RESUMO
BACKGROUND: Parvovirus B19(B19) is a DNA virus. The most common B19 disease is erythema infectiosum (fifth-disease). PCR and ELISA are sensitive for detecting of acute disease. However, it is not clear which test better and the relationship between laboratory tests and clinical findings. OBJECTIVE: To discuss the clinical and laboratory characteristics of pediatric patients infected with B19. STUDY DESIGN: 236 children were examined. Children with at least one positive molecular or serological test were included. Positive serum B19-DNA and/or B19-IgM was considered an acute B19 infection. RESULTS: B19DNA was detected in 80.8 % of acute cases. Serological tests were less positive. Acute B19 infection was observed in 24 patients. Only 17 patients were positive for B19 DNA, 3 for IgM and 4 for both. The sensitivity of B19 DNA is 87.5 %. However, this rate is 29.2 % for B19 IgM. CONCLUSION: B19-DNA and IgM together provide a better, highly accurate diagnosis.
Assuntos
Anticorpos Antivirais , DNA Viral , Eritema Infeccioso , Imunoglobulina M , Parvovirus B19 Humano , Humanos , Parvovirus B19 Humano/genética , Parvovirus B19 Humano/imunologia , Parvovirus B19 Humano/isolamento & purificação , Criança , Imunoglobulina M/sangue , Pré-Escolar , Feminino , Masculino , DNA Viral/sangue , Anticorpos Antivirais/sangue , Eritema Infeccioso/diagnóstico , Eritema Infeccioso/sangue , Eritema Infeccioso/imunologia , Lactente , Sensibilidade e Especificidade , Adolescente , Reação em Cadeia da Polimerase/métodos , Infecções por Parvoviridae/diagnóstico , Infecções por Parvoviridae/sangue , Infecções por Parvoviridae/imunologia , Infecções por Parvoviridae/virologia , Ensaio de Imunoadsorção Enzimática , Testes Sorológicos/métodosRESUMO
BACKGROUND: There should be a heightened index of suspicion for Parvovirus B19 (PVB19)-related anemia in organ transplant recipients. Thus far, there is no consensus or recommendation for clinical routine monitoring methods of PVB19 recipients to allow tailoring of immunosuppression. METHODS: We conducted a retrospective study to evaluate the utility of the function (represented by the abilities to secrete IFN-γ) and numbers of lymphocyte subsets in monitoring PVB19 infections in renal recipients posttransplant. The enrolled 109 patients were split into 2 groups according to whether the recipients had an occurrence of PVB19 infection: 37 (33.94%) recipients developed PVB19 infection and 72 (66.06%) immune-stable recipients. RESULTS: The PVB19 infected group had significantly lower absolute counts and functions of different lymphocyte subsets compared with immune-stable recipients. We showed that the frequencies of IFN-γ + CD4 + T cells, IFN-γ + CD8 + T cells, and IFN-γ + NK cells increased markedly after treatment when compared to the occurrence in patients with timepoint before therapy, especially the percentages of IFN-γ + CD4 + T cells were significantly higher. Receiver operating characteristic (ROC) analysis showed that the optimal infection indicator was IFN-γ + NK cells frequency, with an auROC curve of 0.925. Concomitantly, Cox regression analysis indicated that the post-therapy increasing level of IFN-γ secreting function was significantly predictive of recurrent infections (P < 0.001). CONCLUSIONS: We recommend prospective risk stratification for the high-risk population at risk of early-onset PVB19 infection and its recurrence involves screening strategies of immune-based surveillance with the sensitive IFN-γ + secreting monitoring for antiviral prophylaxis and preemptive therapy goal. Clinical Trial Notation: clinical trial registration number: chiCTR-ROC-17010756.
Assuntos
Eritema Infeccioso , Interferon gama , Transplante de Rim , Parvovirus B19 Humano , Eritema Infeccioso/imunologia , Humanos , Interferon gama/análise , Transplante de Rim/efeitos adversos , Subpopulações de Linfócitos/imunologia , Parvovirus B19 Humano/imunologia , Estudos Retrospectivos , TransplantadosRESUMO
BACKGROUND: Parvovirus B19 is a pathogenic virus often diagnosed by serology, yet little is known about analytical performance of commercial enzyme immunoassays (EIAs). OBJECTIVE: To investigate performance of 4 EIAs for parvovirus B19 IgM and IgG: Liaison, Euroimmun, Mikrogen and Virion/Serion. STUDY DESIGN: To compare 4 EIAs to Biotrin's ELISA on 168 samples and determine consensus score for discordant samples using Mikrogen's confirmatory line assay. RESULTS: Two thirds of results for IgM/IgG were identical for all 4 EIAs and Biotrin. Liaison shows the highest IgM sensitivity, but has low specificity. Euroimmun lacks IgM sensitivity. Mikrogen had a good overall performance, but had the lowest IgG specificity. Virion/Serion had variable performance with a low IgM specificity and the most borderline and cross-reactive results. CONCLUSIONS: Liaison and Mikrogen have similar performance to Biotrin's ELISA. Euroimmun lacks sensitivity and Virion/Serion produced many borderline and cross-reactive results.
Assuntos
Anticorpos Antivirais/sangue , Eritema Infeccioso/diagnóstico , Técnicas Imunoenzimáticas/normas , Parvovirus B19 Humano/imunologia , Testes Sorológicos/normas , Eritema Infeccioso/imunologia , Humanos , Técnicas Imunoenzimáticas/métodos , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Sensibilidade e Especificidade , Testes Sorológicos/métodosAssuntos
Doença de Crohn/tratamento farmacológico , Eritema Infeccioso/virologia , Imunossupressores/efeitos adversos , Infliximab/efeitos adversos , Miocardite/virologia , Infecções Oportunistas/virologia , Parvovirus B19 Humano/patogenicidade , Biópsia , Doença de Crohn/diagnóstico , Doença de Crohn/imunologia , Quimioterapia Combinada , Eletrocardiografia , Técnicas Eletrofisiológicas Cardíacas , Endoscopia Gastrointestinal , Eritema Infeccioso/diagnóstico , Eritema Infeccioso/imunologia , Humanos , Hospedeiro Imunocomprometido , Masculino , Miocardite/diagnóstico , Miocardite/imunologia , Infecções Oportunistas/diagnóstico , Infecções Oportunistas/imunologia , Parvovirus B19 Humano/imunologia , Valor Preditivo dos Testes , Fatores de Risco , Adulto JovemRESUMO
ABSTRACT: Flame figures represent a characteristic but nondiagnostic histological finding in eosinophilic dermatoses. Some bullous autoimmune diseases with a predominant eosinophilic infiltrate, such as bullous pemphigoid, pemphigoid gestationis, and pemphigus vegetans, may show them. However, it is rare to find them in predominant neutrophilic bullous dermatoses such as linear immunoglobulin A. We present a 60-year-old man with a history of chronic urticaria, which presented a bullous disease after an acute parvovirus B19 infection. The histological findings showed an exceptional linear immunoglobulin A bullous dermatosis with an eosinophilic infiltrate in the dermis forming "flame figures." The clinical and histopathological findings for this entity may be identical to those of other dermatoses. For this reason, combining these findings with direct immunofluorescence analysis is essential for correct diagnosis of this bullous disease.
Assuntos
Eosinófilos/imunologia , Eritema Infeccioso/imunologia , Dermatose Linear Bolhosa por IgA/imunologia , Parvovirus B19 Humano/imunologia , Pele/imunologia , Corticosteroides/uso terapêutico , Antialérgicos/uso terapêutico , Anticorpos Antivirais/sangue , Eosinófilos/efeitos dos fármacos , Eosinófilos/virologia , Eritema Infeccioso/diagnóstico , Eritema Infeccioso/virologia , Antagonistas dos Receptores Histamínicos/uso terapêutico , Interações Hospedeiro-Patógeno , Humanos , Imunoglobulina M/sangue , Dermatose Linear Bolhosa por IgA/tratamento farmacológico , Dermatose Linear Bolhosa por IgA/patologia , Dermatose Linear Bolhosa por IgA/virologia , Masculino , Pessoa de Meia-Idade , Parvovirus B19 Humano/patogenicidade , Pele/efeitos dos fármacos , Pele/patologia , Pele/virologia , Resultado do TratamentoRESUMO
Inflammatory cardiomyopathy, characterized by inflammatory cell infiltration into the myocardium and a high risk of deteriorating cardiac function, has a heterogeneous aetiology. Inflammatory cardiomyopathy is predominantly mediated by viral infection, but can also be induced by bacterial, protozoal or fungal infections as well as a wide variety of toxic substances and drugs and systemic immune-mediated diseases. Despite extensive research, inflammatory cardiomyopathy complicated by left ventricular dysfunction, heart failure or arrhythmia is associated with a poor prognosis. At present, the reason why some patients recover without residual myocardial injury whereas others develop dilated cardiomyopathy is unclear. The relative roles of the pathogen, host genomics and environmental factors in disease progression and healing are still under discussion, including which viruses are active inducers and which are only bystanders. As a consequence, treatment strategies are not well established. In this Review, we summarize and evaluate the available evidence on the pathogenesis, diagnosis and treatment of myocarditis and inflammatory cardiomyopathy, with a special focus on virus-induced and virus-associated myocarditis. Furthermore, we identify knowledge gaps, appraise the available experimental models and propose future directions for the field. The current knowledge and open questions regarding the cardiovascular effects associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are also discussed. This Review is the result of scientific cooperation of members of the Heart Failure Association of the ESC, the Heart Failure Society of America and the Japanese Heart Failure Society.
Assuntos
Cardiomiopatias/fisiopatologia , Inflamação/fisiopatologia , Miocardite/fisiopatologia , Viroses/fisiopatologia , Animais , Antivirais/uso terapêutico , Autoimunidade/imunologia , Biópsia , COVID-19/fisiopatologia , COVID-19/terapia , Cardiomiopatias/diagnóstico , Cardiomiopatias/imunologia , Cardiomiopatias/terapia , Cardiomiopatia Dilatada , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Infecções por Coxsackievirus/imunologia , Infecções por Coxsackievirus/fisiopatologia , Infecções por Coxsackievirus/terapia , Infecções por Citomegalovirus/imunologia , Infecções por Citomegalovirus/fisiopatologia , Infecções por Citomegalovirus/terapia , Modelos Animais de Doenças , Infecções por Echovirus/imunologia , Infecções por Echovirus/fisiopatologia , Infecções por Echovirus/terapia , Infecções por Vírus Epstein-Barr/imunologia , Infecções por Vírus Epstein-Barr/fisiopatologia , Infecções por Vírus Epstein-Barr/terapia , Eritema Infeccioso/imunologia , Eritema Infeccioso/fisiopatologia , Eritema Infeccioso/terapia , Infecções por HIV/fisiopatologia , Hepatite C/imunologia , Hepatite C/fisiopatologia , Hepatite C/terapia , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Fatores Imunológicos/uso terapêutico , Inflamação/diagnóstico , Inflamação/imunologia , Inflamação/terapia , Influenza Humana/imunologia , Influenza Humana/fisiopatologia , Influenza Humana/terapia , Leucócitos/imunologia , Miocardite/diagnóstico , Miocardite/imunologia , Miocardite/terapia , Miocárdio/patologia , Prognóstico , Infecções por Roseolovirus/imunologia , Infecções por Roseolovirus/fisiopatologiaRESUMO
BACKGROUND: The seroprevalence of human Parvovirus B19 (PVB19) is 70-85% in adults worldwide. PVB19 is the etiologic agent of the fifth disease, is a cause of aplastic anemia, and can be associated with kidney injury. We aimed to describe the cases of 4 patients with kidney injury related to PVB19 primary infection, and to evaluate the seroprevalence of PVB19 and the incidence of PVB19 primary infection in patients undergoing a native kidney biopsy. METHODS: Cases of PVB19 infection with kidney injury were reviewed from the archives of the department of Nephrology. A systematic screening of anti-PVB19 IgG and IgM antibodies and viral DNA was performed in sera from 100 consecutive patients with a kidney biopsy in 2017-2018. RESULTS: The 4 patients with PVB19 infection-associated kidney disease displayed: one lupus-like glomerulonephritis (GN) without lupus auto-antibodies, one minimal change disease with tubular necrosis, one secondary hemolytic and uremic syndrome and one membrano-proliferative GN. In the 100 patients biopsied, 67 had elevated anti-PVB19 IgG, among whom 8 had elevated IgM, without circulating viral DNA, without any particular renal pathological pattern. One additional patient showed a seroconversion at the time of kidney biopsy, which revealed a class V lupus nephritis. CONCLUSION: PVB19 primary infection can be associated with different kidney diseases. The seroprevalence of PVB19 among patients with a kidney biopsy is similar to the overall population, and primary infection is rarely documented (1%) after systematic screening. Whether PV19 is nephrotoxic, or triggers renal endothelial injury and immune activation, remains to be elucidated.
Assuntos
Injúria Renal Aguda/virologia , Anticorpos Antivirais/imunologia , DNA Viral/sangue , Eritema Infeccioso/imunologia , Parvovirus B19 Humano/imunologia , Injúria Renal Aguda/sangue , Injúria Renal Aguda/imunologia , Injúria Renal Aguda/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Eritema Infeccioso/sangue , Eritema Infeccioso/complicações , Feminino , Glomerulonefrite/sangue , Glomerulonefrite/imunologia , Glomerulonefrite/patologia , Glomerulonefrite/virologia , Glomerulonefrite Membranoproliferativa/sangue , Glomerulonefrite Membranoproliferativa/imunologia , Glomerulonefrite Membranoproliferativa/patologia , Glomerulonefrite Membranoproliferativa/virologia , Síndrome Hemolítico-Urêmica/sangue , Síndrome Hemolítico-Urêmica/imunologia , Síndrome Hemolítico-Urêmica/patologia , Síndrome Hemolítico-Urêmica/virologia , Humanos , Imunoglobulina G/imunologia , Imunoglobulina M/imunologia , Incidência , Rim , Necrose Tubular Aguda/sangue , Necrose Tubular Aguda/imunologia , Necrose Tubular Aguda/patologia , Necrose Tubular Aguda/virologia , Masculino , Pessoa de Meia-Idade , Nefrose Lipoide/sangue , Nefrose Lipoide/imunologia , Nefrose Lipoide/patologia , Nefrose Lipoide/virologia , Parvovirus B19 Humano/genética , Estudos Soroepidemiológicos , Viremia/sangue , Adulto JovemRESUMO
Acquired pure red cell aplasia (PRCA) is characterized by severe normocytic (rarely macrocytic) and normochromic anemia, a low reticulocytes count in peripheral blood, and near absence of erythroid precursors in the bone marrow, with a normal level of erythropoietin. We describe a case of the kidney transplant recipient, diagnosed with PRCA induced with parvovirus B19 infection. Our case demonstrates that although this complication is rare, it should be considered in a differential diagnosis of anemia diagnostics in immunocompromised patients. In our case reduced immune response resulted from post-transplant immunosuppressive therapy. In our patient, apart from infection by parvovirus B19, graft dysfunction due to polyomavirus BK virus infection was also detected together with histologic and serologic features of antibody-mediated renal graft rejection. Considering the entire clinical picture, intravenous immunoglobulin therapy (IVIg) was successfully introduced.
Assuntos
Rejeição de Enxerto/imunologia , Hospedeiro Imunocomprometido/imunologia , Transplante de Rim/efeitos adversos , Complicações Pós-Operatórias/imunologia , Aplasia Pura de Série Vermelha/imunologia , Aplasia Pura de Série Vermelha/virologia , Anticorpos Antivirais/imunologia , Eritema Infeccioso/imunologia , Eritema Infeccioso/virologia , Eritropoetina , Feminino , Rejeição de Enxerto/tratamento farmacológico , Rejeição de Enxerto/virologia , Humanos , Imunoglobulinas Intravenosas/administração & dosagem , Masculino , Pessoa de Meia-Idade , Parvovirus B19 Humano/imunologia , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/virologia , Aplasia Pura de Série Vermelha/tratamento farmacológicoRESUMO
BACKGROUND: Human parvovirus B19 (PVB19) is a cosmopolitan DNA virus transmissible parenterally by blood transfusion. Therefore, the risk of transmission through asymptomatic blood donors should be considered and appropriately managed worldwide. PVB19 screening of blood and blood products for transfusion is not done routinely in the Democratic Republic of Congo (DRC). The main objective of this study was to determine the seroprevalence of PVB19 infection in healthy eligible blood donors in Kinshasa, capital of the DRC, located in the western part of the DRC, and the association of infection with the sociodemographic characteristics of blood donors. MATERIALS AND METHODS: A total of 360 whole blood donors who attended the National Center of Blood Transfusion were examined for anti-PVB19 IgG and IgM antibodies by using enzyme-linked immunosorbent assay kits. Sociodemographic information was collected on the blood donors. All statistical analyses were performed with SPSS 21. RESULTS: Among the study group, 289 men and 52 women were infected with PVB19. The mean age was 32.7 ± 9.8 years, 48.6% of donors were positive only for PVB19 IgG antibodies while 40.8% were positive for both IgG and IgM antibodies. In addition, 5.3% were positive only for PVB19 IgM antibodies and so were considered as a potential group of PVB19 transfusion-transmission. PVB19 seropositivity was significantly associated with sex, with a higher prevalence in men. In multivariate analysis, male sex and Tshangu district have emerged as major factors associated to PVB19 seropositivity. CONCLUSIONS: This research showed that recipients of blood and blood products in Kinshasa are at a high risk (5.3%) of transfusion-transmitted PVB19 infection. Therefore, the implementation of PVB19 nucleic acid testing assays capable of detecting all PVB19 genotypes and discard donations with high titer PVB19 DNA for blood products seems to be necessary.
Assuntos
Anticorpos Antivirais/sangue , Eritema Infeccioso/epidemiologia , Eritema Infeccioso/imunologia , Parvovirus B19 Humano/imunologia , Adolescente , Adulto , Doadores de Sangue , Estudos Transversais , República Democrática do Congo/epidemiologia , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Masculino , Pessoa de Meia-Idade , Estudos Soroepidemiológicos , Adulto JovemRESUMO
BACKGROUND: Parvovirus B19 (B19 V) infection had been reported to be more frequent with serious clinical outcomes in patients with sickle cell disease (SCD) than in the general population. There is a wide variation in data among the existing literature regarding the seroprevalence of B19 V in patients with SCD. These data require further summary and analyses for better accuracy. This systematic review and meta-analysis was done to estimate the seroprevalence of B19 V in patients with SCD. METHODS: This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The databases of MEDLINE/PubMed, Virtual Health Library (VHL), ScienceDirect, Google Scholar, and OpenGrey were used for the systematic search. The random-effects model was used to estimate the pooled prevalence with the corresponding 95% confidence interval (CI) using OpenMeta Analyst software. Publication bias was estimated based on Begg's test, Egger's test, and examination of the funnel plot. Subgroup analyses and metaregression were used to explore the moderators of heterogeneity between studies. RESULTS: A total of 18 studies including 2890 patients were analyzed. The overall IgG seroprevalence of B19 V infection among patients with SCD was found to be 48.8% (95% CI 39.5%-58.0%). Evidence of publication bias was not detected. Evidence of acute viral infection detected by positive IgM antibodies among the screened SCD patients was found in 8.30% (95% CI 5.20%-11.4%) of them. There was a statistically signiï¬cant association between seroprevalence of B19 V and geographical areas. CONCLUSION: There was a high prevalence of B19 V in patients with SCD. Healthcare providers need to be aware of the magnitude of B19 V infection in patients with SCD to ensure effective management. This review could provide a comprehensive view of B19 V prevalence in this susceptible population.
Assuntos
Anemia Falciforme/sangue , Anticorpos Antivirais/sangue , Eritema Infeccioso/sangue , Estudos Soroepidemiológicos , Anemia Falciforme/imunologia , Anemia Falciforme/patologia , Anemia Falciforme/virologia , Anticorpos Antivirais/imunologia , Eritema Infeccioso/imunologia , Eritema Infeccioso/patologia , Eritema Infeccioso/virologia , Humanos , Parvovirus B19 Humano/imunologia , Parvovirus B19 Humano/patogenicidadeRESUMO
Impaired cell-mediated, as well as antibody-mediated immunity predisposes a renal transplant recipient to a wide variety of atypical infection. With an increasing number of re-transplant, the balance between immunosuppression and the risk of recurrent disease poses a clinical and therapeutic challenge. Here, we report a successful re-transplantation in a case of parvovirus B19 infection leading to anaemia and collapsing glomerulopathy in the allograft managed with intravenous immunoglobulin (IVIG) and reduction of immunosuppression. This case emphasizes re-consideration to renal transplant after clearance of the virus in a previous renal allograft lost to PVB19 infection.
Assuntos
Eritema Infeccioso/tratamento farmacológico , Rejeição de Enxerto/terapia , Imunoglobulinas Intravenosas/uso terapêutico , Transplante de Rim/efeitos adversos , Parvovirus B19 Humano/isolamento & purificação , Aplasia Pura de Série Vermelha/etiologia , Aloenxertos/imunologia , Aloenxertos/virologia , Eritema Infeccioso/complicações , Eritema Infeccioso/imunologia , Eritema Infeccioso/virologia , Glomerulonefrite/imunologia , Glomerulonefrite/cirurgia , Rejeição de Enxerto/imunologia , Rejeição de Enxerto/virologia , Humanos , Hospedeiro Imunocomprometido , Imunossupressores/efeitos adversos , Rim/imunologia , Rim/virologia , Doadores Vivos , Masculino , Parvovirus B19 Humano/imunologia , Recidiva , Aplasia Pura de Série Vermelha/tratamento farmacológico , Reoperação , Transplante Haploidêntico/efeitos adversos , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: Infections with parvovirus B19 (B19V) have been associated with a wide range of disease manifestations of which erythema infectiosum (fifth disease) in children is most common. Clinical signs following infection of children with B19V can be similar to measles and rubella. Laboratory detection of B19V infections is based on detection of B19V-specific IgM antibodies by enzyme immunoassay (IgM-EIA) and/or B19V DNA by quantitative PCR (qPCR) on blood samples. The need for invasive sampling can be a barrier for public health diagnostics. OBJECTIVES: To evaluate the use of a dual target B19V-qPCR directed against the NS1 and VP2 of B19V on oral fluid samples as a non-invasive alternative for laboratory diagnosis of B19V infections in children below 12 years of age with exanthema. STUDY DESIGN: Oral fluid and serum samples were collected from 116 children with exanthema. All serum samples were tested by IgM-EIA/IgG-EIA, while all oral fluid and 56 serum samples were tested by B19V-qPCR. RESULTS: B19V-specific IgM antibodies were detected in 25 of 116 children in the study. B19V DNA was detected in oral fluid in 17 of the 25 children who were IgM positive, as well as two children who were IgM-equivocal or negative. The child with the equivocal IgM had a high quantity of B19V DNA in oral fluid (7 log IU/ml), compatible with an acute B19V infection. The IgM-negative child was IgG-positive and 4 log IU/ml B19V DNA was detected in the oral fluid sample, suggesting an acute infection and a falsely negative IgM. Sample size calculations indicated that oral fluid samples for qPCR should be collected from 2 to 3 children during outbreaks of exanthema to achieve similar sensitivity as IgM-EIA for one child (≥0.9) to confirm or exclude B19V. CONCLUSIONS: Results indicate that oral fluid samples are a suitable public health alternative for detection of B19V infections, potentially lowering the barriers for sampling.
Assuntos
Proteínas do Capsídeo/genética , Eritema Infeccioso/diagnóstico , Parvovirus B19 Humano/isolamento & purificação , Saliva/virologia , Proteínas não Estruturais Virais/genética , Anticorpos Antivirais/sangue , Criança , Eritema Infeccioso/imunologia , Feminino , Humanos , Imunoglobulina M/sangue , Masculino , Técnicas de Diagnóstico Molecular , Parvovirus B19 Humano/genética , Parvovirus B19 Humano/imunologia , Reação em Cadeia da Polimerase em Tempo Real , Tamanho da Amostra , Sensibilidade e EspecificidadeRESUMO
Parvovirus B19 has tropism for red line blood cells, causing immune hydrops during pregnancy. A positive anti-Kell Coombs reaction usually happens during pregnancy when there is production of antibodies that target Kell antigens, but cross reactions to other antigens may occur. A 24-year-old Gypsy primigravida, 0 Rhesus positive, presented with persistent isolated hyperthermia for 2 weeks and a positive indirect Coombs test result with anti-Kell antibodies at routine tests. She had a 19-week live fetus. The blood tests revealed bicytopenia with iron deficiency anemia, leucopoenia with neutropenia, and elevated C-reactive protein. She was medicated with imipenem, and had a slow clinical recovery. Blood, urine and sputum samples were taken to perform cultures and to exclude other systemic infections. Escherichia coli was isolated in the urine, which most probably caused a transient cross anti-Kell reaction. Haemophilus influenza in the sputum and seroconversion to parvovirus B19 was confirmed, causing unusual deficits in the white cells, culminating in febrile neutropenia. Despite the patient's lack of compliance to the medical care, both maternal and fetal/neonatal outcomes were good. This a rare case report of 2 rare phenomena, a cross anti-Kell reaction to E. coli and parvovirus B19 infection with tropism for white cells causing febrile neutropenia, both events occurring simultaneously during pregnancy.
O parvovírus B19 tem tropismo para as células sanguíneas da linha vermelha, causando hidropsia imune durante a gravidez. O teste Coombs anti-Kell positivo ocorre durante a gravidez quando há produção de anticorpos contra os antígenos de Kell, mas pode haver reações cruzadas para outros antígenos. Uma grávida primigesta de etnia cigana, de 24 anos, 0 Rhesus positivo, recorreu ao hospital às 19 semanas de gestação por hipertermia isolada persistente por 2 semanas e um teste Coombs indireto positivo por anticorpos anti-Kell em testes de rotina da gravidez. O estudo analítico revelou bicitopenia com anemia ferropênica, leucopenia com neutropenia, e elevação da proteína C-reativa. A paciente foi medicada com imipenem, e teve uma recuperação clínica lenta. Foram colhidas amostras de sangue, urina e expectoração para culturas bacterianas. Na urina, foi isolada Escherichia coli, o que provavelmente causou a reação anti-Kell cruzada transitória. Na expectoração, foi isolada Haemophilus influenza, e foi confirmada seroconversão para o parvovírus B19, que causou um déficit incomum na linhagem sanguínea branca, culminando com neutropenia febril. Apesar da má adesão aos cuidados médicos, os desfechos materno e fetal/neonatal foram bons. Este é um caso de 2 fenômenos raros, uma reação cruzada anti-Kell à infecção por E. coli, e parvovírus B19 com tropismo para células brancas causando neutropenia febril, ambos ocorrendo simultaneamente durante a gravidez.
Assuntos
Eritema Infeccioso/complicações , Eritema Infeccioso/imunologia , Escherichia coli/imunologia , Neutropenia Febril/imunologia , Neutropenia Febril/virologia , Sistema do Grupo Sanguíneo de Kell/imunologia , Parvovirus B19 Humano , Complicações Infecciosas na Gravidez/imunologia , Reações Cruzadas , Feminino , Humanos , Gravidez , Adulto JovemRESUMO
Abstract Parvovirus B19 has tropism for red line blood cells, causing immune hydrops during pregnancy. A positive anti-Kell Coombs reaction usually happens during pregnancy when there is production of antibodies that target Kell antigens, but cross reactions to other antigens may occur. A 24-year-old Gypsy primigravida, 0 Rhesus positive, presented with persistent isolated hyperthermia for 2 weeks and a positive indirect Coombs test result with anti-Kell antibodies at routine tests. She had a 19-week live fetus. The blood tests revealed bicytopenia with iron deficiency anemia, leucopoenia with neutropenia, and elevated C-reactive protein. She was medicated with imipenem, and had a slow clinical recovery. Blood, urine and sputum samples were taken to perform cultures and to exclude other systemic infections. Escherichia coli was isolated in the urine, which most probably caused a transient cross anti-Kell reaction. Haemophilus influenza in the sputum and seroconversion to parvovirus B19 was confirmed, causing unusual deficits in the white cells, culminating in febrile neutropenia. Despite the patient's lack of compliance to the medical care, both maternal and fetal/neonatal outcomes were good. This a rare case report of 2 rare phenomena, a cross anti-Kell reaction to E. coli and parvovirus B19 infection with tropism for white cells causing febrile neutropenia, both events occurring simultaneously during pregnancy.
Resumo O parvovírus B19 tem tropismo para as células sanguíneas da linha vermelha, causando hidropsia imune durante a gravidez. O teste Coombs anti-Kell positivo ocorre durante a gravidez quando há produção de anticorpos contra os antígenos de Kell, mas pode haver reações cruzadas para outros antígenos. Uma grávida primigesta de etnia cigana, de 24 anos, 0 Rhesus positivo, recorreu ao hospital às 19 semanas de gestação por hipertermia isolada persistente por 2 semanas e umteste Coombs indireto positivo por anticorpos anti-Kell em testes de rotina da gravidez. O estudo analítico revelou bicitopenia com anemia ferropênica, leucopenia com neutropenia, e elevação da proteína C-reativa. A paciente foi medicada com imipenem, e teve uma recuperação clínica lenta. Foram colhidas amostras de sangue, urina e expectoração para culturas bacterianas. Na urina, foi isolada Escherichia coli, o que provavelmente causou a reação anti-Kell cruzada transitória. Na expectoração, foi isolada Haemophilus influenza, e foi confirmada seroconversão para o parvovírus B19, que causou um déficit incomum na linhagem sanguínea branca, culminando com neutropenia febril. Apesar da má adesão aos cuidados médicos, os desfechos materno e fetal/neonatal foram bons. Este é um caso de 2 fenômenos raros, uma reação cruzada anti-Kell à infecção por E. coli, e parvovírus B19 comtropismo para células brancas causando neutropenia febril, ambos ocorrendo simultaneamente durante a gravidez.
Assuntos
Humanos , Feminino , Gravidez , Adulto Jovem , Complicações Infecciosas na Gravidez/imunologia , Parvovirus B19 Humano , Eritema Infeccioso/complicações , Eritema Infeccioso/imunologia , Escherichia coli/imunologia , Neutropenia Febril/imunologia , Neutropenia Febril/virologia , Sistema do Grupo Sanguíneo de Kell/imunologia , Reações CruzadasAssuntos
Anemia Hemolítica Autoimune , Eritema Infeccioso , Parvovirus B19 Humano , Aplasia Pura de Série Vermelha , Anemia Hemolítica Autoimune/imunologia , Anemia Hemolítica Autoimune/patologia , Anemia Hemolítica Autoimune/virologia , Criança , Eritema Infeccioso/imunologia , Eritema Infeccioso/patologia , Feminino , Humanos , Aplasia Pura de Série Vermelha/imunologia , Aplasia Pura de Série Vermelha/patologia , Aplasia Pura de Série Vermelha/virologiaRESUMO
Human parvovirus B19 (B19V) causes a number of skin exanthemas and has been related to both cutaneous and systemic diseases. Tropism of the virus for the rapidly proliferating erythroid progenitor cells in the bone marrow and fetal liver explains the pathogenesis of anemia and fetal hydrops. The cutaneous lesions of erythema infectiosum and other B19V-related exanthemas have been attributed to the deposition of immune complexes in the skin. We report on the immunohistochemical detection of B19V protein in the cytoplasm of dermal endothelial cells in a case of periflexural exanthema in a 28-year-old woman. An antibody-dependent enhancement mechanism of entry has been suggested for B19V in myocardial endothelial cells and could also be involved in B19V-related exanthemas.
Assuntos
Anticorpos Facilitadores/imunologia , Proteínas do Capsídeo/imunologia , Endotélio Vascular/virologia , Eritema Infeccioso/imunologia , Exantema/virologia , Adulto , Anticorpos Antivirais/imunologia , Exantema/imunologia , Feminino , Humanos , Imuno-Histoquímica , Parvovirus B19 HumanoRESUMO
Epidemiological studies suggest a viral etiology in approximately 1% of patients presenting with acute arthritis. The arthritogenic effect of viral infections may be related to viral invasion of synovial cells, the cellular and humoral immune response to viral antigens or by induction of autoimmunity. Viral arthritis can mimic rheumatoid arthritis by presenting as a symmetrical polyarticular disease often accompanied by a rash and influenza-like symptoms. Serological testing for pathogen-specific IgM and IgG antibodies is frequently performed for establishing a viral etiology of arthritis. Virus isolation from the joints or detection of viral nucleic acids in the synovium or synovial fluid is only rarely successful and does not always provide proof of a viral origin of arthritis. While viral arthritis in most cases is self-limiting, protracted disease can occur.
Assuntos
Artrite Infecciosa/diagnóstico , Doença Aguda , Formação de Anticorpos/imunologia , Antígenos Virais/imunologia , Artrite Infecciosa/epidemiologia , Artrite Infecciosa/imunologia , Artrite Infecciosa/virologia , Doenças Autoimunes/diagnóstico , Doenças Autoimunes/epidemiologia , Doenças Autoimunes/imunologia , Doenças Autoimunes/virologia , Febre de Chikungunya/diagnóstico , Febre de Chikungunya/imunologia , Comparação Transcultural , Estudos Transversais , Eritema Infeccioso/diagnóstico , Eritema Infeccioso/epidemiologia , Eritema Infeccioso/imunologia , Eritema Infeccioso/virologia , Hepatite Viral Humana/diagnóstico , Hepatite Viral Humana/epidemiologia , Hepatite Viral Humana/imunologia , Hepatite Viral Humana/virologia , Humanos , Imunidade Celular/imunologia , Imunoglobulina G/metabolismo , Imunoglobulina M/metabolismo , Membrana Sinovial/imunologia , Membrana Sinovial/virologiaRESUMO
Parvovirus B19 (PB19) is a common, widespread, small, single-stranded DNA virus which has been linked with a broad spectrum of clinical illnesses, including a variety of neurological complications such as encephalitis, meningitis, myelitis, stroke, cerebellar ataxia, and neuropathy. The authors describe a case of PB19 infection associated with hemolytic anemia and cranial polyneuropathy involving the second and third cranial nerves in a 23-year-old immunocompetent woman. The diagnosis of acute PB19 infection was established with detection of positive DNA and anti-PB19 IgM antibodies in blood samples. Antiganglioside antibody studies were performed and serum anti-GD1b IgG was strongly positive. Further investigation was normal or negative, excluding other infectious or autoimmune disorders. The patient was initially treated with a 5-day course of intravenous immunoglobulin (IGIV). Because of incomplete neurological recovery, methylprednisolone was also administered 7 days after IGIV therapy initiation. Complete resolution of clinical symptoms was observed 3 months after disease onset at follow-up visit, despite the persistence of PB19 DNA and anti-PB19 IgM antibodies in serum 5 months after the initial presentation. Our report provides evidence that PB19 could affect both the central and peripheral nervous system, possibly by triggering an autoimmune mechanism that leads to autoantibody production.