Persistent parvovirus B19 infections in immunocompromised children

Abstract

Immunocompromised patients have been shown to suffer from prolonged viral infections often without detectable immune response. Here chronic infections with low virus levels can be frequently observed. In these patients viral DNA can be detected over long periods by polymerase chain reaction (PCR). In this study parvovirus B19 presence was assessed by PCR, immunoblot and enzyme-linked immunosorbent assay in sera from children with mainly oncological and hematological diseases. In 45% of sera B19 DNA was observed. Of the children 25% had IgG antibodies to viral protein 1 and 2 (VP1/2) and 15% to nonstructural protein 1 (NS1). In 6% of children IgM antibodies to VP1/2 were detected. These results indicate that the number of children with immune response to B19 proteins is distinctly lower than the number of children with B19 DNA. Transfusions of blood products might have been a possible route for B19 infection. Establishment and maintenance of a persistent parvovirus B19 infection with or without immune response are enhanced in the analyzed immunocompromised children in comparison with immunocompetent children. A persistence of B19 DNA was demonstrated up to 10 months in patients sera.

Persistent B19 infection in immunocompetent individuals: implications for transfusion safety

“…Although these indirect elements suggest a low risk of B19 transmission by seropositive blood products, such might not be the case in severely immunodeficient recipients such as patients receiving immunosuppressive treatment for bone marrow or solid organ transplants. 6,28,31 The serologic results obtained in the pregnant women were not always concordant with the molecular data. Indeed, the presence of B19 IgM at a low level without detectable B19 DNA was unexpected and might be explained by false reactivity related to the physiologic elevation of immune globulins in pregnant women.…”

“…However, a persistent infection may be observed in immunocompromised patients unable to produce neutralizing antibodies and to clear the virus, leading to chronic B19 carriage with or without anemia. [6][7][8] Persistence of infection in the bone marrow has also been reported in immunocompetent individuals with or without symptoms. [9][10][11] The primary route of transmission of B19 is respiratory (via aerosol droplets), but the infection may also be transmitted by transfusion of blood components; in particular, packed red cells from blood collected during the short preseroconversion viremic phase.…”

Advances in Human B19 Erythrovirus Biology

“…A transient, high-level viremia is present for less than 1 week and then declines with the appearance of specific IgM antibodies that persist for 8 to 10 weeks (3) and specific IgG antibodies that persist for the lifetime of the individual. Persistent infections may be observed in immunocompromised patients unable to produce neutralizing antibodies and to clear the virus, leading to chronic carriage of B19V with or without anemia (28,29,49). However, even though the immune response is able to clear infection in healthy individuals and to provide lifelong protection against B19V, persistence of infection in the bone marrow has been reported in immunocompetent individuals with or without symptoms (12,57,71), and recently, persisting low levels of B19V DNA has been evidenced in the blood of immunocompetent individuals several years after primary infection (13,50).…”

New LightCycler PCR for Rapid and Sensitive Quantification of Parvovirus B19 DNA Guides Therapeutic Decision-Making in Relapsing Infections

“…In patients with an underlying hematologic disorder and high blood cell turnover (e.g., hemolytic anemia), transient aplastic anemia may ensue. Immunocompromised patients, who have an increased risk of developing a persistent B19 infection, are threatened by a chronic reticulocytopenic anemia, also known as pure red cell anemia (2,8).Diagnosis of uncomplicated cases of acute B19 infection (fifth disease or arthropathy) is usually clinically based and can be accomplished by detection of specific immunoglobulin M (IgM) antibodies except in immunocompromised patients, who are prone to persistent infection and who may generate IgMspecific B19 antibodies less reliably (7,19). Likewise, specific IgG is not a reliable marker for discriminating a reconvalescent status from chronic persistent infection (35), although recent data indicate that IgG antibodies specific for nonstructural protein 1 (NS-1) of B19 are more frequently associated with persistent infection (24).…”

“…Diagnosis of uncomplicated cases of acute B19 infection (fifth disease or arthropathy) is usually clinically based and can be accomplished by detection of specific immunoglobulin M (IgM) antibodies except in immunocompromised patients, who are prone to persistent infection and who may generate IgMspecific B19 antibodies less reliably (7,19). Likewise, specific IgG is not a reliable marker for discriminating a reconvalescent status from chronic persistent infection (35), although recent data indicate that IgG antibodies specific for nonstructural protein 1 (NS-1) of B19 are more frequently associated with persistent infection (24).…”