Acute encephalitis and encephalopathy associated with human parvovirus B19 infection in children

Reports of neurologic manifestations of human parvovirus B19(B19) infection have been on the rise. Acute encephalitis and encephalopathy is the most common, accounting for 38.8% of total B19-associated neurological manifestations. To date, 34 children with B19encephalitis and encephalopathy have been reported, which includes 21 encephalitis and 13 encephalopathy cases. Ten(29%) were immunocompromised and 17(39%) had underlying diseases. Fever at the onset of disease and rash presented in 44.1% and 20.6% of patients, respectively. Neurological manifestations include alteration of consciousness occurred in all patients, seizures in 15(44.1%) patients, and focal neurologic signs in 12(35.3%) patients. Anemia and pleocytosis in cerebrospinal fluid(CSF) occurred in 56.3% and 48.1% of patients, respectively. Serum Anti-B19 Ig M(82.6%) and CSF B19 DNA(90%) were positive in the majority of cases. Some patients were treated with intravenous immunoglobulins and/or steroids, although an accurate evaluation of the efficacy of these treatment modalities cannot be determined. Nineteen(57.6%) patients recovered completely, 11(33.3%) patients had some neurological sequelae and 3(8.8%) patients died. Although the precise pathogenesis underlying the development of B19 encephalitis and encephalopathy is unclear, direct B19 infection or NS1 protein of B19 toxicity in the brain, and immune-mediated brain injuries have been proposed.