Spectrum of Parvovirus B19 Infection: Analysis of an Outbreak of 43 Cases in Cadiz, Spain

Abstract

In the spring of 1993, an epidemic of infection with human parvovirus B19 occurred in Cadiz, Spain. Evaluation of the 43 patients in whom this diagnosis was confirmed revealed four groups of predominant manifestations: (1) hematologic manifestations in six cases (13.9%), including four of aplastic crisis and two of pancytopenia; (2) dermatologic manifestations in 23 cases (53.4%), including 10 of erythema infectiosum and one of erythema multiforme ampullosum; (3) arthralgias/arthritis in nine cases (20.9%), including two with a chronic course; and (4) infection during pregnancy in three cases (7.0%), including two that ended in abortion. Of the 43 patients, 37.2% presented with fever and adenopathies, and these were the only manifestations in two cases. The appearance of clinical disease correlated with modifications in isotype and serum level of specific antibodies to parvovirus B19; the disappearance of IgM antibodies coincided with the resolution of clinical manifestations. Although their presence did not correlate with the course of the disease, the detection of circulating immune complexes in 81.6% of cases supports the possibility that some manifestations were immune mediated.

Human Parvovirus B19 and Blood Products

“…In nominally immunocompetent individuals infection is often asymptomatic, but in affected individuals results most frequently in erythema (especially in children) and arthralgia (particularly in female adults) [55]. This is confirmed by two recent prospective studies performed during epidemic outbreaks, which also showed that aplastic crisis and intrauterine infection occur at a significant frequency [56,57]. Furthermore 9 of the total of 96 patients followed up in these two studies exhibited chronic infection with symptoms usually involving arthralgia, hence confirming previous reports of persistent infection in some individuals in association with arthritis [58,59], chronic April to June 95 (7 in 27 PCR-positive) (1 in 6,534) CIE = Counter immunoelectrophoresis; DID = double immunodiffusion (sens 10 9 /ml); PCR = polymerase chain reaction (sens 10 2 -10 4 / ml); RHA = receptor-mediated haemagglutination (sens 10 5 -10 6 /ml).…”

Parvovirus B19 in the acute arthropathies and juvenile rheumatoid arthritis

“…In adult B19 arthropathies, mostly smaller joints are affected 5,6 . On the other hand, some studies like ours showed that in children 7 and in some adult series 12 the major joints especially the knees have been affected. Polyarticular and symmetrical involvement are seen in adults, 4,6,10 while pauciarticular involvement is more common in childhood 7 .…”

Human parvovirus B19 infection mimicking systemic lupus erythematosus

“…Clinical features (Table 1) Sixteen patients (cases [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] presented at the Department of Internal Medicine, and the others (cases [17][18][19][20][21][22] presented at the Department of Dermatology. Some of them were referred to us from peripheral medical centers as having rheumatic disease.…”

“…Soloninka et al 18 reported that 68% of individuals recently recovered from HPV-B19 infection had elevated levels of anti-dsDNA and anti-ssDNA antibodies. Garcia-Tapia et al 19 evaluated the clinical and hematological findings in 43 patients with HPV-B19 infection and found hematological abnormalities in 13.9%, arthralgia/arthritis in 20.9%, and circulating immune complexes in 81.6%. Gendi et al 20 examined 47 patients with proven HPV-B19 infection during an outbreak in Oxfordshire (UK) in 1993, and looked at C3 and C4 complement components and ANA 1 year later.…”