妊娠期细小病毒B19感染

细小病毒B19感染是人类常见一种传染性疾病。妊娠期感染细小病毒B19后可导致流产、胎儿水肿、胎儿畸形,甚至胎儿死亡等。有报道,胎儿传染率为33％,16－28周妊娠期的胎儿似乎对细小病毒感染表现的尤为敏感。细小病毒特异性IgM抗体存在,提示近期感染。目前可用DNA杂交技术或聚合酶链反应进行DNA实验以检测羊水或血液中的细小病毒抗原的存在。妊娠合并细小病毒感染无特效方法,目前报道表明宫腔输血可以减轻B19病毒毒性及治疗胎儿水肿,对病毒有效的疫苗正在研制之中,有望可以预防生育年龄妇女的细小病毒感染。     

微小病毒B_(19)与相关疾病的研究进展

人细小病毒B19（11um。np。。OVlruSB19），B19是小DNA病毒属中唯一对人类致病的病毒，能弓l起人类多种疾病。妊娠期感染B19可导致流产、胎儿水肿及死胎。儿童中常见的出疹性疾病、传染性红斑、再生障碍性贫血危象（简称再障危象）、关节炎、全血细胞减少症等是由Bl。感染引起。B19感染已成为不可忽视的危害人类健康的病原。1病原学B19是一种单链小DNA病毒，直径23Dffi，无缝膜包裹，长约5．SKb。它是由英国学者Cossart在1975年常规检测献血员血液中乙型肝炎病毒（HB）时偶然从标本号为19的献血员中发现的，为了不与人类乳头瘤病毒…     

黄疸婴儿血清TORCH及COV感染的血清学检测

人类巨细胞病毒（HCMV）在人群中感染率较高，是先天性感染中最常见的致畸、致残病毒之一，据文献报告，妊娠期原发CMV感染率为0．70％～4％，其胎儿新生儿感染率为30％～40％.本文对我院新生儿科291例高胆红素血症患儿行TORCH及COV—IgM（柯萨奇病毒-IgM）进行了检测，以了解其感染情况。     

白细胞介素17与乙型肝炎病毒宫内感染的相关研究进展

乙型肝炎是一种严重危害人类健康的世界性传染病,全球慢性HBV感染约有3.5亿,其中围生期传播是一种主要的传播方式,我国人群感染率达5%-18%。有文献报告活产新生儿宫内感染率达20%。因此,胎儿感染HBV机理的研究及进一步预防已成为亟待解决的问题,胎盘作为母体与胎儿物质交换的重要器官是研究的重点,     

妊娠期妇女人细小病毒B19感染与异常流产及胎儿畸形关系的研究

目的分析妊娠期妇女感染人细小病毒B19(HPVB19)与异常流产及胎儿畸形的关系,为妊娠期妇女孕期保健随访方案制定提供参考,提升优生优育水平。方法选择2010年1月-2017年1月在我院行孕期保健、分娩符合纳入条件的的妊娠期孕妇608例。所有孕妇均于入组后行HPVB19筛查,将患者按照HPVB19筛查结果分为阳性组(118例)和阴性组(490例)。统计两组孕妇妊娠结局(异常流产率、剖宫产率、终止妊娠率、自然分娩剖宫产率)、新生儿妊娠结局(畸形率、死胎率、新生儿窒息率)并比较。统计HPVB19阳性孕妇筛查结果为阳性妊娠周期分布,不同妊娠周期检出HPVB19阳性孕妇及新生儿妊娠结局并比较。采用spearson相关性分析程序分析妊娠期妇女感染HPVB19与异常流产、胎儿畸形间的相关性。结果两组孕妇年龄、入组时孕周、体重、体质量指数(BMI)、孕次、产次比较差异无统计学意义(P0.05)。所有产前即37-41w检出HPVB阳性孕妇,经治疗后,HPVB19IGM转阴。HPVB19阳性组孕妇异常流产率、剖宫产率、自然分娩转剖宫产率、终止妊娠率明显高于阴性组(P0.05)。HPVB19阳性组孕妇新生儿胎儿宫内畸形率、新生儿畸形率、死胎率、新生儿窒息率均明显高于阴性组孕妇新生儿(P0.05)。118例HPVB19阳性孕妇检出阳性孕周分布较为均匀。孕18-24w检出HPVB19阳性孕妇异常流产率即胎儿畸形率明显高于其它时段检出HPVB19阳性孕妇(P0.05)。妊娠期妇女发生HPVB19感染与孕妇异常流产率、胎儿畸形间的相关性系数均0.5,有较强的相关性。结论妊娠期妇女感染HPVB19与异常流产和胎儿畸形呈较高相关性,做好孕前筛查及健康宣教,孕期HPVB19筛查及相应对策,尽可能降低异常流产及胎儿畸形风险,提升优生优育水平具有重要意义。     

微小病毒B19感染与死胎妊娠结局关系的研究

人微小病毒Ｂ19(简称Ｂ19)感染广泛存在 ,人群中感染率达 6 0 %以上[1] 。目前 ,公认该病毒与传染性红斑、急性造血停滞、胎儿水肿、死胎、关节炎等多种人类疾病有关。为了进一步了解Ｂ19病毒感染与不良妊娠特别是死胎结局的影响 ,我们对 1996年 6月至 2 0 0 1年 6月间来我站做     

用套式PCR检测孕妇及胎儿B19病毒感染

目的：研究人微小病毒B19病毒感染对胎儿的影响。方法：运用套式PCR检测孕妇外周血及脐血,胎盘及死肥和畸形胎儿的各种组织（脑,肝、肾、脾、肺,骨髓等）B19病毒的感染情况,阳性标本用第三对引物扩增进行证实,部分阳性标本扩增产物进行序列分析。结果：孕妇外周血中B19-DNA的阳性率为9.62%(10/104）（疾病组=7/54,对照组=3/50）,脐血为4.8%(5/104)(5/54、0/50）,胎盘为23.08%(24/104)(22/54,2/50),各种异常胎儿组织的平均阳性率为18.52%。扩增产物的DNA序列与GenBank中的B19病毒DNA序列同源性为98%。结论：B19病毒感染是引起死胎和畸形的主要因素之一。孕期应加强监测和预防感染。     

无锡地区3782例新生儿脐血CMV—IgM抗体水平调查

巨细胞病毒（ＣＭＶ）感染，是人类最常见的病原体之一，女妇妊娠期感染ＣＭＶ，ＣＭＶ可通过胎盘致胎儿宫内感染导致流产、畸形、死胎、早产及胎儿宫内生长迟缓，也是小儿病残的主要原因之一。因此，降低围产期ＣＭＶ感染率是降低新生儿出生缺陷率的重要手段。为了解无锡地区新生儿先天性ＣＭＶ感染率，我们于１９９５年至１９９７年４月对３７８２例活产新生儿脐血进行了巨细胞病毒抗体ＩｇＭ（ＣＭＶ－ＩｇＭ）的筛查。共检出ＣＭ     

胎儿水囊状淋巴管瘤的产前诊断及预后分析

目的探讨胎儿囊性淋巴瘤（cystic hygroma，CH）的产前诊断及妊娠期的处置。方法回顾性分析2006年1月～2008年4月间我院35例胎儿CH产前超声声像、介入性羊膜腔穿刺查胎儿染色体及TORCH感染情况、胎儿病理。结果发生在颈背部者33例，腋窝2例。足月分娩6例并存活，引产29例（包括死胎2例）。染色体核型分析异常者共19例，占58%，其中Turner′s综合征最常见，共11例，占33%；Down′s综合征5例，占15%；Trisomy182例，占6%；Tri-somy131例，占3%。结论超声及介入性羊膜腔穿刺查胎儿染色体在早期诊断及处置胎儿CH起决定性作用，胎儿CH与Turner综合征等染色体异常相关。     

乌鲁木齐地区孕妇人细小病毒B19与TORCH感染的比较

目的了解我区孕早期妇女TORCH及人细小病毒B19的感染情况.方法用ELISA法检测185例孕早期妇女血清中特异性 TORCH/HPVB19-IgM抗体.结果感染率分别为弓形体(TOX)2.16%,风疹病毒(RV)1.62%,巨细胞病毒(CMV)1.62%,单纯疱疹病毒Ⅱ型(HSV-Ⅱ)1.08%,人细小病毒B19(HPVB19)8.11%,其HPVB19-IgM抗体阳性率与TORCH各项相比,差异有显著的统计学意义(P＜0.01).结论我区孕妇中人细小病毒B19新近感染率明显高于其它TORCH各项病原体的新近感染率,有必要把HPVB19列入TORCH监测项目中,以提高妊娠质量.     

Parvovirus B19 infection in pregnancy.

Parvovirus B19 is a small single-stranded DNA virus and a potent inhibitor of erythropoiesis, due to its cytotoxicity to erythroid progenitor cells. Infection with parvovirus B19 during pregnancy can cause several serious complications in the fetus, such as fetal anemia, neurological anomalies, hydrops fetalis, and fetal death. Early diagnosis and treatment of intrauterine parvovirus B19 infection is essential in preventing these fetal complications. Testing maternal serum for IgM antibodies against parvovirus B19 and DNA detection by PCR can confirm maternal infection. If maternal infection has occurred, ultrasound investigation of the fetus and measurement of the peak systolic flow velocity of the middle cerebral artery are sensitive non-invasive procedures to diagnose fetal anemia and hydrops. Intrauterine transfusion is currently the only effective treatment to alleviate fetal anemia, but if the fetus is (near) term, induction of delivery should be considered. Most maternal infections with parvovirus B19 occur through contact with infected children at home. Individual counseling of susceptible pregnant women will reduce unnecessary fetal deaths.     

Gestational and fetal outcomes in B19 maternal infection: a problem of diagnosis

Parvovirus B19 infection during pregnancy is a potential hazard to the fetus because of the virus' ability to infect fetal erythroid precursor cells and fetal tissues. Fetal complications range from transitory fetal anemia and nonimmune fetal hydrops to miscarriage and intrauterine fetal death. In the present study, 72 pregnancies complicated by parvovirus B19 infection were followed up: fetal and neonatal specimens were investigated by serological and/or virological assays to detect fetal/congenital infection, and fetuses and neonates were clinically evaluated to monitor pregnancy outcomes following maternal infection. Analysis of serological and virological maternal B19 markers of infection demonstrated that neither B19 IgM nor B19 DNA detected all maternal infections. IgM serology correctly diagnosed 94.1% of the B19 infections, while DNA testing correctly diagnosed 96.3%. The maximum sensitivity was achieved with the combined detection of both parameters. B19 vertical transmission was observed in 39% of the pregnancies, with an overall 10.2% rate of fetal deaths. The highest rates of congenital infections and B19-related fatal outcomes were observed when maternal infections occurred by the gestational week 20. B19 fetal hydrops occurred in 11.9% of the fetuses, and 28.6% resolved the hydrops with a normal neurodevelopment outcome at 1- to 5-year follow-up. In conclusion, maternal screening based on the concurrent analysis of B19 IgM and DNA should be encouraged to reliably diagnose maternal B19 infection and correctly manage pregnancies at risk.     

Comparative evaluation of virological and serological methods in prenatal diagnosis of parvovirus B19 fetal hydrops.

Human parvovirus B19 infection in pregnancy represents a potential hazard to the fetus since fetal loss or fetal hydrops can occur. The risk of fetal loss due to transplacental B19 transmission has been evaluated in several studies using different diagnostic methods on maternal and fetal specimens. We analyzed the diagnostic value of virological and serological techniques on maternal serum, fetal cord blood, and amniotic fluid specimens obtained at the time of clinical diagnosis of fetal hydrops in 18 cases of B19 fetal hydrops. B19 DNA was detected by nested PCR, dot blot hybridization, and in situ hybridization assay. Anti-B19 immunoglobulin M and G antibodies were detected by immunoassays using recombinant B19 antigens. Our data suggest that for maternal sera, virological and serological methods have a complementary role in diagnosis, while for fetal specimens the in situ detection of B19 DNA in fetal cord blood is the most sensitive diagnostic system.     

Human parvovirus B19 infection during pregnancy--value of modern molecular and serological diagnostics.

BACKGROUND: Over 95% of fetal complications (fetal hydrops and death) occur within 12 weeks following acute parvovirus B19 (B19) infection in pregnancy. Therefore, weekly fetal ultrasound monitoring is generally recommended for this time period. However, in the majority of women, typical symptoms of acute infection (rash or arthropathy) are absent, and during epidemics, B19 infection may be diagnosed incidentally by antibody screening of women at risk. OBJECTIVE: To assess the diagnostic value of currently available molecular and serological methods for reliable diagnosis of primary B19 infection in pregnancy. STUDY DESIGN: Large panels of well-characterized acute-phase or convalescent sera were used to investigate the ability of a VP2 IgM EIA, a Light-Cycler-based B19-DNA PCR, a VP1-IgG avidity EIA and two VP2-IgG epitope-type specificity [ETS] EIAs to pinpoint the time of primary B19 infection in pregnancy. RESULTS: The duration of low-level IgM positivity varied greatly (range 4-26 weeks). Samples collected within the first 2 weeks of infection showed high-level viremia (mean 1.75 x 10(8) geq/ml). During follow-up, low-level DNAemia (mean 9.7 x 10(4)geq/ml) persisted for at least 18 weeks in 91% (20/22) of patients. Considering the first 12 weeks after onset of disease the window of greatest risk for fetal complications, the "acute" phase was extended to cover this full period. In this case, performing the avidity and ETS-EIA sequentially, the positive predictive value was 100% in patients showing concordant avidity and ETS-EIA results. CONCLUSIONS: In the presence of low IgM titres and/or low-level DNAemia the use of supplementary serological assays such as VP1-IgG avidity EIA and VP2-ETS-EIA is advisable for restriction or avoidance of unnecessary fetal ultrasound examinations or invasive diagnostics; and in general for strengthening the reliability of B19 serodiagnosis of pregnant women.     

Detection of parvovirus B19 DNA, antigen, and particles in the human fetus

Human parvovirus B19 commonly infects children, causing erythema infectiosum (fifth disease). However, there is a significant adult population which has not been exposed to the virus and, consequently, does not have protective antibody. Recent reports have associated B19 infection during pregnancy with fetal death, although normal outcome of pregnancy is more common. To characterise further the role of B19 infection in fetal deaths, a series of laboratory investigations has been undertaken on tissues obtained at autopsy. These have demonstrated the presence of virion-sized DNA by Southern blotting, viral antigen by radioimmunoassay, and viral particles by electron microscopy, all from tissues of hydrops fetalis. These data confirm that the human parvovirus B19 can cross the placenta and replicate in fetal tissues.     

Placental macrophage contact induces complete replicative cycle of human immunodeficiency virus in latently infected syncytiotrophoblast cells: role of interleukine-6 and tumor necrosis factor-β

Parvovirus B19 is the aetiological agent of one of the classical diseases of childhood, the rash illness fifth disease (erythema infectiosum). Beside this usually harmless illness parvovirus B19 was, however, found to be associated with a variety of severe diseases, mainly arthritis, anemia, thrombo- and granulocytopenia, hepatitis and myocarditis. In these cases parvovirus B19 may persist over long periods of time in the peripheral blood or in individual organs of the patients. During pregnancy B19-infections may result in spontaneous abortions, hydrops fetalis, and intrauterine fetal death. The detection of viral DNA and antibodies in the maternal serum and precise ultrasound surveillance of the allows an early diagnosis of the development of hydropic symptoms in the fetus. In most cases in time intrauterine blood transfusions result in the birth of sound children. Since about half of the young adults are not immunologically protected parvovirus B19-infections should be assumed as an important reason for virus-correlated problems during pregnancy. Based on these epidemiological data that were accumulated during the past years clinicians should pay more attention to B19-infections and the mode of viral transmission.     

Fetal erythropoiesis and parvovirus B19]

Target cells for the human parvovirus B19 include erythroid progenitors located in the bone marrow in adults and in the liver in fetuses of 12 to 30 weeks gestational age. The main manifestations of fetal parvovirus B19 infection seem to be related to lysis of the erythroid progenitors which causes non immune hydrops fetalis with severe anemia, congestive heart failure, generalized edema and death. The exact incidence of human parvovirus B19 infection during pregnancy remains unclear.     

Parvovirus B19 infection in pregnancy: quantitative viral DNA analysis using a kinetic fluorescence detection system (TaqMan PCR)

Human parvovirus B19 infections are common in the general population, and infection during pregnancy may cause hydrops fetalis and fetal death. To initiate adequate treatment, accurate laboratory diagnosis is essential. The most sensitive tests are nested PCR systems, but these assays provide semiquantitative results at best. A parvovirus B19 DNA assay was developed based on the real time TaqMan PCR. This method was calibrated on the basis of serial plasmid dilutions and tested with an international parvovirus B19 standard. The assay was capable of quantifying parvovirus B19 DNA from one to about 5 x 10(7) genome equivalents per reaction (corresponding to 100 to 5 x 10(9) genome equivalents per ml serum). Samples from 51 pregnant women with suspected acute parvovirus B19 infection were tested, and positive PCR results were obtained in at least one of the materials investigated in 41 cases. The median viral DNA load in maternal blood samples was 1.3 x 10(4) copies/ml (range 7.2 x 10(2)-2.6 x 10(7)). Maternal virus DNA concentration was not associated with the presence of maternal symptoms and/or fetal complications. As the stage of infection was not known in the majority of cases, our data do not exclude an association between peak levels of parvovirus B19 DNA and the development of complications. Maternal sera and corresponding fetal material were available for concurrent testing from 15 DNA-positive cases: in most fetal samples, viral DNA concentrations were several orders of magnitude higher (up to 2.1 x 10(12) copies/ml) compared to the corresponding maternal blood samples.     

A clinical and epidemiological study of human parvovirus B19 infection in fetal hydrops using PCR southern blot hybridization and chemiluminescence detection

Ninety-eight samples from 80 cases of spontaneous abortions after fetal death or hydrops fetalis from 12,000 pregnant women were examined using PCR. DNA was extracted from amniotic fluid, fetal blood, ascitic fluid and fetal biopsies or placenta specimens using QIA amp kits (QIAGEN). A 270-bp length fragment located within the B19 gene NS1 was amplified using PCR followed by electrophoresis and southern-blot hybridization assay using a horseradish peroxidase-labelled probe and chemiluminescence detection. This assay was able to detect 1 to 10 DNA copies in a 10 |gml sample. Parvovirus B19 was identified in 11 cases (14% of fetal hydrops; 1 case for 1,100 pregnancies). Amniotic fluid was the most common and reliable sample to assess the diagnosis. Gestational age ranged from 17 to 28 weeks (mean 23 weeks). IgM antibodies were detected in 3 maternal sera, 2 patients of which reported an exposure to B19 infection during pregnancy. In 2 cases, intrauterine blood transfusions led to the cessation of symptoms and to birth of normal babies. J. Med. Virol. 54:140–144, 1998. © Wiley-Liss, Inc.     

Acute parvovirus B19 infection associated with myocarditis in an immunocompetent adult

Inflammatory heart disease is causally linked with progressive left ventricular dysfunction and congestive heart failure. In childhood, infection with parvovirus B19 (PVB19) is usually benign, causing erythema infectiosum. However, severe fetal PVB19 infection may be associated with hydrops fetalis and fetal death caused by myocarditis. Here we report a PVB19-induced myocarditis in a previously healthy 37-year-old patient admitted to the hospital because of chest pain and dyspnea due to left ventricular dysfunction. Four weeks after the onset of symptoms, we found lymphocytic infiltrates and PVB19 genome in left ventricular endomyocardial biopsy specimens. Consistently, acute PVB19 infection was indicated serologically by elevated IgM titers and the presence of PVB19 genome in peripheral blood lymphocytes. In conclusion, PVB19 infection may be complicated by acute myocarditis in immunocompetent adults. Because PVB19 myocarditis may progress to chronic dilated cardiomyopathy, early diagnosis by endomyocardial biopsy is important to initiate anti-inflammatory treatment.