The relationship between arthritis and human parvovirus B19 infection

In order to evaluate the role of human parvovirus B19 in the etiopathogenesis of autoimmune diseases such as rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE), synovial fluid and blood specimens were collected at 1-month intervals from 20 patients with early synovitis (ES) and 31 with RA. Blood specimens were also collected from 25 patients with SLE, 25 with osteoarthritis (OA) as the diseased control group, and 50 healthy blood donors (HBD) as the healthy control group. Detection of B19 IgM and B19 IgG were performed by enzyme-linked immunosorbent assay from serum specimens, and B19 DNA was detected by polymerase chain reaction from synovial fluid samples. B19 IgM, B19 IgG, and B19 DNA were found in the three patients of the ES group. Subsequently, two of them were diagnosed with RA and one with SLE. B19 DNA was also detected in the synovial fluid of eight patients in the RA group. Of them, all were positive for B19 IgG and half were positive for B19 IgM. B19 IgM was not detected in either of the control groups. To define the role of B19 in the etiopathogenesis and prognosis of undiagnosed arthritis and other chronic inflammatory diseases such as RA and SLE, we need broader serial and prospective studies based on clinical and laboratory collaboration. In conjunction with case reports, these studies would also serve to detect other possible factors in the etiopathogenesis of chronic inflammatory diseases.     

Association between human parvovirus B19 infection and arthritis.

OBJECTIVE--To gain information concerning the association between parvovirus B19 infection and arthritis. METHODS--Blood or synovial fluid, or both, from a total of 77 adult patients with various arthropathies (rheumatoid arthritis 13; mechanical arthropathies 11; crystal induced arthritis 13; idiopathic mono/oligoarthritis 25; suspicion of viral arthritis 15) were tested for the presence of the viral genome and anti-B19 antibodies. B19 DNA in blood and synovial fluid was investigated by nested polymerase chain reaction, and anti-B19 IgM and IgG antibodies were detected in blood by enzyme immunoassay. RESULTS--A recent parvovirus infection was documented by the presence of anti-B19 IgM antibodies in the blood of 13 patients. B19 DNA, together with anti-B19 IgM and IgG antibodies, were detected in the blood of seven patients who had an acute transient arthritis, putatively of viral origin. Viral DNA was detected in a synovial fluid sample and in the blood of one patient with monoarthritis who had an anti-B19 IgG response only. CONCLUSIONS--The prevalence of anti-B19 IgG antibody in these patients with various forms of arthritis (63%) was within the same range as that in the general population (blood donors). However, for the patients with clinical suspicion of viral arthritis, the increased seroprevalence of anti-B19 IgM and the presence of the B19 genome point to an association between human parvovirus infections and acute forms of arthritis.     

Remission of juvenile rheumatoid arthritis after infection with parvovirus B19.

A 22-year-old Caucasian woman with a 6 year history of persistently active, systemic onset juvenile rheumatoid arthritis (JRA) developed symptoms of headache, dry cough, nausea, vomiting, abdominal pain, diarrhea, and dehydration associated with a high fever, elevated liver enzymes, and lymphopenia. Subsequent investigation revealed acute infection with parvovirus B19. Following clinical improvement over 10-14 days solely with supportive care, her underlying disease remained in remission for about 7 months.     

Risk of adverse outcomes of pregnancy after human parvovirus B19 infection

Human parvovirus B19 (B19) infection during pregnancy has been associated with fetal deaths. We conducted several studies to develop data needed to make recommendations for preventing fetal death associated with infection. In the first study, after an outbreak of B19 infection, specimens of cord blood from 47 infants with congenital anomalies, 10 with suspected intrauterine infection, and gestational age-matched controls were tested for IgG and IgM antibodies to B19. None had evidence of recent infection. Next, 192 women with unknown exposure to B19 who had stillbirths or spontaneous abortions were studied. Two patients and two controls had evidence of recent B19 infection. In a second case-control study of women who had stillbirths after outbreaks of erythema infectiosum in area schools, none of the 20 patients or 26 controls were IgM positive at the time of delivery. The rate of infection, as demonstrated by IgM positivity, among 267 pregnant control subjects was approximately 1%. These studies suggest that among pregnant women unselected for exposure to B19, neither infection nor stillbirths are common.     

Lupus-like presentation of human parvovirus B19 infection.

The diagnosis of systemic lupus erythematosus (SLE) was a leading initial consideration in 2 patients with rash, arthritis and hypocomplementemia. One patient also had leukopenia and thrombocytopenia. Spontaneous regression occurred. In both patients antinuclear antibodies were negative. Serologic studies indicated recent human parvovirus B19 infection. We propose adding human parvovirus B19 infection to the list of conditions that may masquerade as SLE.     

Neutropenia accompanying parvovirus B19 infection after gynecologic surgery

The hematologic data and symptoms of 7 patients seropositive for parvovirus B19 IgM antibody after gynecologic surgery were analysed. Parvovirus may have been transmitted by fibrin glue prepared from heat-treated human plasma and used for hemostasis during surgery. The peripheral blood neutrophil count decreased to below 1 x 10(9)/l between postoperative day (POD) 10 and 18, but recovered spontaneously to within the normal range. G-CSF injection was effective in preventing neutropenia or obtaining a prompt recovery. The reticulocyte count fell below 10 x 10(9)/l between POD 13 and 19, and also recovered spontaneously. A slapped-cheek rash was not observed in any of the 7 patients.     

Effusive-constrictive pericarditis associated with human parvovirus B19 infection

A woman presented after an illness of fever and arthralgia, with increasing shortness of breath. Investigations revealed she had effusive constrictive pericarditis, anaemia, a pulmonary infiltrate, and evidence of acute parvovirus B19 infection. Parvovirus should be considered as a cause of pericarditis, especially if there is recent arthralgia or associated anaemia.     

Human parvovirus B19 and rheumatoid arthritis

Summary Human parvovirus B19 infections have been linked with the development of a short-lived symmetrical polyarthritis and, rarely, a more persistent arthritis. We prospectively looked for serological evidence of recent B19 infection in 25 early synovitis patients presenting within 12 weeks of symptom onset and compared them with 21 controls seen over the same time period. None of the control patients had evidence of recent B19 infection while 3 of the early synovitis patients had raised IgM anti-B19 antibody levels. Two had a transient arthritis and 1 developed persistent seropositive rheumatoid arthritis.     

Association of human parvovirus B19 infection with acute meningoencephalitis

To find out the incidence and clinical presentation of parvovirus B19 meningoencephalitis, we tested samples of cerebrospinal fluid from 162 patients (one from each patient) with undiagnosed meningoencephalitis, who presented between March, 1997, and March, 1998 (an outbreak period) using nested PCR for B19 genes. Seven patients were positive; an incidence of 4.3%. Five additional cases of meningoencephalitis were detected from other years. Three patients with underlying disorders (haemophagocytic lymphohistiocytosis, Cockayne's syndrome, and Turner's syndrome) died. Neurological sequelae were observed in three surviving patients, all of whom had had striking abnormalities detected on brain scans done during the acute phase.     

A clinical study of adult human parvovirus B19 infection

OBJECTIVE: We investigated the clinical aspects of adult human parvovirus (HPV) B19 infection. PATIENTS AND METHODS: We retrospectively reviewed the charts of 21 consecutive patients [4 males, aged 32 to 43 years (average 38.0 years), and 17 females, aged 15 to 43 (average 34.2)] with adult HPV B19 infection who visited our outpatient department between July 1997 and June 1998. All diagnoses of adult HPV B19 infection were based on positive anti-HPV B19 IgM antibody in serum and/or positive HPV B19 DNA in peripheral blood. RESULTS: The predominant signs and symptoms of the patients were: fever (81.0%), arthralgia/myalgia (61.9%), skin rash (47.6%), general fatigue (42.9%), lymph node swelling (38.1%) and edema (38.1%). Six patients had the following underlying diseases or complications: pregnancy, myoma uteri, cervical cancer of the uterus, lupus diathesis/ endometriosis, hereditary spherocytosis, and multiple sclerosis. The following abnormal laboratory findings (more or less than normal limits) were observed: anemia (81.0%), leukopenia (33.3%), elevated transaminases (28.6%), and elevated lactate dehydrogenase (LDH) (57.1%). Six patients were considered to have persistent infection. CONCLUSION: HPV B19 can infect healthy adults and causes more predominant signs and symptoms (arthralgia, myalgia and fever) than in children, and adult HPV B19 infection can be suspected from the familial history and clinical findings. Accordingly, more attention must be paid to adult HPV B19 infection, particularly when erythema infectiosum is prevalent in children.     

关注人细小病毒B19感染对人类健康的危害

1975年Cossart等从1例无症状者血清标本电镜检查中发现直径20～25nm球形病毒样颗粒,编定为B19病毒,经证实该病毒属细小病毒。以往发现的细小病毒只能感染牛、猫、狗、水貂、小鼠等哺乳动物,不感染人,故将B19病毒命名为人细小病毒(human parvovirus,HPV)B19。     

Role of human parvovirus B19 in the pathogenesis of rheumatoid arthritis

Rheumatoid arthritis (RA) is a chronic inflammatory disease of unknown origin. It has been speculated that infectious agents are responsible for triggering RA. Persistent infection with human parvovirus B19 and its induction of immunopathology are hypothesized to explain the initiation and perpetuation of the disease process.     

Life-threatening human parvovirus B19 infection transmitted by intravenous immune globulin

Infection of human parvovirus B19 (B19) is usually a self-limiting febrile illness, but can sometimes be life-threatening under certain circumstances, such as aplastic crisis in patients with haemolytic anaemia, hydrops fetalis in pregnant women and fulminant hepatitis. B19 can be transmitted through respiratory secretions, transplacentally and by transfusion of blood or blood products. In the present case, administration of intravenous immune globulin (i.v.Ig) transmitted B19 infection and consequently caused pure red cell aplasia and aggravation of hepatitis to fulminant hepatitis. Our case may raise important questions as to the safety of i.v.Ig and possible contamination by B19.