Parvovirus B19 transmitted by bone marrow

Abstract

Summary. We describe a case of symptomatic parvovirus B19 infection transmitted by bone marrow (BM). The infection caused prolonged anaemia, thrombocytopenia, arthralgia and erythema infectiosum in a 16-year-old girl with acute myeloid leukaemia receiving a BM transplant (BMT). The BM donor was a 19-year-old asymptomatic brother who had parvovirus B19 viraemia at the time of BM harvest. Sequencing of the VP2 gene from the patient and the donor showed a perfect match of DNA sequences, confirming the mode of transmission. Parvovirus B19 represents a potential complicating factor in patients undergoing BMT, but screening by polymerase chain reaction (PCR) of donor BM may reduce the risk of infection.Keywords: bone marrow, ELISA, parvovirus B19, polymerase chain reaction, transplantation.Parvovirus B19 exhibits a marked tropism to human bone marrow (BM) and replicates only in erythroid progenitor cells (Brown & Young, 1995). The virus is transmissible by the respiratory route or by blood and infection may lead to erythema infectiosum, arthropathy, hydrops fetalis and various haematological disorders (aplastic crisis, chronic anaemia, idiopathic thrombocytopenic purpura). We present the first case of symptomatic parvovirus B19 infection transmitted by BM causing prolonged anaemia, thrombocytopenia, arthralgia and erythema infectiosum. PATIENT AND METHODSA 16-year-old girl diagnosed with acute myeloid leukaemia underwent bone marrow transplantation (BMT) on 25 October 1984 (day 0). Twelve days later, she developed fever and a rash involving the upper extremities. The rash subsequently progressed, involving the lower extremities, neck and face (slapped cheek appearance). Coinciding with these findings, the patient complained of arthralgia, mainly involving the large joints. The symptoms gradually disappeared over a 3-week period.Examination of BM slides (air-dried BM inoculum) using light microscopy revealed no lantern cells or giant pronormoblasts at the time of BMT or during follow-up. Apart from red cell hypoplasia, no specific changes were noted. Reticulocytes were absent for extended periods of time (days 0±15 and 35±75) and reoccurred briefly in small numbers (days 16±34), before showing a slow but steady increase towards normal levels (day 76 onwards). Within the first 76 d, haemoglobin levels were accordingly low (5´6±11´6 g/dl), and a reduced number of platelets (5± 78 Â 10 9 /l) were observed. Transfusion of 16 units of red blood cells and 101 units of platelets were needed to sustain and correct these parameters. The patient then finished the standard protocol involving methotrexate and cyclosporin treatment and has had no adverse haematological symptoms during 15 years of follow-up.As part of a retrospective pilot study of parvovirus B19 infection in BM recipients, we tested a number of stored BM and serum samples from the patient by enzyme-linked immunosorbent assay (ELISA) and amplified the NS and VP genes by nested polymerase chain reaction (PCR) (Hornsleth et al, 1994). Examination of this material reve...

Autologous peripheral blood progenitor cells are a potential source of parvovirus B19 infection

“…Parvovirus B19 is most often transmitted by respiratory tract secretions, but transmission by the transfusion of RBCs, 19 PLTs, 20 clotting factor concentrates, 2122 and IVIG 23 has been well documented. In addition, transmission of parvovirus by allogeneic marrow progenitor cells has been previously confirmed 12 . Our case illustrates that the PBPCs are a potential source of parvovirus infection after autologous BMT.…”

“…Parvovirus infection has been shown to cause PRCA, chronic anemia, and engraftment failure after allogeneic BMT 5,6 , 12‐16 and PRCA after autologous BMT 17 . In many cases, the source of infection is difficult to ascertain.…”

Human Parvovirus B19 in Solid Organ Transplantation

“…However, nucleic acid testing (NAT) is available for plasma units in process of being fractionated . There is evidence that transmission of parvovirus B19 infection may occur at the time of transplantation . Barzon et al showed that in the majority of 10 pediatric kidney transplant patients (pretransplant parvovirus serology D+/R−), positive detection of parvovirus B19 DNA in the allograft kidney biopsy sample, preservation solution or washing solution (which contain circulating donor cells and resident kidney cells) was associated with posttransplant detection of parvovirus DNA in the blood of the recipient .…”

Pure red cell aplasia due to parvovirus B19 infection transmitted probably through hematopoietic stem cell transplantation

“…During parvovirus B19 infection, viremia usually persists for about a week, but virus DNA may be detectable by PCR methods for extended periods of time in serum (8, 12–14) and bone marrow (15), even in healthy, non‐anemic, asymptomatic individuals. Epidemiologic studies revealed that DNA B19 positivity among blood donors can be found with varying, usually very low frequency (according to various studies, from 0.003% to 0.6%) and there are reports in the literature that B19 may be transmitted by bone marrow (2, 8, 16) and blood‐derived products such as platelets (17) or intravenous immunoglobulin (18). Parvovirus B19 infection has also been reported in patients receiving solvent‐ or detergent‐treated plasma (19, 20).…”

“…Transmission of parvovirus B19 infection poses a risk of persistent infection and chronic anemia for immunocompromised patients, solid organ transplantation and bone marrow recipients, as well as for HIV patients. There are proposals that B19 screening of blood components destined for children with malignancies (20) and testing of bone marrow donors before transplantation should be considered (16). Because the overall rate of infection is low, testing all donors may be unnecessary, but this precaution especially applies to child recipients, as at a younger age there is greater possibility that the recipient may be seronegative, and also applies to patients receiving blood components derived from multiple blood units (such as clotting factors concentrates).…”