What is the morbidity of parvovirus B19 (B19V) infection?

Updated: Oct 11, 2019
  • Author: David J Cennimo, MD, FAAP, FACP, AAHIVS; Chief Editor: Russell W Steele, MD  more...
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Answer

Morbidity is as follows:

  • Erythema infectiosum (Fifth disease) is described in clinical manifestations below.

  • Polyarthropathy syndrome is mostly seen in adult women with acute infection. Patients develop acute symmetric arthritis affecting the small joints of the hands and feet, typically lasting for 1-3 weeks. In a small number, the arthritis may be prolonged, lasting for months. These symptoms can be confused with rheumatoid arthritis and further complicated by transient rheumatoid factor production during parvovirus B19 infection. [15] For this reason, parvovirus B19 infection should be considered in the differential diagnosis of newly diagnosed rheumatoid arthritis. Studies have not shown a causal link between parvovirus B19 infection and rheumatoid arthritis, and parvovirus B19 does not cause degenerative joint changes. [8]

  • In patients with hemoglobinopathies or hemolytic anemias, in whom the duration of erythrocyte survival is decreased, a decrease in the reticulocyte count to less than 1% (usually to 0%) may precipitate TAC. Such a crisis is characterized by profound anemia caused by a temporary halt in new erythrocyte production. [4] Abnormal erythrocytes, such as those associated with hemoglobinopathies, have a significantly shortened half-life because they are removed from circulation by the reticuloendothelial system. Any interruption in new erythrocyte production may trigger a crisis.

  • The bone marrow during TAC reveals an absence of erythroid precursors and the presence of striking giant pronormoblasts; rarely, necrosis may occur. [16] Parvovirus B19 is the only infectious cause of TAC known and has been shown to be the cause of aplastic crisis in over 80% of patients with sickle cell disease. [2, 8] .

  • Patients who are immunocompromised (eg, receiving chemotherapy or immunosuppressive drugs or have immune defects [congenital and acquired]) may develop chronic parvovirus B19 infection that results in chronic anemia. Pure red cell aplasia (PRAC) persists until the virus is cleared and should be distinguished from the transient anemia described above. [8, 5, 6, 10] Chronic parvovirus B19 infection in transplant recipients has been linked to anemia, other hematologic abnormalities, myocarditis, and pneumonitis. [17] Pediatric patients with hematologic malignancies and parvovirus B19 infection have suffered prolonged anemia that interferes with chemotherapy timing [18] .

  • Parvovirus B19 has been linked to other hematologic abnormalities. Thrombocytopenia, leukopenia, or both may be seen in acute infection, even in immunologically normal hosts. Cases of immune thrombocytopenic purpura, Henoch-Schönlein purpura, and the hemophagocytic syndrome have been attributed to parvovirus B19. However, transient erythroblastopenia of childhood and true aplastic anemia are not associated with infection. [8, 19, 11]

  • Hydrops fetalis, perhaps the most serious complication of parvovirus B19 infection, may occur when a nonimmune woman is infected, usually in the first 20 weeks of pregnancy.

    • Parvovirus B19 infection is the most common cause of nonimmune hydrops fetalis and can result in fetal death in 2-6% of cases. [9]

    • As many as 50% of women of childbearing age may not be immune to parvovirus B19 and are susceptible to infection. [5] The seroconversion rate in the same group is 1.5% per year. [9] The vertical infection rate is estimated at 25-50%. The rate of fetal loss is estimated to be 1.6-9%. [5, 21, 22, 23] Of fetuses infected in the first half of pregnancy, 85% develop hydrops develops within 10 weeks (mean 6-7 wk). In one case series, no fetus infected after 21 weeks' gestation developed severe anemia. [24]

    • The most critical gestational age appears to be 13-16 weeks' gestation, when the fetus has the highest rates of hepatic hematopoiesis.

    • Historically, hydrops had a 30% mortality rate; however, newer data demonstrate a resolution of 94% of cases within 6-12 weeks and a mortality rate of less than 10% if the fetus can be supported by transfusion. [25]

    • Investigators have also called attention to the occurrence of severe anemia in fetuses with hydrops and suggest this may complicate the transfusion procedure. [24]

    • Intrauterine growth retardation, myocarditis, and pleural and pericardial effusions may also occur; however, parvovirus B19 is not associated with a congenital malformation. [9, 8, 14, 22]

    • Infection in the pregnant patient is further covered below.

    • A guideline reviewed the evidence relating to the effects of parvovirus B19 on the pregnant woman and fetus, and also the management of women who are exposed to, who are at risk of developing, or who develop parvovirus B19 infection in pregnancy. Investigation for parvovirus B19 infection was recommended apart from the standard workup for fetal hydrops or intrauterine fetal death. [26, 27]


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