Evidence of parvovirus B19 infection in patients of pre‐eclampsia and eclampsia with dyserythropoietic anaemia

Abstract

Summary Parvovirus B19 (PVB19) infection can induce transient anaemia in patients with increased erythropoiesis. However, the dynamic change within the bone marrow after PVB19 infection is not well understood. Increased erythropoiesis is a physiological phenomenon in puerperital women. Nevertheless, anaemia as a result of PVB19 infection in puerperital women has never been reported. We report one patient with eclampsia and two patients with pre‐eclampsia who had transient, severe anaemia during the puerperital period because of PVB19 infection. Viral genomes were detected in the peripheral blood during the anaemic period by polymerase chain reaction and became undetectable after the anaemia was resolved. Viral genomes and protein could also be detected in bone marrow by in situ hybridization and immunohistochemical staining, respectively. Serial aspiration cytology of bone marrow showed severe dysplastic change involving erythroid precursors with a few apoptotic cells at the initial onset of anaemia, markedly increased apoptotic cells that was confirmed by the increased expression of activated caspase 3, around the nadir of anaemia, and a normal marrow picture without features of apoptosis after recovery from anaemia. Our data indicates that PVB19 infection can induce transient, severe dyserythropoietic anaemia in puerperital women with pre‐eclampsia/eclampsia and the pathogenetic mechanism may probably involve the induction of apoptosis following PVB19 infection.

Agonist autoantibodies against the angiotensin AT1 receptor in renal and hypertensive disorders

“…Taking all these findings into consideration, we hypothesize that a past PVB19 infection and subsequent virus persistence lead to an antigen exposure (VP1, VP2) that could be responsible for the generation of antibodies mimicking agonistic effects at the AT1 receptor, and consequently promote the preeclamptic phenotype. This hypothesis was further supported by the observation of simultaneous occurrence of an acute PVB19 infection in pregnancy and preeclampsia [40][41][42].…”

Fatal parvovirus B19 infections: a report of two autopsy cases

“…The slides were washed with distilled water, rinsed in an ethanol series (70, 95, and 100%), and air-dried. The oligonucleotide probe sequence complementary to the gene encoding the NS protein was described previously [11]; 5′ digoxigenin-GATTCTCC TGAACTGGTCCC-3′ was synthesized (Purigo Biotech, Inc., Taipei, Taiwan). A glass coverslip was placed over the probe (10 ng/ml), and the slides were put into ThermoBrite (Abbott, USA), denatured for 2 min at 95°C, and then hybridized for 16 h at 37°C.…”

Infection and Reactive Changes

“…In one patient with parvovirus -induced pancytopenia there were also large atypical cells of granulocyte lineage, which were shown to contain viral antigens [35] . Rarely parvovirus infection has been associated with transient pure red cell aplasia leading to anaemia in haematologically and immunologically normal subjects [36] , transient severe dyserythropoiesis [37] , recurrent pure granulocytic aplasia with neutropenia [38] or pure megakaryocyte hypoplasia or aplasia with thrombocytopenia [36,39] . Uncommonly, in apparently immunologically normal people, there is persistent infection leading to chronic red cell aplasia.…”