Aplastic crisis due to human parvovirus B19 infection in glucose-6-phosphate dehydrogenase deficiency

Human parvovirus B19 is known to cause aplastic crisis in patients with hemolytic anemias due to cytotoxic effect of the infection to erythroid progenitor cells. We report here the first case of aplastic crisis by B19 in a patient with glucose-6-phosphate dehydrogenase deficiency. A five-year-old boy was admitted to the hospital because of severe anemia, fever and jaundice. Four weeks after admission, he developed erythema infectiosum. B19 infection was confirmed using countercurrent immunoelectrophoresis, Southern blotting and hybridization method, and radioimmunoassay for B19 specific IgM. B19 virus antigen was detected by an indirect immunofluorescent method in both the cytoplasm and nucleus of large mononuclear cells that had no granules in bone marrow. On admission, the hemoglobin was 3.1 g/dl and no reticulocytes were detected in the peripheral blood smear. Bone marrow examination revealed a normocellular marrow with erythroid hypoplasia and M/E ratio of 7.38. Large basophilic erythroblasts containing vacuoles were also noticed. Elevation of indirect bilirubin and hemoglobinuria suggested intravascular hemolysis. Transient mild thrombocytopenia associated with increased PAIgG was observed. It is likely that B19 virus infection caused hemolysis which contributed to severe anemia.     

先天性细小病毒B19感染与母婴传播研究进展

B19病毒感染广泛存在，人群感染率大约为50%，妊娠者感染率的范围为35%-53%，妊娠期急性B19感染的发生率为3.3%-3.7%，妊娠期急性B19感染与胎儿贫血、非免疫性胎儿水肿、胎儿死亡有关，现将B19感染的诊断、治疗及处置进行了综述。     

Autoimmune haemolytic anaemia due to Omeprazole

A 72-year-old lady who was prescribed Omeprazole for gastroesophageal reflux developed an allergic reaction within two days, which manifested initially as a generalised rash and marked eosinophilia. This was followed by a fall in haemoglobin without any obvious bleeding. Investigations pointed to drug related intravascular haemolysis as the cause. She made an uneventful recovery after omitting Omeprazole and treatment with steroids. Omeprazole should be considered amongst other recognised causes of drug-induced haemolysis     

上海市儿童感知统合失调发生率及其影响因素的调查

目的：了解上海市儿童感知统合失调（SID）的发生情况及其影响因素。方法：采用现场调查的方法对小学一年级学生 家长及班主任老师使用统一问卷进行调查。采用回顾性调查方法对上海市精神卫生中心1991-1994年287例7-9岁因SID就诊的儿童进行分娩方式的调查,结果：SID在正常人群中的发生率为18.9%,影响因素有围产期先天因素如出生时脐带绕颈,低出生体重和母亲吸烟等,这些因素与SID的发生呈正相关关系。在因SID而就诊的儿童中剖宫产比例明显高于正常阴道产;在后天因素中父母亲文化程度、母乳喂养与SID呈负相关关系。而住房层次与SID呈正相关关系。结论：上海市SID发生率高于我国台湾地区的报道,值得重视的是虽然本调查在正常人群中未发现剖宫产与SID的显著关系。但就诊的儿童中剖宫产比例明显高于正常阴道产的结果提示剖宫产的可能危害性,另外,本调查发现喂养方式、居住环境及家庭教育对SID发生的影响,提示需加强母乳喂养的宣教,鼓励儿童户外活动,提倡早期教育,以减少SID的发生。     

Fetal infection with human parvovirus B19

The case of premature infant with nonimmune hydrops secondary to human parvovirus B19 infection is presented. The infection was not suspected clinically. The fetal autopsy showed intranuclear inclusions in erythroid cells that stained positively with a DNA hybridization probe for B19 parvovirus.     

Neurological manifestations of human parvovirus B19 infection

Since its discovery, human parvovirus B19 has been linked with a broad spectrum of clinical syndromes. An aetiological role for the virus has been confirmed in erythema infectiosum, transient aplastic crisis, persistent infection manifesting as pure red cell aplasia in immunocompromised persons, non-immune hydrops fetalis and arthritis. Less commonly recognised, but receiving increasing attention recently, are the neurological manifestations, a variety of which have been described in patients with either clinically diagnosed or laboratory confirmed B19 infection. The purpose of this review is to summarise present knowledge of B19, its known and potential pathogenic mechanisms and its association with human diseases, particularly those with neurological manifestations. The outcome of the review supports an aetiological role of the virus in neurological disease. However, the pathogenesis remains unknown and elucidating this is a priority.     

Human parvovirus B19 infection and antiphospholipid antibodies

Erythema infectiosum is the main manifestation of human parvovirus B19 infections. Further B19-related diseases commonly associated with the acute infection are flue-like symptoms, transient aplastic crisis, transient arthralgias, leukopenia and thrombocytopenia, spontaneous abortion and hydrops fetalis in pregnant women. Hepatitis, myocarditis, meningitis, encephalitis as well as pure red cell anemia may occur occasionally. In addition parvovirus B19 infections have been frequently described as cause or trigger of various forms of autoimmune diseases affecting all blood cell lines, joints, connective tissue, uvea, large and small vessels. Molecular mimicry may be one major contribution to the appearance of autoimmune antibodies, f.e. antiphospholipid and antineutrophil cytoplasmic antibodies as well as antinuclear antigens. These mechanisms implicated in the pathogenesis of parvovirus B19 triggered autoimmune diseases, especially focused on the development of antiphospholipid antibodies will be discussed in this short review.