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Monteiro VS, Baía-da-Silva DC, Silva VA, Pivoto João GA, Marinho EPM, Cubas-Vega NC, Val FFA, Perez-Gomez AS, Monte RL, Mota A, Lacerda MVG, Souza Bastos M. Neurological Manifestations Associated with Parvovirus B19 Infection in Immunocompetent Children: Case Series and Systematic Review. J Trop Pediatr 2021; 67:fmab078. [PMID: 34545404 DOI: 10.1093/tropej/fmab078] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
An increasing number of reports have described human parvovirus B19 infection in association with a variety of neurological manifestations, especially in children. This study assessed the clinical and laboratory outcomes found in a case series of immunocompetent children who tested positive for parvovirus B19 by qualitative polymerase chain reaction assays of cerebrospinal fluid, in a tertiary referral center in the western Brazilian Amazon. We screened 178 children with clinically diagnosed central nervous system infections (meningoencephalitis). Of these, five (2.8%) were positive for parvovirus B19. A literature review also presented herein identified a further 50 cases of parvovirus B19 with neurological manifestations. Thus, even if the classic signs of parvovirus B19 infection are absent, such as the well-known rash, children with signs of neurological infection should also be evaluated for parvovirus B19 infection.
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Affiliation(s)
- Vinícius Silva Monteiro
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Amazonas 69040-000, Brazil
| | - Djane Clarys Baía-da-Silva
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Amazonas 69040-000, Brazil
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus 69040-000, Brazil
- Instituto Leônidas and Maria Deane, Fiocruz, Manaus 69.057-070, Brazil
| | - Valderjane Aprigio Silva
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Amazonas 69040-000, Brazil
| | - Guilherme Augusto Pivoto João
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Amazonas 69040-000, Brazil
| | - Eveny Perlize Melo Marinho
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal do Amazonas, Manaus 69077-000, Brazil
| | - Nadia Carolina Cubas-Vega
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus 69040-000, Brazil
| | - Fernando Fonseca Almeida Val
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Amazonas 69040-000, Brazil
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus 69040-000, Brazil
| | - Aline Stephanie Perez-Gomez
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Amazonas 69040-000, Brazil
| | - Rossiclea Lins Monte
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Amazonas 69040-000, Brazil
| | - Adolfo Mota
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal do Amazonas, Manaus 69077-000, Brazil
| | - Marcus Vinícius Guimarães Lacerda
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Amazonas 69040-000, Brazil
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus 69040-000, Brazil
| | - Michele Souza Bastos
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Amazonas 69040-000, Brazil
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal do Amazonas, Manaus 69077-000, Brazil
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Cnc Garcia RD, Leon LA. Human parvovirus B19: a review of clinical and epidemiological aspects in Brazil. Future Microbiol 2021; 16:37-50. [PMID: 33438475 DOI: 10.2217/fmb-2020-0123] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Since the first evidence of human parvovirus B19 (B19V) infection in late 80s, several studies have been conducted to clarify the spectrum of clinical diseases in Brazil. B19V infection is prevalent in the general population and has exhibited a cyclical pattern of occurrence every 4-5 years, with the predominance of genotype 1 over 3b. During epidemic periods the wide range of clinical conditions, such as ertythema infectiosum, arthropathy, transient aplastic crisis, nonimmune hydrops fetalis and B19V-hepatitis were diagnosed. However, many infections are likely asymptomatic or have a self-limiting clinical course and are not readly diagnosed. Besides, the similarity of the symptoms of ertythema infectiosum to other rash diseases and the broadly circulation of arboviruses makes differential diagnosis more difficult. In this article, we provide a historical comprehensive overview of the research on parvovirus B19 conducted in Brazil, with a focus on the clinical and epidemiological aspects of the infection.
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Affiliation(s)
- Rita de Cnc Garcia
- Departamento de Microbiologia e Parasitologia, Instituto Biomédico, Universidade Federal Fluminense (UFF), Rua Professor Hernani Melo 101, Niterói, RJ 22430 190, Brazil
| | - Luciane Aa Leon
- Laboratório de Desenvolvimento Tecnológico em Virologia, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Avenida Brasil 4365, Manguinhos, RJ 21040 360, Brazil
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Vilmane A, Terentjeva A, Tamosiunas PL, Suna N, Suna I, Petraityte-Burneikiene R, Murovska M, Rasa-Dzelzkaleja S, Nora-Krukle Z. Human Parvoviruses May Affect the Development and Clinical Course of Meningitis and Meningoencephalitis. Brain Sci 2020; 10:brainsci10060339. [PMID: 32503112 PMCID: PMC7349785 DOI: 10.3390/brainsci10060339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/29/2020] [Accepted: 06/01/2020] [Indexed: 12/18/2022] Open
Abstract
Meningitis and meningoencephalitis are neurological inflammatory diseases, and although routine diagnostics include testing of a wide range of pathogens, still in many cases, no causative agent is detected. Human parvovirus B19 (B19V), human bocaviruses 1–4 (HBoV1–4), and human parvovirus 4 (hPARV4) are members of the Parvoviridae family and are associated with a wide range of clinical manifestations including neurological disorders. The main aim of this study was to determine whether human parvoviruses infection markers are present among patients with meningitis/meningoencephalitis in Latvia as well as to clarify the role of these viruses on the clinical course of the mentioned diseases. Our study revealed HBoV1–4 and B19V genomic sequences in 52.38% and 16.67% of patients, respectively. Furthermore, symptoms such as the presence of a headache and its severity, fatigue, disorientation, and difficulties to concentrate were significantly frequently present in patients with active parvovirus infection in comparison with parvoviruses negative patients, therefore we suggest that HBoV1–4 and B19V infection should be included in the diagnostics to reduce the number of meningitis/meningoencephalitis with unknown/unexplained etiology.
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Affiliation(s)
- Anda Vilmane
- Institute of Microbiology and Virology, Rīga Stradiņš University, 5 Ratsupites St., LV-1067 Riga, Latvia; (A.T.); (M.M.); (S.R.-D.); (Z.N.-K.)
- Correspondence: ; Tel.: +371-67060838
| | - Anna Terentjeva
- Institute of Microbiology and Virology, Rīga Stradiņš University, 5 Ratsupites St., LV-1067 Riga, Latvia; (A.T.); (M.M.); (S.R.-D.); (Z.N.-K.)
| | - Paulius L. Tamosiunas
- Vilnius University Life Sciences Center Institute of Biotechnology, 7 Sauletekio Al., 10257 Vilnius, Lithuania; (P.L.T.); (R.P.-B.)
| | - Normunds Suna
- Department of Neurology and Neurosurgery, Riga East Clinical University Hospital “Gaiļezers”, 2 Hipokrata St., LV-1038 Riga, Latvia; (N.S.); (I.S.)
| | - Inga Suna
- Department of Neurology and Neurosurgery, Riga East Clinical University Hospital “Gaiļezers”, 2 Hipokrata St., LV-1038 Riga, Latvia; (N.S.); (I.S.)
| | - Rasa Petraityte-Burneikiene
- Vilnius University Life Sciences Center Institute of Biotechnology, 7 Sauletekio Al., 10257 Vilnius, Lithuania; (P.L.T.); (R.P.-B.)
| | - Modra Murovska
- Institute of Microbiology and Virology, Rīga Stradiņš University, 5 Ratsupites St., LV-1067 Riga, Latvia; (A.T.); (M.M.); (S.R.-D.); (Z.N.-K.)
| | - Santa Rasa-Dzelzkaleja
- Institute of Microbiology and Virology, Rīga Stradiņš University, 5 Ratsupites St., LV-1067 Riga, Latvia; (A.T.); (M.M.); (S.R.-D.); (Z.N.-K.)
| | - Zaiga Nora-Krukle
- Institute of Microbiology and Virology, Rīga Stradiņš University, 5 Ratsupites St., LV-1067 Riga, Latvia; (A.T.); (M.M.); (S.R.-D.); (Z.N.-K.)
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Barah F, Whiteside S, Batista S, Morris J. Neurological aspects of human parvovirus B19 infection: a systematic review. Rev Med Virol 2014; 24:154-68. [PMID: 24459081 PMCID: PMC4238837 DOI: 10.1002/rmv.1782] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 11/28/2013] [Accepted: 11/29/2013] [Indexed: 02/06/2023]
Abstract
Parvovirus B19 has been linked with various clinical syndromes including neurological manifestations. However, its role in the latter remains not completely understood. Although the last 10 years witnessed a surge of case reports on B19-associated neurological aspects, the literature data remains scattered and heterogeneous, and epidemiological information on the incidence of B19-associated neurological aspects cannot be accurately extrapolated. The aim of this review is to identify the characteristics of cases of B19-associated neurological manifestations. A computerized systematic review of existing literature concerning cases of B19-related neurological aspects revealed 89 articles describing 129 patients; 79 (61.2%) were associated with CNS manifestations, 41 (31.8%) were associated with peripheral nervous system manifestations, and 9 (7.0%) were linked with myalgic encephalomyelitis. The majority of the cases (50/129) had encephalitis. Clinical characteristic features of these cases were analyzed, and possible pathological mechanisms were also described. In conclusion, B19 should be included in differential diagnosis of encephalitic syndromes of unknown etiology in all age groups. Diagnosis should rely on investigation of anti-B19 IgM antibodies and detection of B19 DNA in serum or CSF. Treatment of severe cases might benefit from a combined regime of intravenous immunoglobulins and steroids. To confirm these outcomes, goal-targeted studies are recommended to exactly identify epidemiological scenarios and explore potential pathogenic mechanisms of these complications. Performing retrospective and prospective and multicenter studies concerning B19 and neurological aspects in general, and B19 and encephalitic syndromes in particular, are required. © 2014 The Authors. Reviews in Medical Virology published by John Wiley & Sons, Ltd.
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Affiliation(s)
- Faraj Barah
- Center for Neuroscience and Cell Biology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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Hourfar MK, Mayr-Wohlfart U, Themann A, Sireis W, Seifried E, Schrezenmeier H, Schmidt M. Recipients potentially infected with parvovirus B19 by red blood cell products. Transfusion 2011; 51:129-36. [PMID: 20663115 DOI: 10.1111/j.1537-2995.2010.02780.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Since 2000, blood donor screening for parvovirus B19 (B19) by nucleic acid testing (NAT) at the Ulm Institute has been conducted 6 to 8 weeks postdonation, that is, after transfusion of cellular blood products, whereas at the Frankfurt Institute all donations are screened before releasing any blood product. In this study, we evaluated the infectivity of B19-positive blood products in relation to the virus concentration in the transfused blood component. STUDY DESIGN AND METHODS Recipients were classified into two groups (A, transfused with blood products with B19 virus load less than 10(5) IU/mL; and B, transfused with blood products with B19 virus load greater than 10(5) IU/mL). Phylogenetic analyses were done for B19 DNA-positive donor and recipient pairs in the variant VP-1u genome region. All samples were investigated for immunoglobulin (Ig)M and IgG B19 antibodies. RESULTS B19 DNA was detected in 9 of 18 recipients of red blood cells (RBCs) from Group B, whereas none of the 16 recipients of RBCs from Group A were positive for B19 DNA (p=0.016). Phylogenetic analysis demonstrated identical genomic sequences between the donors and recipients. Because recipient B19 DNA and antibody results were not available before transfusion, we interpret our overall data to indicate equivocal evidence of B19 transmission by RBC transfusion. CONCLUSION B19 transmission by cellular blood products correlates with the virus concentration and the concentration of neutralizing antibodies. Thus, blood donor screening for B19 by minipool NAT should be done to supply at-risk patients (e.g., immunosuppressed patients) with B19-negative blood components.
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Affiliation(s)
- Michael Kai Hourfar
- Institute for Transfusion Medicine and Immunohematology, Johann Wolfgang Goethe University, German Red Cross, Baden-Württemberg-Hessen, Institute Frankfurt, Frankfurt, Germany
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Yung E, Asavasopon S, Godges JJ. Screening for head, neck, and shoulder pathology in patients with upper extremity signs and symptoms. J Hand Ther 2010; 23:173-85; quiz 186. [PMID: 20149960 DOI: 10.1016/j.jht.2009.11.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2009] [Revised: 11/05/2009] [Accepted: 11/11/2009] [Indexed: 02/03/2023]
Abstract
UNLABELLED NARRATIVE REVIEW: Conditions of the head, neck, thorax, and shoulder may occur simultaneously with arm pathology or produce symptoms perceived by the patient to originate in the elbow, wrist, or hand. Identification of the tissue disorder and associated impairments, followed by matching the rehabilitative intervention to address these issues, leads to optimal outcomes. With this goal in mind, the hand therapist needs to recognize clinical findings that signal potentially serious medical conditions of the brain, cervical region, chest, or shoulder. Additionally, less serious but potentially debilitating, musculoskeletal or neurogenic pain from proximal sources must also be differentiated from somatic pain originating in the elbow, wrist, or hand so that the clinician can decide to further examine and intervene or refer to an appropriate health care provider. This article describes clinical findings that suggest the presence of serious medical pathology in the head, neck, or thorax and presents a screening algorithm to assist in discriminating pain derived from local structures in the distal arm from referred pain originating in the more proximal regions of the shoulder, thorax, neck, or brain. LEVEL OF EVIDENCE 5.
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Affiliation(s)
- Emmanuel Yung
- Orthopaedic Physical Therapy Residency Program, Kaiser Permanente Southern California, Los Angeles, California 90034, USA.
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Canović P, Ravić-Nikolić A. [Acute serous meningitis in a patient with erythema infectiosum]. VOJNOSANIT PREGL 2006; 63:73-5. [PMID: 16471253 DOI: 10.2298/vsp0601073c] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Clinical manifestations caused by parvovirus B19 (PVB19) are various and depend on the age and immunity of an infected person. In children, the most frequent clinical manifestation of parvovirus B19 primary infection is erythema infectiosum (EI). CASE REPORT In this case report we presented a 12-year-old patient with 2 clinical syndromes: erythema infectiosum and serous meningitis. Erythema infectiosum was manifested as fever, typical skin lesions ("slapped cheeks"), erythematous macules and papules confluent with reticular appearance on the extremities and the trunk. Serous meningitis had a mild course with an increased number of lymphocytes (120/ mm3) and the mildly increased level of proteins (0.75 g/l). The serological examination showed the presence of IgM and IgG antibodies against parvovirus B19 in serum, as well as in cerebrospinal fluid (CSF). The reduction of serum/CSF ratio of IgG antibodies was present. The symptomatic therapy was used in the treatment. The course and the prognosis were benign. CONCLUSION Human PVB19, although non-specifically associated with CNS diseases could be an etiological factor that might cause serous meningitis. So, it should be considered in different diagnosis in patients with aseptic meningitis, especially during the outbreaks of erythema infectiosum.
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Affiliation(s)
- Predrag Canović
- Klinicki centar Kragujevac, Infektivna klinika, Kragujevac, Srbija i Crna Gora.
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