Unusual bone marrow manifestations of parvovirus B19 infection in immunocompromised patients

Crook, Terri W.; Rogers, Beverly Barton; McFarland, Richard; Kroft, Steven H.; Muretto, Pietro; Hernández, José Antonio; Latimer, M. Jane; McKenna, Robert W.

doi:10.1016/s0046-8177(00)80215-4

Cited by 42 publications

(10 citation statements)

References 29 publications

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“…Of the methods employed in our study, the easier to do was microscopic examination of HE-stained slides. The eosinophilic inclusions corresponding to the "lantern cells" were easily seen, and conformed to the descriptions made in the literature (Krause et al 1992, Crook et al 2000. However, contrariwise to what was observed by several authors (Barretto-Netto et al 1988, Crook et al 2000, the bone marrow samples examined by us were normocellular or hypocellular.…”

Section: Discussionsupporting

confidence: 91%

“…The eosinophilic inclusions corresponding to the "lantern cells" were easily seen, and conformed to the descriptions made in the literature (Krause et al 1992, Crook et al 2000. However, contrariwise to what was observed by several authors (Barretto-Netto et al 1988, Crook et al 2000, the bone marrow samples examined by us were normocellular or hypocellular. Some of the changes described (Barretto- Netto et al 1988, Krause et al 1992, Crook et al 2000 were also frequent in our cases, as the finding of many plasma cells (including numerous Russell bodies), histiocytosis and hyperplasia of megakaryocytes, with immature and dysmorphic forms.…”

Section: Discussionsupporting

confidence: 91%

“…However, contrariwise to what was observed by several authors (Barretto-Netto et al 1988, Crook et al 2000, the bone marrow samples examined by us were normocellular or hypocellular. Some of the changes described (Barretto- Netto et al 1988, Krause et al 1992, Crook et al 2000 were also frequent in our cases, as the finding of many plasma cells (including numerous Russell bodies), histiocytosis and hyperplasia of megakaryocytes, with immature and dysmorphic forms. Despite the easiness with which HE examination is done and interpreted, the medical literature does not encourage us to consider HE-positivity as a sufficient evidence of erythrovirus B19 infection.…”

Section: Discussionsupporting

confidence: 77%

“…The authors' conclusion was that the presence of giant pronormoblasts is neither sensitive nor specific of chronic erythrovirus B19 infection in HIV-positive patients. Crook et al (2000) described eight immunodeficient patients in whom the first evidence of erythrovirus B19 infection was the presence of numerous intranuclear inclusions in the bone marrow biopsies. The infections were confirmed by ISH.…”

Section: Discussionmentioning

confidence: 99%

“…Bone marrow specimens, which are different from those obtained from other tissues (as they have to be previously decalcified) are not easily worked upon with molecular techniques (Jordan & Penchansky 1995, Liu et al 1997. Also, the number of positive cells in bone marrow samples of immunocompromised patients is in general low in comparison to what occurs in the fetus (Crook et al 2000). Another factor that probably influences the variation seen in the results of different studies is the seasonality of the erythrovirus B19 activity.…”

Section: Discussionmentioning

confidence: 99%

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Erythrovirus B19 infection in acquired immunodeficiency syndrome: screening by histopathology, immunohistochemistry, and in situ hybridization

Setúbal

Oliveira

Pires

et al. 2006

Mem. Inst. Oswaldo Cruz

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Erythrovirus B19 infects erythrocytic progenitors, transiently interrupting erythropoiesis. In AIDS patients it causes chronic anemia amenable to treatment. We looked for evidences of B19 infection in stored bone marrow material from patients with acquired immunodeficiency syndrome. Histological sections were made from stored paraffin blocks from 33 autopsies (39 blocks) and 35 biopsies (45 blocks, 30 patients) performed from 1988 to 2002. They were examined after hematoxylin-eosin (HE) staining, immunohistochemical (IHC), and in situ hybridization. HE revealed intra-nuclear inclusion bodies ("lantern cells") suggesting B19 infection in 19 sections corresponding to 19 of 63 patients examined with this test. Seven of 78 sections subjected to immunohistochemistry were positive, corresponding to 7 of 58 patients examined with this test. Fourteen sections corresponding to 13 of the 20 HE and/or IHC positive patients were subjected to in situ hybridization, with six positives results. Among the 13 patients subjected to the three techniques, only one gave unequivocal positive results in all and was considered a true positive. The frequency of B19 infection (1/63 patients) in the material examined can be deemed low.Key words: parvovirus B19-anemia -chronic-immunodeficiency Erythrovirus B19 infects human erythrocytic progenitor cells, leading to a transient interruption of erythropoiesis. In the immunocompetent host this viral infection is cleared within two weeks as a result of the appearance of serum specific antibodies, and the hematological manifestations are restricted to a slight and asymptomatic decline in the hemoglobin levels. When the antibodies appear there may be symptoms of immune complex disease like arthralgias and exanthema. This is what normally takes place during the common childhood exanthematic disease erythema infectiosum. The course can be quite different in certain kinds of host, like those with hereditary hemolytic anemias (e.g., sickle-cell anemia), in whom an acceptable hematocrit is maintained only through an intense and uninterrupted bone marrow activity. In this context erythrovirus B19 infection usually leads to the rapid onset of a life threatening acute anemia, the so called "transient aplastic crisis". The patient is transfusion-dependent until the appearance of specific antibodies spontaneously clears the infection. A similar situation can be found in the fetus, where normal erythron volume expansion also demands a high activity of the hematopoietic fetal tissues. The sudden interruption of hematopoiesis leads to fetal heart failure and anasarca (hydrops fetalis), which may result in fetal death. In immunocompromised individuals (e.g., HIV-infected patients) erythrovirus infection is not readily cleared and its long persistence leads to chronic anemia. In these patients, intravenous standard immunoglobulin infusions usually end viremia and restore hematopoiesis (de Mayolo & Temple 1990, Mitchell et al. 1990, Gottlieb & Deutsch 1992, Noronha et al. 2005.Erythrovirus B19 was discovered by...

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Erythrovirus B19 infection in acquired immunodeficiency syndrome: screening by histopathology, immunohistochemistry, and in situ hybridization

Setúbal

Oliveira

Pires

et al. 2006

Mem. Inst. Oswaldo Cruz

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Antiviral Agents, DNA

Middleton

Rockway

2003

Burger's Medicinal Chemistry and Drug Discovery

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The seven families of DNA viruses that cause disease in humans show tremendous variety in the relationships that they have with their hosts. This variety is reflected both in the disease states that they cause and the approaches used to develop antiviral drugs to treat them. The most successful antiviral tools have been nucleoside analogs, particularly those targeting the polymerases of herpesviruses and hepatitis virus B. The list of nucleoside analog drugs continues to expand as compounds are developed with greater potency or range, better bioavailability, or improved side effect profiles. Other viral targets have started to receive more attention, including helicases, proteases, and enzymes required for virion assembly. These targets should gain in importance as resistance to currently available drugs becomes more prevalent. In addition, expanding the list of viable viral targets is particularly important with regard to members of the parvovirus, papillomavirus, and polyomavirus families, which do not encode a viral polymerase. Some effective antiviral treatments have not targeted the virus but rather the immune response to the viral infection. An optimal immune response is critical to elimination of some classes of viruses, and exploiting this aspect of the host‐virus interaction provides another approach to antiviral drug development.

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