Neutropenia accompanying parvovirus B19 infection after gynecologic surgery

Human Parvoviruses

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.

The use of fibrin glue in surgery of the knee

Fibrin glue, also known as fibrin sealant, is now established as a haemostatic agent in surgery, but its role in orthopaedic surgery is neither well known nor clearly defined. Although it was originally used over 100 years ago, concerns about transmission of disease meant that it fell from favour. It is also available as a slow-release drug delivery system and as a substrate for cellular growth and tissue engineering. Consequently, it has the potential to be used in a number of ways in orthopaedic surgery. The purpose of this review is to address its use in surgery of the knee in which it appears to offer great promise.

Biodegradable Adhesive (LYDEX) with Hydroxyapatite Granules

A new biodegradable adhesive(LYDEX) which is based on Schiff base formation had developed. LYDEX is easy to control the setting time and degradation speed and it has no risk of infection. In the previous study, LYDEX showed high bonding strength and low cytotoxicity in vitro[1]. In the present study, good bone repair was seen in rat bone defect models, especially in rapidly degrading type. On the other hand, slowly degrading type kept its shape longer without excessive inflammation. In rabbit critical defect model with hydroxyapatite granules (HAs), more newly formed bone was seen in rapidly degrading group and hydroxyapatite group, in 3weeks. In 6weeks, more new bone was seen in slowly degrading type group, whereas, almost no new bone was seen in deep area of the fibrin group, in 12weeks. Direct bonding between HAs and bone was seen in HA group and LYDEX groups. These findings suggest that LYDEX with hydroxyapatite granules can be a promising bone substitute.

Neutropénie avec fièvre après double pontage aortocoronarien

Plasma-derived products are often used in cardiac surgery. We report the case of a patient developing an infection due to Parvovirus B19 after coronary artery bypass. Symptoms were fever, asthenia, anemia, and pancreatitis. This infection can be transmitted from plasma-derived product, like fibrin sealant (used for hemostasis during surgery). Parvovirus B19 is resistant to existing virus-inactivating techniques. The patient had to leave our hospital after symptomatic treatment which has significantly increased the length to stay.

Frequency of transmission of human parvovirus B19 infection by fibrin sealant used during thoracic surgery

BACKGROUND

Fibrin sealant is used in many kinds of surgical procedures. Although pasteurization is insufficient to remove human parvovirus (HPV) B19 from this plasma-derived product, the frequency of HPV B19 infection transmitted by its use has never been known.

METHODS

Blood samples of 85 patients more than 20 years of age who had undergone pulmonary resection with fibrin sealant were obtained before and 12, 24, and 48 weeks after surgery. Anti-HPV B19 antibody IgG (HPV B19 IgG) and HPV B19 DNA were detected with these samples.

RESULTS

In 56 (65.9%) of 85 patients, blood samples obtained before operation were positive for HPV B19 IgG. In these 56 patients, blood samples obtained 12 to 48 weeks after surgery were all negative for HPV B19 DNA by polymerase chain reaction (PCR). In 6 (20.7%) of 29 patients whose blood samples were negative for HPV B19 IgG before surgery, blood samples obtained 12 to 48 weeks after surgery were positive for HPV B19 DNA by PCR and also positive for HPV B19 IgG. In 5 of these 6 patients reticulocyte counts decreased to less than 10 x 10(9)/l 12 to 20 days after surgery.

CONCLUSIONS

Epidemiologic evidence suggests that more than 20% uninfected persons were subsequently infected with HPV B19 by use of fibrin sealant during surgery.

Idiopathic, immune, infectious, and idiosyncratic neutropenias

In idiopathic and immune neutropenias the susceptibility to infectious agents is highly variable, but the reason why some patients exhibit no undue susceptibility whereas others contract life-threatening infections is poorly understood. An important factor is the efficacy of delivery of neutrophils to the tissues. Recent investigations of the mechanisms for mild to moderate chronic neutropenias have shown the significance of interactions between myelopoiesis and the immune system, as for example, in relation to immunoglobulin aberrations and the cytokine network. Antibody-mediated neutropenias (alloimmune, autoimmune) are now well-characterized diseases. If infections occur, apart from antibiotics, granulocyte colony-stimulating factor (G-CSF) is the treatment of choice, while intravenous or monoclonal immunoglobulins and cyclosporine are reserved for refractory cases.