细小病毒B19感染酷似急性心肌梗死

[K櫣ｈｌＵ,PauschingerM ,BockT ,etal .Circulation ,2 0 0 3 ,10 8:945～95 0 (英文) ]罹患心肌炎时,表明心脏有感染性,毒性或自身免疫过程而出现炎症。临床上常表现为ECG异常、心力衰竭、心脏扩大等。亦可酷似急性心肌梗死(AMI)表现,如急性胸痛、ECG异常、心肌酶学升高、心     

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。     

三峡地区献血人员人细小病毒B19感染率调查

目的:调查三峡地区无偿献血员人细小病毒B19(HPVB19)的流行情况,为该地区未来的献血筛查策略提供数据支撑。方法:采用ELISA方法,对934例献血员进行了HPVB19IgG、IgM抗体筛查。结果:934例献血员中,HPVB19IgG阳性率43.36%(405/934),HPVB19IgM阳性率2.46%(23/934)。阳性率随年龄增加有上升的趋势,不同年龄组之间HPVB19IgG抗体阳性检出率差异有统计学意义(P<0.01)。结论:三峡地区献血员中HPVB19感染率较高,多数是曾经感染,近期感染或急性感染较低,但作为血源,仍有一定传播病毒的风险,选用适当的方法筛查病毒,保障血液制品质量十分必要。     

先天性心脏病术后人细小病毒B19感染患儿的临床特征分析

目的总结小儿先天性心脏病(congenital heart disease,CHD)术后人细小病毒B19(human parvovirus B19,HPV-B19)感染患儿的临床特点、治疗及转归。方法回顾性分析2019年6月至2021年6月广东省人民医院儿科重症监护室(pediatric intensive care unit,PICU)确诊的CHD术后HPV-B19感染患儿的临床表现、诊断及治疗。结果 10例HPV-B19感染患儿中,男4例,女6例;年龄为0.84(0.3～9.0)岁;体质量为9.0(3.5～14.5)kg。10例患儿均出现发热,高热为主,无伴有明显中毒症状,同时伴发贫血突然加重。2例躯干弥漫充血性皮疹;4例轻度贫血,6例中度贫血;4例白细胞减少,2例粒细胞缺乏,1例粒细胞减少;5例血小板减少;1例血细胞三系减少;3例骨髓增生减低;3例单纯红系增生减低。于术后第12.8(7～23.0)天分别行定量聚合酶链反应(qPCR)检测呈阳性。9例给予静脉输注丙种球蛋白(intravenous injection of gamma globulin,IVIG)治疗,输注量466.7(300～700)mg·kg~(-1)·d~(-1),疗程2～5 d,另外1例仅需输注浓缩红细胞及对症治疗;8例应用IVIG后于第4.4(2～9)天(内热退,3例第4.3(2～7)天血小板恢复正常,4例第5.3(3～8)天白细胞恢复正常,4例第12.5(5～17)天血红蛋白逐渐恢复,5例应用IVIG前输注了浓缩红细胞血红蛋白无继续下降;8例第13.0(7～23)天动态检测HPV-B19病毒载量,7例应用IVIG后定量聚合酶链反应检测提示HPV-B19拷贝数下降,1例拷贝数降为0 copies/mL,1例应用IVIG前检测提示拷贝数仍升高。治愈出院9例,1例死于心源性休克。结论小儿CHD术后早期不明原因发热伴白细胞减少、贫血加重者,应警惕感染HPV-B19;确诊后尽早使用IVIG有助于促进康复。     

人微小病毒B19感染与优生

据统计，每年新生儿缺陷的发生率在2.5％左右，幸存者在精神、体格方面的缺陷给本人、家庭及社会都带来诸多严重的影响。这已成为医学界尚未解决的疑难问题之一。新生儿先天缺陷的病因，由单纯遗传性因素引起的占10％，主要是染色体异常和基因突变引起的缺陷;由单纯环境因素引起的占10％，如感染;遗传和环境因素共同作用所引起的占70％～80％‘”。随着人们对优生研究的重视以及“出生缺陷监测”手段的提高，发现病毒是一重要的致病因素，除常见的致畸病毒，如风疹病毒、巨细胞病毒、水痘一带状疟疾病毒外，近年来，人微小病毒B19（PVB19…     

孕早期人细小病毒B19感染与血清hCG、hPL水平变化的关系

目的 探讨孕早期人细小病毒B19感染与血清人绒毛膜促性腺激素(hCG)、人胎盘生乳素(hPL)水平变化的关系.方法 采用酶联免疫吸附试验(ELISA)法检测294例孕早期人工流产孕妇(其中阳性22例,阴性272例)血清中人细小病毒B19抗体IgM(HPVB19-IgM)及IgG的含量,根据血清HPVB19-IgM检测结果,将所有患者分为阳性组(22例)及阴性组(272例),采用ELISA和MIROELISA法检测其相应外周血血清中hCG、hPL水平.结果 孕早期人工流产孕妇HPVB19-IgM阳性者血清中hCG为(83.19 ±32.69) mIU/mL,阴性组为(106.68±43.26)mIU/mL,两组比较,P＜0.05;阳性组血清中hPL为(51.06±40.63) ng/mL,阴性组为(75.49 ±53.17) ng/mL,两组比较,P＜0.05.结论 孕早期人细小病毒B19感染可减少hCG、hPL的分泌量,这可能是孕早期HPVB19感染引起不良妊娠结局的生殖内分泌基础.     

细小病毒B19感染与系统性红斑狼疮相关性研究

目的通过检测系统性红斑狼疮(SLE)患者血清中细小病毒B19(PVB19)特异性抗体,观察B19 IgM阳性与SLE病情及活动程度的相关性,探讨PVB19感染与SLE之间可能存在的联系。方法采用德国IBL Hamburg公司PVB19-VP2-IgM、IgG酶联免疫吸附试验(ELISA)检测试剂盒,检测51例SLE患者及20名正常人血清PVB19的特异性抗体。结果51例SLE患者中B19 IgM抗体阳性11例(22%)。而正常对照组都为阴性,差异有统计学意义(P＜0．01)。根据B19 IgM阳性/阴性对SLE患者分组后发现,B19 IgM阳性组SLE疾病活动评分(SLEDAI)显著高于阴性组(P＜0．05)；B19 IgM阳性组与阴性组临床特征相比,除丙氨酸转氨酶(ALT)或天冬氨酸转氨酶(AST)上升差异有统计学意义(P＜0．05)外,其余差异均无统计学意义(P＞0．05)。对5例B19 IgM阳性的SLE患者随访2年发现,这些患者临床症状显著改善,SLEDAI评分显著下降(P＜0．05),但自身抗体水平[抗核抗体(ANA)、抗双链DNA(dsDNA)]无显著性改变(P＞0．05),ALT或AST均恢复正常。结论PVB19感染在诱发SLE活动中起作用,但与SLE预后可能无关。     

胎儿感染细小病毒B19可能引起神经发育延缓

据Medscape．com2007年1月16日报道（原载Obstet Gynecol 2007；109：42—47），研究表明，宫内感染细小病毒B19引起的胎儿水肿，在儿童期会表现出神经系统发育异常。[第一段]     

人微小病毒B19感染的血液学异常

人微小病毒B19(HPVB19)骨髓感染引起造血功能紊乱,为了解该类感染的发生率和临床表现,我们调查血红蛋白<90g/L的患者121例,其中33例HPVB19-DNA阳性,阳性率27.3%;临床可表现为白细胞减少或增加,全血细胞减少、肝炎并发再生障碍性贫血、继发性骨髓增生异常综合征等.缺铁性贫血可并发HPVB19感染.因此,对不易解释的血液学改变,检测HPVB19-DNA,有助于明确病因.     

肝移植术后人类微小病毒B19感染致骨髓抑制1例报告

正人类微小病毒(human parvovirus, HPV)B19是一种单链小DNA病毒,与人类多种疾病相关。该病毒感染正常免疫力人群只会出现短暂病变,临床表现与宿主的年龄和免疫状态有关,感染后主要侵袭人体造血系统,可表现为骨髓抑制,也会发生发热、皮疹和关节痛多种并发症等~([1])。但对于移植术后的免疫抑制人群,HPV B19感染发病率较高,可引起急性骨髓造血衰     

Seroprevalence of parvovirus B19 in fibromyalgia syndrome

This study was aimed to evaluate the seroprevalence of parvovirus B19 in patients with fibromyalgia syndrome (FS). Seventy-five patients with FS (44.3 ± 8.3) and 75 healthy controls (44.2 ± 8.1) were evaluated. Serum anti-B19 IgM and IgG antibodies were measured by ELISA technique. Patients were questioned about duration of symptoms, characteristic features of FS, and symptoms related with viral infection preceding the onset of FS. No significant difference was found regarding the prevalence of anti-B19 IgM antibodies between the groups (p = 0.494). Seropositivity of anti-B19 IgG of the patients was significantly higher than control group (81.3% vs. 64% respectively, p = 0.027). No statistically significant differences were found regarding to the clinical features between fibromyalgia patients with IgG antibody compared to those without IgG antibody. Parvovirus B19 IgG seropositivity was found to be significantly higher in patients with FS. Parvovirus B19 infection might have a role in the etiopathogenesis of FS or might act as a triggering factor.     

MolecularphenotypesofhumanparvovirusB19inpatientswithmyocarditis Bock CT,Düchting A,Utta F,Brunner E,Sy BT,Klingel K,Lang F,Gawaz M,Felix SB,

AIM: To investigate molecular phenotypes of myocardial B19V-infection to determine the role of B19V in myocarditis and dilated cardiomyopathy (DCM).METHODS: Endomyocardial biopsies (EMBs) from 498 B19V-positive patients with myocarditis and DCM were analyzed using molecular methods and functional experiments. EMBs were obtained from the University Hospitals of Greifswald and Tuebingen and additionally from 36 German cardiology centers. Control tissues were obtained at autopsy from 34 victims of accidents, crime or suicide. Identification of mononuclear cell infiltrates in EMBs was performed using immunohistological staining. Anti-B19V-IgM and anti-B19V-IgG were analyzed by enzyme-linked immunosorbent assay (ELISA). B19V viral loads were determined using in-house quantitative real-time polymerase chain reaction (PCR). For B19V-genotyping a new B19V-genotype-specific restriction fragment length polymorphism (RFLP)-PCR was established. B19V-genotyping was verified by direct DNA-sequencing and sequences were aligned using BLAST and BioEdit software. B19V P6-promoter and HHV6-U94-transactivator constructs were generated for cell culture experiments. Transfection experiments were conducted using human endothelial cells 1. Luciferase reporter assays were performed to determine B19V-replication activity. Statistical analysis and graphical representation were calculated using SPSS and Prism5 software.RESULTS: The prevalence of B19V was significantly more likely to be associated with inflammatory cardiomyopathy (iCMP) compared to uninflamed DCM (59.6% vs 35.3%) (P < 0.0001). The detection of B19V-mRNA replication intermediates proved that replication of B19V was present. RFLP-PCR assays showed that B19V-genotype 1 (57.4%) and B19V-genotype 2 (36.7%) were the most prevalent viral genotypes. B19V-genotype 2 was observed more frequently in EMBs with iCMP (65.0%) compared to DCM (35%) (P = 0.049). Although there was no significant difference in gender-specific B19V-loads, women were more frequently infected with B19V-genotype 2 (44.6%) than men (36.0%) (P = 0.0448). Coinfection with B19V and other cardiotropic viruses was found in 19.2% of tissue samples and was associated with higher B19V viral load compared to B19V-monoinfected tissue (P = 0.0012). The most frequent coinfecting virus was human herpes virus 6 (HHV6, 16.5%). B19V-coinfection with HHV6 showed higher B19V-loads compared to B19V-monoinfected EMBs (P = 0.0033), suggesting that HHV6 had transactivated B19V. In vitro experiments confirmed a 2.4-fold increased B19V P6-promoter activity by the HHV6 U94-transactivator.CONCLUSION: The finding of significantly increased B19V loads in patients with histologically proven cardiac inflammation suggests a crucial role of B19V-genotypes and reactivation of B19V-infection by HHV6-coinfection in B19V-associated iCMP. Our findings suggest that B19V-infection of the human heart can be a causative event for the development of an endothelial cell-mediated inflammatory disease and that this is related to both viral load and genotype.     

Acute parvovirus B19 infection mimicking myelodysplastic syndrome of the bone marrow

Summary A 36-year-old, previously healthy woman was referred to our institution with pancytopenia and splenomegaly for suspected acute leukemia. Bone marrow aspiration showed marked dysplastic changes, excess of blasts, and only spurious red blood cell precursors. Action was taken to prepare allogeneic bone marrow transplantation from an HLA identical sibling for myelodysplastic syndrome. Repeat cytological examination of the bone marrow revealed striking hyperplasia of the red cell line with presence of abnormal giant proerythroblasts. Acute parvovirus B19 infection was suspected and confirmed by detection of anti-B19 IgM and B19 DNA. The underlying disease for this transient aplastic crisis was a formerly unknown hereditary spherocytosis.     

Emerging lupus-like manifestations in acute parvovirus B19 infection

We encountered an adult patient with acute parvovirus B19 infection who presented with transient lupus-like symptoms (i.e., polyarthritis, fever, myalgia, pancytopenia, hypocomplementemia, and nephritis). Our case is characterized by the demonstration of acute nephritis as a complication of this infection, making it difficult to distinguish between a viral infection and the first episode of systemic lupus erythematosus.     

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.     

Human parvovirus B19 infection mimicking systemic lupus erythematosus

Abstract

Although several recent reports have discussed the similarities between human parvovirus B19 (HPV-B19) infection and systemic lupus erythematosus (SLE), the relationship between these conditions has not been established owing to the small number of patients investigated. In 1998–1999, an outbreak of Erythema infectiosum occurred close to our hospital, enabling us to investigate the clinical, hematological, and serological findings, including serum complement and antinuclear antibodies (ANA), in 22 patients with acute HPV-B19 infection. The principal symptoms included rash (86.3%), edema (59%), arthralgia (45.4%) and fever (31.8%). Lymphadenopathy was seen in three of the 22 cases. The laboratory findings showed high incidences of leukopenia (50%), hypocomplementemia (95%), and ANA (64.7%). At the time of disease onset, patients with acute HPV-B19 infection presented with features which were similar to those of SLE. The possibility of HPV-B19 infection should therefore be considered in patients presenting with SLE-like features.     

Human parvovirus B19 infection mimicking systemic lupus erythematosus

Although several recent reports have discussed the similarities between human parvovirus B19 (HPV-B19) infection and systemic lupus erythematosus (SLE), the relationship between these conditions has not been established owing to the small number of patients investigated. In 1998–1999, an outbreak of Erythema infectiosum occurred close to our hospital, enabling us to investigate the clinical, hematological, and serological findings, including serum complement and antinuclear antibodies (ANA), in 22 patients with acute HPV-B19 infection. The principal symptoms included rash (86.3%), edema (59%), arthralgia (45.4%) and fever (31.8%). Lymphadenopathy was seen in three of the 22 cases. The laboratory findings showed high incidences of leukopenia (50%), hypocomplementemia (95%), and ANA (64.7%). At the time of disease onset, patients with acute HPV-B19 infection presented with features which were similar to those of SLE. The possibility of HPV-B19 infection should therefore be considered in patients presenting with SLE-like features. Received: January 18, 2001 / Accepted: April 19, 2001     

人微小病毒B19感染所致肝损害19例临床分析

目的探讨B19病毒感染所致肝损害的临床表现、实验室检查特点及治疗与转归。方法对人微小病毒B19感染患者19例的临床资料进行回顾性分析。结果在人微小病毒B19感染的19例患者,主要症状有乏力(12例)、黄疸(10例)、脾肿大(10例),伴有发热(10例)、皮疹(6例)及肌肉关节疼痛(6例),有6例伴有如下疾病或并发症:如妊娠(1例)、急性肝功能衰竭(2例)、精神分裂症(1例)、急性骨髓停滞(1例)和肺炎(1例)。以血清天门冬氨酸氨基转移梅(AST)升高为主,黄疸大多数表现为轻到中度,容易出现凝血酶原活动度(PTA)下降,但胆碱脂酶(CHE)下降不明显。经积极对症支持治疗,肝功能等各项指标正常后治愈出院。人微小病毒B19可致肝功能受损,导致急性肝炎或急性重型肝炎。结论对临床上非甲～戊型肝炎病人,应注意检查血清抗B19病毒IgM。该病毒感染是一个急性或亚急性过程,呈良性经过,有自愈倾向。     

Anasarca as the presenting manifestation of parvovirus B19 associated juvenile dermatomyositis

Anasarca as the presenting manifestation of juvenile dermatomyositis (JDMS) is extremely rare. We report a case of a 4-year-old boy who was initially managed for nephrotic syndrome in view of anasarca and mild hypoalbuminemia. Later, at presentation to our institute, a diagnosis of severe edematous JDMS was made in view of associated profound muscle weakness and characteristic skin changes. The child responded to aggressive immunosuppressive therapy. On further evaluation, he had evidence of acute parvovirus B19 infection. Our case illustrates anasarca as an uncommon severe manifestation of JDMS and the possible role of parvovirus B19 in the onset of this autoimmune disorder.