 10.3% (95% CI: 5.5%-18.4%). After sensitivity analysis excluded a study that solely included KTx patients with anemia, the pooled estimated incidence rate of positive parvovirus B19 DNA after KTx was 7.6% (95% CI: 3.7%-15.0%). Among KTx with anemia, the pooled estimated incidence rate of positive parvovirus B19 DNA was 27.4% (95% CI: 16.6%-41.7%). Meta-regression analysis demonstrated no significant correlations between the year of study and the incidence rate of positive parvovirus B19 DNA (P = 0.33). Egger's regression asymmetry test was performed and demonstrated no publication bias in all analyses. Conclusion The overall estimated incidence of positive parvovirus B19 DNA after KTX is 10.3%. Among KTx with anemia, the incidence rate of positive parvovirus B19 DNA is 27.4%. The incidence of positive parvovirus B19 DNA does not seem to decrease overtime.
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Affiliation(s)
- Charat Thongprayoon
- Department of Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, USA
| | - Nadeen J Khoury
- Department of Medicine, Division of Nephrology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Tarun Bathini
- Department of Internal Medicine, University of Arizona, Tucson, Arizona, USA
| | - Narothama Reddy Aeddula
- Department of Medicine, Division of Nephrology, Indiana University School of Medicine and Deaconess Health System, Evansville, Indiana, USA
| | - Boonphiphop Boonpheng
- Department of Internal Medicine, East Tennessee State University, Johnson City, Tennessee, USA
| | | | | | - Napat Leeaphorn
- Department of Medicine, Renal Transplant Program, University of Missouri-Kansas City School of Medicine, Saint Luke's Health System, Kansas City, Missouri, USA
| | - Supavit Chesdachai
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Aldo Torres-Ortiz
- Department of Medicine, Division of Nephrology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Wisit Kaewput
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Mahidol University, Bangkok, Thailand
| | - Jackrapong Bruminhent
- Department of Medicine, Division of Infectious Diseases, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Michael A Mao
- Department of Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Jacksonville, Florida, USA
| | - Wisit Cheungpasitporn
- Department of Medicine, Division of Nephrology, University of Mississippi Medical Center, Jackson, Mississippi, USA
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Bentata Y. Mycophenolates: The latest modern and potent immunosuppressive drugs in adult kidney transplantation: What we should know about them? Artif Organs 2020; 44:561-576. [DOI: 10.1111/aor.13623] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 11/25/2019] [Accepted: 12/20/2019] [Indexed: 12/18/2022]
Affiliation(s)
- Yassamine Bentata
- Nephrology and Kidney Transplantation Unit University Hospital Mohammed VI University Mohammed First Oujda Morocco
- Laboratory of Epidemiology Clinical Research and Public Health Medical School University Mohammed First Oujda Morocco
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Parvovirus Infection-Related Anemia after Kidney Transplantation. Case Rep Transplant 2020; 2020:6437392. [PMID: 32082691 PMCID: PMC7013336 DOI: 10.1155/2020/6437392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 01/07/2020] [Accepted: 01/20/2020] [Indexed: 11/17/2022] Open
Abstract
Anemia postkidney transplantation is an important issue which has been correlated with increased hospitalizations and higher mortality. Infections, including those due to parvovirus B19, CMV, and BK virus (polyomavirus), have also been associated with an increased risk of anemia. Here, we present a case of new-onset anemia in a kidney transplant recipient within 3 months of transplant. The patient was found to have multiple viral infections from parvo B19, BK virus, and rhinovirus. The anemia resolved completely after successful reduction in the parvo B19 and BK viral load. Workup for viral infections must be considered in the differential diagnosis of postkidney transplant anemia.
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15
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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.
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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
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Inamdar N, Nada R, Minz R, Kenwar DB, Singh S, Sharma A, Kumar V, Rathi M, Kohli HS, Ramachandran R. Successful re-transplantation in patient with recurrent parvovirus B19 pure red cell aplasia. Transpl Infect Dis 2019; 21:e13164. [PMID: 31483919 DOI: 10.1111/tid.13164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 07/29/2019] [Accepted: 08/25/2019] [Indexed: 11/29/2022]
Abstract
Impaired cell-mediated, as well as antibody-mediated immunity predisposes a renal transplant recipient to a wide variety of atypical infection. With an increasing number of re-transplant, the balance between immunosuppression and the risk of recurrent disease poses a clinical and therapeutic challenge. Here, we report a successful re-transplantation in a case of parvovirus B19 infection leading to anaemia and collapsing glomerulopathy in the allograft managed with intravenous immunoglobulin (IVIG) and reduction of immunosuppression. This case emphasizes re-consideration to renal transplant after clearance of the virus in a previous renal allograft lost to PVB19 infection.
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Affiliation(s)
- Neeraj Inamdar
- Department of Nephrology, Post graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritambhra Nada
- Department of Histopathology, Post graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ranjana Minz
- Department of Immunopathology, Post graduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepesh Benjamin Kenwar
- Department of Transplant Surgery, Post graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sarabpreet Singh
- Department of Transplant Surgery, Post graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashish Sharma
- Department of Transplant Surgery, Post graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vivek Kumar
- Department of Nephrology, Post graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manish Rathi
- Department of Nephrology, Post graduate Institute of Medical Education and Research, Chandigarh, India
| | - Harbir S Kohli
- Department of Nephrology, Post graduate Institute of Medical Education and Research, Chandigarh, India
| | - Raja Ramachandran
- Department of Nephrology, Post graduate Institute of Medical Education and Research, Chandigarh, India
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17
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Pabisiak K, Stępniewska J, Ciechanowski K. Pure Red Cell Aplasia After Kidney Transplantation: Parvovirus B19 Culprit or Coincidence? Ann Transplant 2019; 24:123-131. [PMID: 30833537 PMCID: PMC6419532 DOI: 10.12659/aot.913663] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Anemia is present even in long-term observation after kidney transplantation. Observational study results indicate the presence of chronic post-transplantation anemia in 1 in 3 recipients. An extreme form of erythroid line dysfunction is pure red cell aplasia (PRCA). It may be caused by immunosuppressive treatment per se or a side effect, opportunistic pathogen activation. Parvovirus B19 (PV B19) infection is quite likely the cause of refractory normocytic anemia in immunocompromised patients. Case Report In this case report we discuss biological and clinical features of this phenomenon and the treatment strategies, based on 2 PRCA cases in kidney transplant recipients. Additionally, a systematic review of published reports of PV B19 related PRCA in kidney recipients is presented. Conclusions PV replication should be ruled out in cases of persistent and/or refractory anemia after kidney transplantation. The established first-line treatment of PRCA is passive immunization. Taking into account cost effectiveness, a decrease in immunosuppression load is reasonable under careful control of allograft function.
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Affiliation(s)
- Krzysztof Pabisiak
- Department of Nephrology Transplantation and Internal Medicine, Pomeranian Medical University, Szczecin, Poland
| | - Joanna Stępniewska
- Department of Nephrology Transplantation and Internal Medicine, Pomeranian Medical University, Szczecin, Poland
| | - Kazimierz Ciechanowski
- Department of Nephrology Transplantation and Internal Medicine, Pomeranian Medical University, Szczecin, Poland
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Das P, Chatterjee K, Chattopadhyay NR, Choudhuri T. Evolutionary aspects of Parvovirus B-19V associated diseases and their pathogenesis patterns with an emphasis on vaccine development. Virusdisease 2019; 30:32-42. [PMID: 31143830 PMCID: PMC6517593 DOI: 10.1007/s13337-019-00525-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 03/15/2019] [Indexed: 12/16/2022] Open
Abstract
Parvovirus B-19, a single human pathogenic member of the Parvoviridae family with it's small ssDNA and non-enveloped structure, is known to cause diseases in erythroid progenitor cells. But a wide range of clinical association of this virus with cells of non-erythroid origins has recently been discovered and many of those are being investigated for such association. Higher substitution rates in due course of evolution has been suggested for this cellular tropism and persistence. In this report, we have summarized the different disease manifestations of B-19 virus and have tried to find out a pattern of pathogenesis. Finally, we have focused on the vaccination strategies available against B-19 virus to correlate these with the mechanisms involved in various diseases caused by this virus.
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Affiliation(s)
- Piyanki Das
- Department of Biotechnology, Visva Bharati Santiniketan, Siksha Bhavana, Bolpur, West Bengal 731235 India
| | - Koustav Chatterjee
- Department of Biotechnology, Visva Bharati Santiniketan, Siksha Bhavana, Bolpur, West Bengal 731235 India
| | - Nabanita Roy Chattopadhyay
- Department of Biotechnology, Visva Bharati Santiniketan, Siksha Bhavana, Bolpur, West Bengal 731235 India
| | - Tathagata Choudhuri
- Department of Biotechnology, Visva Bharati Santiniketan, Siksha Bhavana, Bolpur, West Bengal 731235 India
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