2016-2017年武汉地区儿童细小病毒B19感染及流行情况分析

摘要：目的 了解武汉地区儿童细小病毒B19感染状况及流行病学特征。 方法 采集自2016年1月1日至2017年12月31日在我院门、急诊和住院部就诊或住院治疗的疑似细小病毒B19感染儿童静脉血,通过ELISA法检测血清细小病毒B19-IgM,并对抗体活性值在10 ~20 U/mL之间的标本进行细小病毒B19 DNA定量检测,综合分析武汉地区儿童细小病毒B19感染状况及流行病学特征。结果 武汉地区2017年儿童细小病毒B19感染率为2.83%,较2016年6.31%的感染率显著下降,两年平均总体感染率为4.34%;儿童细小病毒B19感染状况具有明显的年龄（2岁以上）及性别（女性高于男性）差异; ELISA法检测HPV-B19抗体活性值处于10~13 U/mL之间的标本与PCR检测结果一致性较好,阴性符合率为93.54%;抗体活性值处于13~17 U/mL之间的标本结果一致性较差,阳性符合率为43.21%。抗体活性值17~20 U/mL的标本,阳性符合率为74.81%。结论 武汉地区儿童细小病毒B19感染具有年龄、性别差异,同时对于经ELISA法检测抗体活性值处于13~20 U/mL之间的标本,有必要进行PCR检测确诊。     

Seroprevalence of human parvovirus B19 amongst North Indian blood donors - do current donor testing guidelines need a relook?

Objectives

The present study was aimed to find out the prevalence of parvovirus B19? amongst healthy blood donors and blood transfusion recipients so as to determine the feasibility of providing seronegative blood components to vulnerable recipients.

佛山地区无偿献血人群人细小病毒B19感染情况分析

目的了解佛山地区无偿献血人群人细小病毒(HPV)B19感染现状。方法采用ELISA检测血液中的HPV B19IgG和IgM抗体,并用PCR检测抗体阳性标本HPV B19DNA。结果 368例无偿献血者标本中检出HPV B19IgG阳性92例,阳性率为25.00%;检出HPV B19IgM阳性2例,阳性率为0.54%,两者比较差异有统计学意义(P0.01)。94例抗体阳性标本中,检测HPV B19DNA阳性4例,阳性率为4.26%。结论佛山地区无偿献血人群存在较高的HPV B19既往感染率,急、慢性感染率较低,慢性感染者HPV B19病毒载量较低。     

正常孕妇与不孕不育妇女血清TORCH抗体比较

目的通过对近6年佛山市禅城区中心医院TORCH结果进行回顾性分析,对正常孕妇与不孕不育妇女血清TORCH抗体结果进行比较,了解TORCH感染与不孕不育的相关性。方法采用酶联免疫吸附试验（ELISA）测定血清TORCH抗体。RT-6000酶标仪上测定OD值,根据试剂说明书判定结果。结果1920例正常孕妇弓形虫（TOX）TOX—IgG、TOX—IgM、风疹病毒RUV—IgM、微小病毒B19-IgM、巨细胞病毒CMV—IgM、单纯疱疹Ⅱ病毒（HSV）HSVII—IgG、HSV II-IgM的阳性率分别为2．14％、0．78％、0．16％、0．52％、0．36％、6．8％、0．73％;635例不孕不育妇女弓形虫（TOX）TOX—IgG、TOX—IgM、风疹婀毒RUV—IgM、微小病毒B19-IsM、巨细胞病毒CMV—IgM、单纯疱疹Ⅱ病毒（HSVII）HSVII—IgG、HSVII—IgM、的阳性半分别为3．15％、0．79％、0．31％、1．89％、1．10％、15．75％、1．26％;结论不孕育龄妇女B19-IgM、CMV—IgM、HSVII—IgG阳性率明显高于正常孕妇组,TORCH感染与不孕不育密切相关。     

Clinical manifestations and outcomes of parvovirus B19 infection during pregnancy in Japan

Parvovirus B19 is a small DNA virus. Infection with parvovirus B19 during pregnancy may cause serious complications in the fetus, including hydrops fetalis and fetal death. The purpose of the present study is to clarify the clinical manifestations and outcomes of parvovirus B19 infection during pregnancy. This prospective study enrolled 478 women with suspected B19 infections during pregnancy between 1999 and 2004. One hundred cases (21%) of B19 infection were detected in 478 pregnant women who had been exposed to B19. Serological infection was confirmed by measurement of B19-specific IgM and IgG in sera. Forty-nine cases reported maternal clinical symptoms and 51 cases were asymptomatic. Facial rash was the most common symptom, with 51% (25/49) of the symptomatic patients complaining of either a facial, body or limb rash. The most common infectious source was children living in the home. Overall, the incidence of adverse fetal effects (including hydrops fetalis and fetal death) related to intrauterine B19 infection was 7% (7/100), and all seven cases were exposed to B19 infection before 20 weeks of gestation. Although half of the cases with parvovirus B19 infections during pregnancy were asymptomatic, patients with adverse fetal effects tended to be symptomatic including rash and fever. These clinical data may supply useful information to produce clinical guidelines for managing B19 infection during pregnancy.     

Clinical presentations of parvovirus B19 infection

Although most persons with parvovirus B19 infection are asymptomatic or have mild, nonspecific, cold-like symptoms, several clinical conditions have been linked to the virus. Parvovirus B19 usually infects children and causes the classic "slapped-cheek" rash of erythema infectiosum (fifth disease). The virus is highly infectious and spreads mainly through respiratory droplets. By the time the rash appears, the virus is no longer infectious. The virus also may cause acute or persistent arthropathy and papular, purpuric eruptions on the hands and feet ("gloves and socks" syndrome) in adults. Parvovirus B19 infection can trigger an acute cessation of red blood cell production, causing transient aplastic crisis, chronic red cell aplasia, hydrops fetalis, or congenital anemia. This is even more likely in patients with illnesses that have already shortened the lifespan of erythrocytes (e.g., iron deficiency anemia, human immunodeficiency virus, sickle cell disease, thalassemia, spherocytosis). A clinical diagnosis can be made without laboratory confirmation if erythema infectiosum is present. If laboratory confirmation is needed, serum immunoglobulin M testing is recommended for immunocompetent patients; viral DNA testing is recommended for patients in aplastic crisis and for those who are immunocompromised. Treatment is usually supportive, although some patients may require transfusions or intravenous immune globulin therapy. Most patients recover completely.     

Prevalence and Quantity of Parvovirus B19 DNA Among Blood Donors from a Regional Blood Center in Turkey

ObjectiveParvovirus B19 causes a range of diseases and morbidity in humans and is transmissible by transfusion of blood, blood components and plasma derivatives. The objective of the study was to investigate the prevalence and quantity of B19 DNA among blood donors. Method: Totally 1053 samples were collected from March to July 2016 at a blood bank for detection of Parvovirus B19 DNA and serological status of blood donors. Testing of the presence of viral DNA was performed by a quantitative real-time PCR with a 101 copies/ml detection limit. All DNA positive and randomly selected 267 samples were tested for the presence of anti-B19 IgM and IgG by ELISA.ResultsAge distribution of donors was between 18-64; mean age was 27 and median was 23. Among the 1053 samples, 5 (0.47%) had PB19 DNA. All PB19 DNA positive donations had both B19 IgM and IgG antibodies. The DNA level for positive donations were between 0.9 × 102 to 3.1 × 104 copies/ml. IgG and IgM were present in 59.9% (160/267) and 0,74% (2/267) respectively among the healthy donors without PB19 DNA.ConclusionDetected DNA concentration was less than 105 copies/ml. The presence of IgM in low level PB19 DNA positive donors may indicate that there might be a risk in transmission of PB19 to particularly immunosuppressed recipients. The clinical follow-up of blood donation with low level of PB19DNA should be considered to answer the questions about blood safety.     

Cytomegalovirus infection in low-birth-weight infants with acute respiratory tract disease

To determine a participation of cytomegalovirus (CMV) infection in acute respiratory tract disease (ARTD) of low-birth-weight (LBW) infants, specific antibodies against CMV antigens, IgG antibodies against early antigens of CMV (IgG EA) and IgM antibodies against membrane antigens of CMV (IgG MA) were analyzed. The frequency of IgG EA in patients with ARTD was higher than that in controls (46% vs. 32%), and the geometrical mean titer (GMT) of IgG EA in the patients was also higher than that in controls (50.2 vs. 20.1). Five of 15 ARTD patients had IgM MA, and the frequency was significantly higher than that of controls (33% vs. 1.3%, p less than 0.01). Eleven of 15 LBW patients with ARTD had a history of blood transfusions during the neonatal period, and 5 of them had significant IgM MA indicating active CMV infection. All 4 LBW patients without blood transfusion were negative for IgM MA. These results suggest a close relationship of CMV infection to ARTD of LBW infants, but it remains for further studies whether blood transfusion is a primary source of CMV infection in LBW infants.     

Clinical illness due to parvovirus B19 infection after infusion of solvent/detergent-treated pooled plasma

BACKGROUND: Lipid-enveloped viruses such as HIV, HBV, and HCV can be inactivated by treatment with solvents and detergents. HAV and human parvovirus B19 lack lipid envelopes and are not inactivated. Solvent/detergent-treated pooled plasma (S/D plasma) contains neutralizing antibodies, but it is not known whether the parvovirus B19 antibody content is sufficient to prevent transmission of the disease. A patient is described who developed a clinical illness due to parvovirus B19 infection after the infusion of S/D plasma. CASE REPORT: A 36-year-old woman with myasthenia gravis underwent five plasma exchange procedures from January 15 to January 25, 1999, using albumin, except for 5 units of SD plasma given because of a low fibrinogen level. Four of the 5 units were implicated in a recall after high levels of parvovirus B19 DNA were found in several lots. Two weeks after the infusion, the patient developed fatigue, a rash, and severe polyarthralgias. Parvovirus B19 IgG and IgM antibody titers were consistent with an acute infection. CONCLUSION: Clinically apparent parvovirus B19 infection can follow the use of S/D plasma that contains high levels of parvovirus B19 DNA.     

The diagnostic problems in cytomegalovirus infection in patients with a transplanted kidney]

Several methods of cytomegaloviral (CMV) infection diagnosis were studied in patients with a transplanted kidney. EIA was used to examine clinically normal subjects and patients with CMV infection symptoms for the presence of anti-CMV IgM and IgG. Pulmonary cells of the human embryo were infected with the patients' blood and urine, followed by examination for the presence of antigen. After 7 to 14 days part of the infected cultures were examined for virus isolation. The cytological specimens prepared from the saliva and urinary sediment were investigated for the presence of cells containing characteristic CMV inclusions. Altogether 87 patients were examined. Of these, 27 had evident signs of the disease. As for the patients, virus from the blood was isolated in 60, that from the urine in 90% of cases. Viral antigen was found in the cells infected with material from the urine (in 70% of cases) and blood (in 80% of cases). It the group of the clinically normal subjects, the same parameters turned out much lower: virus from the blood was isolated in 12, that from the urine in 11% of cases. In the clinically normal subjects, anti-CMV IgG and IgM were demonstrated in 80 and 21% of cases, respectively. As for the patients, anti-CMV IgG was discovered in 100 and anti-CMV IgM in 70% of cases. All the patients with a transplanted kidney exhibited markers of CMV infection.     

Transfusion- and community-acquired cytomegalovirus infection in children with malignant disease: a prospective study

BACKGROUND: The use of cytomegalovirus (CMV)-"safe" blood has been recommended for CMV seronegative patients with newly diagnosed malignant disease for whom bone marrow transplantation is a future option. STUDY DESIGN AND METHODS: To evaluate this policy, 76 CMV- seronegative children with lymphoreticular malignancies or solid tumors were randomly assigned to receive either blood components that were not screened for CMV antibody or CMV-seronegative red cell (RBC) and platelet units. Subjects were followed for evidence of CMV infection by the use of enzyme-linked immunosorbent assays and virus isolation. Follow-up continued long after the blood transfusions to determine the risk of community-acquired CMV infection. RESULTS: No cases of transfusion-acquired CMV infection were documented. The prevalence of CMV IgG and IgM antibody in blood donors was 40.5 and 0.9 percent, respectively. Patients assigned to receive standard blood components and CMV-negative components were given a median (range) of 7 (1-30) and 9 (1-38) RBC units and 11 (0-123) and 14 (0-71) platelet units, respectively. The risk of transfusion-acquired CMV infection is estimated to be less than 1 in 698 donor exposures. Two patients developed asymptomatic community-acquired CMV infection, for an incidence of 1.7 percent per patient-year of follow-up. CONCLUSION: The risk of transfusion-acquired CMV infection in this population is low, largely because of the patients' low level of exposure to seropositive blood and the use of relatively white cell-reduced components for purposes other than CMV prevention. Such children at this center therefore continue to receive standard blood components. Strategies to prevent CMV seroconversion in these children should include parental education to minimize the risk of community-acquired infection.     

Immunoglobulin levels and specific viral antibodies in relation to smooth-muscle antibodies in cytomegalovirus infection.

Among 17 patients with cytomegalovirus (CMV) infection smooth-muscle antibodies (SMA) of the IgM class were detected in 9 (53%) and IgG-SMA in 6 (35%), while no IgA-SMA were found. IgM-SMA were present most often and in the highest titres (10-160) in the beginning of the disease, while IgG-SMA were found both early and late during the course of infection. SMA occurred most frequently in patients with specific CMV antibodies of the IgM class and in patients with elevated serum alanine aminotransferase values, but these relationships were not significant. Elevated levels of serum IgG, IgA and IgM were found in CMV infection, and a correlation between serum IgM values and IgM-SMA titres was demonstrated (alpha less than 0.01). A similar correlation between serum IgG and IgG-SMA could not be established. These findings are in support of the assumption that IgM-SMA account for a minor part of the elevated serum IgM levels in CMV infection, but not of the hypothesis that the stimulus for antibody production is the release of antigens from liver cells.     

Prenatal diagnosis of cytomegalovirus infection

Prognostic value of markers of cytomegalovirus infection (CMV) in pregnant women for the neonatal status was assessed. Detection of such markers as antiCMV IgM and CMV DNA in cervical secretion by DNA dot-spot hybridization in women with a complicated course of pregnancy indicates a 5.7% risk of delivery of children with stable symptoms. Studies of antibodies to pre-early proteins (IE CMV) showed that antiCMV IgG to IE are more incident in pregnant women than antiCMV IgM; moreover, antiCMV IgG to IE but not antiCMV IgM are detected in umbilical blood. The results of detection of antiCMV IgG and IgM to IE correlated with the clinical characteristics of newborns.     

广州地区献血人群人类细小病毒B19感染情况及病毒载量分析

目的了解广州地区献血者HPVB19感染状况。方法采用EIA对献血者血进行HPVB19 IgG、IgM筛查,并用PCR法对HPV B19抗体阳性血样进行HPV B19 DNA检测。结果HPV B19 IgG阳性率为38.6%(679/1760),HPVB19 IgM阳性率为1.9%(33/1760),两者有显著差异(P<0.001)。33例HPVB19 IgM阳性样本,HPVB19 DNA阳性检出率为63.6%(21/33);56例HPVB19 IgG阳性样本,HPVB19 DNA阳性检出率为1.8%(1/56),两者有显著差异(P<0.001)。21例HPV B19 DNA阳性样本中,病毒载量≥1×104Copies/ml占51.9%(13/21)。结论广州地区献血者HPV B19病毒既往感染率较高,但HPV B19病毒急慢性感染率较低。     

细小病毒B19宫内感染与新生儿贫血的相关性研究

目的探讨细小病毒B19宫内感染与新生儿贫血的相关性。方法收集138例贫血新生儿和85例未贫血新生儿的脐血,应用酶联免疫吸附试验检测两组患儿脐血中的人细小病毒B19IgM抗体水平。结果两组患儿脐血检测结果差异具有统计学意义(P0.05)。结论 B19病毒宫内感染与新生儿贫血具有一定的相关性。     

Diagnosis of parvovirus B19 infection in patients with secondary immunodeficiency diseases

The method of immune-enzyme assay was used to examine 113 patients with secondary immunodeficiency, including 16 HIV-infected drug-addicts (group 1), 36 patients with cytomegalovirus infection (CMVI) and with immunoregating index CD4/CD8 below 1.0 (group 2), 30 patients with CMVI and with CD4/CD8 below 1.2 (group 3) and 31 patients with aplastic anemia and with anemia of unclear genesis (group 4), for parvovirus infection caused by parvovirus B19. As for groups 1 and 4, the antibodies were detected in 50 and 48.4% of cases; it is noteworthy that an active parvovirus infection was registered in the above groups more often than in groups 2 and 3. There were patients with the antibodies in group 2 by 1.8 times more than in group 3. It is suggested that the simultaneous impact of HIV, CMV and parvoviruses significantly aggravates the immunodeficiency and contributes to a more severe clinical course.     

Chronic anemia due to parvovirus B19 infection in a bone marrow transplant patient after platelet transfusion

BACKGROUND: Many reports document the transmission of human parvovirus B19 (B19) infection by clotting factor concentrates manufactured from large plasma pools. Transmission via other blood components originating from a single donor or a small number of donors, however, seems to occur only rarely. The study reported here identifies a B19 infection that was transmitted via a platelet donation. CASE REPORT: A multiply transfused allogeneic bone marrow transplant patient developed chronic anemia due to persistent B19 infection. The anemia responded to therapy with intravenous immunoglobulin. It was postulated that a transfusion was the source of the B19 infection. Archived sera from 90 implicated blood donors were tested for B19 IgM and DNA by the use of dot-blot hybridization and a nested polymerase chain reaction with primers from the B19 nonstructural gene. B19 DNA from patient and donor sera were sequenced. One of the 90 blood donors (Donor A) was B19 IgM positive and had a high level of B19 DNA. The patient was viremic 3 days after transfusion of platelets from this donor, and the sequence of B19 DNA from the patient exactly matched that of B19 DNA from the donor. A second blood donor (Donor B) had a low level of B19 DNA but was IgM negative. The patient showed no evidence of B19 infection after the transfusion of red cells from Donor B, and the sequence of this donor's B19 DNA was different from that in the patient. CONCLUSION: Blood Donor A with asymptomatic acute B19 infection was the source of B19 infection in the bone marrow transplant patient. Donor B with a low level of B19 DNA was not the source of infection.     

早产儿先天性巨细胞病毒感染特点及危险因素分析

目的 调查早产儿先天性巨细胞病毒（CMV）感染状况,分析其特点及危险因素。方法 选择住院的早产儿,分别采用荧光定量PCR（FQ-PCR）法和ELISA法检测脐血血清CMV IgM与DNA。同时记录新生儿和母亲的人口学信息,采用二元多因素logistic回归分析早产儿先天性CMV感染相关影响因素。结果 共纳入1315例早产儿,血清CMV IgM和（或）CMV DNA阳性者占1.98%（26/1315）,CMV IgM阳性者占1.44%（19/1315）,血清CMV DNA阳性者占1.14%（15/1315）,CMV IgM与CMV DNA均为阳性者占0.61%（8/1315）。早产儿先天性CMV感染症状较为轻微。母亲年龄< 25岁、初次妊娠、孕期胎膜早破是早产儿先天性CMV感染的危险因素（P均< 0.05）。结论 早产儿先天性CMV感染发生率较高,以无症状感染为主。提高年轻育龄妇女对CMV的知晓率、加强早产儿先天性CMV感染的管理是很有必要的。     

Lack of difference in cytomegalovirus transmission via the transfusion of filtered-irradiated and nonfiltered-irradiated blood to newborn infants in an endemic area

BACKGROUND: It is accepted that white cells contained in blood components are the most significant source of cytomegalovirus (CMV) infection in immunocompromised and immunodeficient recipients. STUDY DESIGN AND METHODS: To determine whether white cell filtration of blood would be effective in preventing infection among newborn transfusion recipients in a hyperendemic area, a randomized study was performed. All donor blood units were irradiated before issue to prevent posttransfusion graft-versus-host disease. Recipients were monitored for CMV infection by seroconversion (development of IgM anti-CMV) and CMV-DNA isolation. RESULTS: Three (9%) of 33 infants who received filtered blood and 1 (5%) of 19 infants given nonfiltered blood were infected with CMV, as determined by the presence of IgM anti-CMV and/or CMV DNA isolation.There was no significant difference in the rate of CMV infection in the two groups. CONCLUSION: The CMV infection observed in the study may come from other routes such as breastfeeding, rather than from transfusion. Our findings suggest that the routine use of white cell-reduction filtration to reduce the risk of transmitting CMV is unwarranted for neonates in endemic regions.     

Screening of patients with complex regional pain syndrome for antecedent infections.

OBJECTIVE: This study was designed to investigate whether Complex Regional Pain Syndrome type I (CRPS I) could be linked to any previous infection. PATIENTS: Fifty-two patients with CRPS I of one extremity were screened for the presence of antibodies against mostly neurotropic microorganisms. RESULTS: Of these 52 patients, none had antibodies against Treponema pallidum, Borrelia burgdorferi, or HTLV-1. Only four patients were positive for Campylobacter jejuni. For cytomegalovirus, Epstein-Barr virus, herpes simplex virus, and Toxoplasma gondii, seroprevalences were similar to control values. The total seroprevalence of Parvovirus B 19 in our CRPS population was 77%, which was significantly higher than in an independent Dutch population group (59%). Seroprevalence in lower extremity CRPS 1 (94%) was significantly higher than in upper extremity CRPS I patients (68%). In this study all patients were seropositive for varicella zoster virus (VZV) antibodies, but a high prevalence of VZV antibodies is similar to its prevalence in a normal population (>90%). CONCLUSIONS: In this study we found a significantly higher seroprevalence of Parvovirus B19 in CRPS I and this is most striking in lower extremity CRPS I patients. Further serologic research in other geographic areas is needed to provide additional information about a potential role of Parvovirus B 19 or other microorganisms in the etiopathogenesis of CRPS I.