Hydrops fetalis and neonatal death from human parvovirus B19: an unusual complication

Abstract

A case of prenatally diagnosed human parvovirus B19 (HPVB19) infection is reported. The neonate died after intrauterine therapy and premature delivery. The fetus was diagnosed with oedema, cardiomegaly, poor myocardial contractility and a pericardial effusion at 24/40 weeks' gestation. Ultrasound using colour flow Doppler showed a midcerebral artery peak systolic velocity (MCA PSV) raised at 45 cm/s, suggesting fetal anaemia. This was confirmed on fetal blood sampling, but recovery was suggested with a reticulocyte count of 16.8%. The fetal karyotype was normal, 46,XY. Fetal IgM was positive for Parvovirus. A week later, severe fetal anaemia was suspected and intrauterine transfusion carried out. Altogether three transfusions were given. At 31/40 weeks, the mother presented to her local hospital with suspected preterm labour, a caesarean section was carried out because of fetal compromise on cardiotocography. The baby was in poor condition at birth and resuscitation was stopped at 45 min of age. The post-mortem examination confirmed the hydrops and proved persistent Parvovirus infection, cardiac involvement and severe liver fibrosis.HPVB19 generally follows a benign course with intrauterine therapy; however, in this case, the fetus died despite successful transfusions. The reasons for this are discussed.

A Review of Findings in Fetal Cardiac Section Drawings

“…In case 9, the heart is globally enlarged ( Figure 11). This can result from, or be present in, many different conditions, 43 such as endocardial fibroelastosis, fetal anemia, 44 storage disorders, ischemia, 45 infections, 46,47 atrioventricular and semilunar valve regurgitation after tachycardia, and an atrioventricular block. Some extreme forms of shunts, 48 such as a vein of Galen "aneurysm" (in fact a varix) 49,50 and chorioangioma, and obstructive lesions (aortic stenosis, idiopathic infantile aortic calcinosis, premature closure of the ductus, a true knot of the cord, and tumors in the outflow tracts) also cause global enlargement.…”

Human Parvovirus B19: Molecular Virology, Clinical Features, Prevalence, Diagnosis and Control

“…An unusual case of foetal demise, caused by B19 infection, has been described by Marton et al (2005). Here, despite the successful administration of multiple foetal blood transfusions to prevent anaemia, foetal hydrops worsened and cardiac enlargement was observed upon foetal echocardiographic analysis which resulted in foetal death after delivery at week 31 of gestation.…”

Quelles surveillance et thérapeutique appliquer en cas de contage avec le Parvovirus B19 en cours de grossesse ?

“…La fréquence du passage est mesurée à 0 % quand l'infection maternelle a eu lieu dans le premier mois de grossesse, à 24 % lorsque l'infection est survenue entre 17 et 20 semaines d'aménorrhée, puis à 67 % si elle est survenue entre 29 et 32 semaines d'aménorrhée [25]. Au total et en moyenne, 33 % des primo-infections maternelles à Parvovirus B19 de la femme enceinte entraînent une infection foetale [26][27][28]. L'infection foetale reste asymptomatique dans deux tiers des cas [4,29].…”

“…Quelques anomalies congénitales ont été rapportées, mais leur incidence se rapproche de celle de la population générale [30] et aucun effet tératogène du Parvovirus B19 n'est retenu chez l'Homme. Les associations malformatives rapportées semblent fortuites [26,31].…”