RESUMO
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
Parvovirus B19 infection is undiagnosed in recipients undergoing solid organ transplantation. It is usually responsible for unexplained acute and chronic red blood cell aplasia that does not respond to erythropoietin therapy. Cases of parvovirus B19 infection associated with pancytopenia, solid organ dysfunction, and allograft rejection have been described in the literature. The deterioration of the immune system as a result of severe immunotherapy favors the reactivation of a previous infection or the acquisition of a new one. We present a case of a 32-year-old woman with a 1-year history of renal allograft transplant and previous cytomegalovirus (CMV) infection who presented with chest pain, polyarthritis, pancytopenia, and renal dysfunction. A serum sample using polymerase chain reaction showed a parvovirus titer of 13.8 trillion IU/mL and a CMV titer of 800 IU/mL. The renal biopsy revealed nucleomegaly with focal viral inclusions, along with changes associated with immunotherapy toxicity. Electron microscopy demonstrated capillary and tubular epithelial cells with "viral factories," thereby confirming the diagnosis. Thus, screening for parvovirus B19 is advised in high-risk patients who present with refractory anemia to avoid the complications of a chronic infection associated with the fatal rejection of the transplanted organ.
Assuntos
Artrite/patologia , Dor no Peito/patologia , Eritema Infeccioso/sangue , Eritema Infeccioso/patologia , Transplante de Rim/efeitos adversos , Pancitopenia/patologia , Parvovirus B19 Humano/isolamento & purificação , Adulto , Aloenxertos/patologia , Aloenxertos/ultraestrutura , Aloenxertos/virologia , Artrite/tratamento farmacológico , Artrite/virologia , Biópsia por Agulha , Inibidores de Calcineurina/uso terapêutico , Dor no Peito/tratamento farmacológico , Dor no Peito/virologia , Citomegalovirus/isolamento & purificação , DNA Viral/isolamento & purificação , Eritema Infeccioso/tratamento farmacológico , Eritema Infeccioso/virologia , Feminino , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Imunossupressores/uso terapêutico , Rim/patologia , Rim/ultraestrutura , Rim/virologia , Microscopia Eletrônica , Pancitopenia/tratamento farmacológico , Pancitopenia/virologia , Parvovirus B19 Humano/genética , Reação em Cadeia da PolimeraseAssuntos
Eritema Infeccioso/virologia , Imunossupressores/efeitos adversos , Falência Renal Crônica/cirurgia , Transplante de Rim/efeitos adversos , Infecções Oportunistas/virologia , Aplasia Pura de Série Vermelha/virologia , Adolescente , Transfusão de Sangue , Resistência a Medicamentos , Eritema Infeccioso/diagnóstico , Eritema Infeccioso/tratamento farmacológico , Eritema Infeccioso/imunologia , Eritropoetina/uso terapêutico , Hematínicos/uso terapêutico , Humanos , Hospedeiro Imunocomprometido , Imunoglobulinas Intravenosas/uso terapêutico , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/etiologia , Masculino , Nefrite Hereditária/complicações , Infecções Oportunistas/diagnóstico , Infecções Oportunistas/tratamento farmacológico , Infecções Oportunistas/imunologia , Aplasia Pura de Série Vermelha/diagnóstico , Aplasia Pura de Série Vermelha/tratamento farmacológico , Aplasia Pura de Série Vermelha/imunologia , Resultado do TratamentoRESUMO
BACKGROUND: Chronic viral infections of the heart are considered one antecedent event leading to progressive dysfunction of the myocardium, often with an impaired prognosis due to a virus- or immune-mediated myocardial injury. Symptomatic treatment does not influence the viral cause of heart failure, and the effect of antiviral treatment has not been determined, yet. METHODS AND RESULTS: In this phase II study 143 patients with symptoms of heart failure and biopsy-based confirmation of the enterovirus (EV), adenovirus, and/or parvovirus B19 genomes in their myocardial tissue were randomly assigned to double-blind treatment, and received either placebo (n = 48) or 4 × 10(6) (n = 49) and 8 × 10(6) IU (n = 46) interferon beta-1b (IFN-ß-1b) for 24 weeks, in addition to standard heart failure treatment. Patients with active myocarditis or other specific causes of heart failure were excluded. Compared to placebo, virus elimination and/or virus load reduction was higher in the IFN-ß-1b groups (odds ratio 2.33, p = 0.048), similarly in both interferon groups and both strata. IFN-ß-1b treatment was associated with favourable effects on NYHA functional class (p = 0.013 at follow-up week 12), improvement in quality of life (Minnesota Heart Failure score; p = 0.032 at follow-up week 24) and patient global assessment (follow-up week 12 to follow-up week 24; p = 0.039). The frequency of adverse cardiac events was not higher in the IFN-ß-1b groups compared to the placebo group. CONCLUSIONS: Immunomodulatory IFN-ß-1b treatment is a well-tolerated and safe treatment option, leading to effective virus clearance or reduction of the virus load in patients with chronic viral cardiomyopathy. Favourable clinical effects assess quality of life, NYHA functional class, and patient global assessment. ClinicalTrials.gov identifier: NCT001185250.
Assuntos
Infecções por Adenoviridae/tratamento farmacológico , Antivirais/uso terapêutico , Cardiomiopatias/tratamento farmacológico , Infecções por Enterovirus/tratamento farmacológico , Eritema Infeccioso/tratamento farmacológico , Interferon beta-1b/uso terapêutico , Infecções por Adenoviridae/diagnóstico , Infecções por Adenoviridae/fisiopatologia , Infecções por Adenoviridae/virologia , Adulto , Idoso , Antivirais/efeitos adversos , Biópsia , Cardiomiopatias/diagnóstico , Cardiomiopatias/fisiopatologia , Cardiomiopatias/virologia , Doença Crônica , Método Duplo-Cego , Infecções por Enterovirus/diagnóstico , Infecções por Enterovirus/fisiopatologia , Infecções por Enterovirus/virologia , Eritema Infeccioso/diagnóstico , Eritema Infeccioso/fisiopatologia , Eritema Infeccioso/virologia , Europa (Continente) , Feminino , Humanos , Interferon beta-1b/efeitos adversos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Recuperação de Função Fisiológica , Fatores de Tempo , Resultado do Tratamento , Carga ViralRESUMO
We describe 2 cases of 6-year-old twin girls presenting with acute carpal tunnel syndrome (CTS) associated with human parvovirus B19 (HPV-B19) infection, as evidenced by serological data and detection of HPV-B19 DNA in blood with use of polymerase chain reaction (PCR). To our knowledge, this is the first time that HPV-B19 infection has been suggested as the causal agent of simultaneous acute bilateral CTS in twins, thus presenting the possibility that similar immunologic responses can be observed in twins during viral infections.
Assuntos
Síndrome do Túnel Carpal/diagnóstico , Síndrome do Túnel Carpal/tratamento farmacológico , Eritema Infeccioso/tratamento farmacológico , Parvovirus B19 Humano , Doença Aguda , Anti-Inflamatórios não Esteroides/uso terapêutico , Síndrome do Túnel Carpal/virologia , Criança , Feminino , Humanos , Naproxeno/uso terapêutico , Reação em Cadeia da Polimerase , Gêmeos , Complexo Vitamínico B/uso terapêuticoRESUMO
Persistent parvovirus B19 (PVB) infection has been reported sporadically in immunocompromised patients including hematopoietic stem cell and solid organ transplant recipients. However, the pathogenesis of persistent infection has yet to be fully elucidated. We report here a patient with multiple myeloma developing red cell aplasia during the hematopoietic recovery after allogeneic hematopoietic stem cell transplantation (HSCT) caused by PVB. The patient had already had PVB viremia before transplantation and remained asymptomatic. The route of PVB transmission was considered to be direct contact with the patient's family member with primary PVB infection 1 month before transplantation. Treatment with intravenous immunoglobulin resulted in prompt resolution of anemia. These findings suggest that monitoring of PVB DNA is recommended for patients undergoing HSCT and having contact with individuals with documented PVB infection, even if they are asymptomatic.
Assuntos
Eritema Infeccioso/complicações , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Parvovirus B19 Humano , Aplasia Pura de Série Vermelha/virologia , Adulto , Eritema Infeccioso/tratamento farmacológico , Eritema Infeccioso/transmissão , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Fatores Imunológicos/uso terapêutico , Masculino , Mieloma Múltiplo/terapiaAssuntos
Colite/etiologia , Eritema Infeccioso/complicações , Exantema/etiologia , Doença Enxerto-Hospedeiro/etiologia , Linfoma de Célula do Manto/complicações , Parvovirus B19 Humano , Doença Aguda , Adulto , Antígenos Virais/imunologia , Colite/tratamento farmacológico , Colite/imunologia , Reações Cruzadas/imunologia , Eritema Infeccioso/tratamento farmacológico , Eritema Infeccioso/imunologia , Exantema/tratamento farmacológico , Exantema/imunologia , Doença Enxerto-Hospedeiro/tratamento farmacológico , Doença Enxerto-Hospedeiro/imunologia , Humanos , Linfoma de Célula do Manto/imunologia , Linfoma de Célula do Manto/terapia , Masculino , Parvovirus B19 Humano/imunologia , Transplante de Células-Tronco de Sangue Periférico , Linfócitos T/imunologia , Condicionamento Pré-Transplante , Transplante AutólogoRESUMO
A 6-year-old girl developed shock and multiple organ dysfunction including acute respiratory distress syndrome in association with parvovirus B19 infection. The diagnosis was based on positive antibodies and the detection of parvovirus 19 DNA in serum, bronchial secretions and skin biopsy. It seems likely, but it was not proved, that the parvovirus infection caused acute respiratory distress syndrome.
Assuntos
Eritema Infeccioso/complicações , Insuficiência de Múltiplos Órgãos/virologia , Parvovirus B19 Humano , Síndrome Respiratória Aguda Grave/virologia , Anticorpos Antivirais/sangue , Antivirais/uso terapêutico , Criança , DNA Viral/análise , DNA Viral/isolamento & purificação , Eritema Infeccioso/diagnóstico , Eritema Infeccioso/tratamento farmacológico , Eritema Infeccioso/patologia , Feminino , Humanos , Insuficiência de Múltiplos Órgãos/diagnóstico , Insuficiência de Múltiplos Órgãos/tratamento farmacológico , Insuficiência de Múltiplos Órgãos/patologia , Parvovirus B19 Humano/imunologia , Parvovirus B19 Humano/isolamento & purificação , Reação em Cadeia da Polimerase , Síndrome Respiratória Aguda Grave/diagnóstico , Síndrome Respiratória Aguda Grave/tratamento farmacológico , Síndrome Respiratória Aguda Grave/patologiaRESUMO
Desde su descubrimiento hace menos de 25 años, mucho se ha progresado en el conocimiento de la infección causada por parvovirus B19, reconociéndose actualmente un amplio espectro de manifestaciones y la existencia de infecciones crónicas o persistentes. Este agente debe ser considerado en el diagnóstico diferencial de las variadas entidades clínicas que se describen en esta revisión. En este artículo se discuten también aspectos históricos, virológicos, epidemiológicos, de diagnóstico y manejo terapéutico de las infecciones por parvovirus B19
Assuntos
Humanos , Eritema Infeccioso/etiologia , Infecções por Parvoviridae/etiologia , Parvovirus B19 Humano/patogenicidade , Anemia Aplástica/etiologia , Anemia Aplástica/tratamento farmacológico , Anti-Inflamatórios não Esteroides/uso terapêutico , Eritema Infeccioso/diagnóstico , Eritema Infeccioso/tratamento farmacológico , Eritema Infeccioso/transmissão , Hospedeiro Imunocomprometido , Hidropisia Fetal/tratamento farmacológico , Hidropisia Fetal/etiologia , Imunoglobulinas Intravenosas/uso terapêutico , Infecções por Parvoviridae/diagnóstico , Parvovirus B19 Humano/efeitos dos fármacos , Parvovirus B19 Humano/isolamento & purificaçãoRESUMO
There are striking similarities between human parvovirus B19 (HPV-B19) infection and systemic lupus erythematosus (SLE): both may present with malar rash, fever, arthropathy, myalgia, cytopenia, hypocomplementemia, anti-DNA, and antinuclear antibodies (ANA). Therefore, it is difficult at times to differentiate HPV-B19 infection from SLE presentation or exacerbation. We report 4 cases of HPV-B19 infection mimicking SLE and review 10 other reported cases, all of whom were women. The similarity to a typical SLE presentation was indeed striking: most patients presented with rash, arthropathy, myalgia, fever, and positive ANA. In some cases, HPV-B19 infection seemed to exacerbate SLE rather then resemble it, and differentiation was difficult. Nearly all patients improved within several weeks. However, a few patients had symptoms and laboratory abnormalities lasting more than 6 months. The possibility of HPV-B19 infection should be entertained in patients presenting with SLE-like features.
Assuntos
Eritema Infeccioso/diagnóstico , Lúpus Eritematoso Sistêmico/diagnóstico , Adulto , Anticorpos Antinucleares/análise , Anticorpos Antivirais/análise , Criança , Diagnóstico Diferencial , Eritema Infeccioso/tratamento farmacológico , Eritema Infeccioso/fisiopatologia , Feminino , Humanos , Ibuprofeno/administração & dosagem , Ibuprofeno/uso terapêutico , Lúpus Eritematoso Sistêmico/fisiopatologia , Parvovirus B19 Humano/imunologia , Parvovirus B19 Humano/isolamento & purificação , PrognósticoRESUMO
We reported an adult case of transverse myelitis with erythema infectiosum. A 33-year-old female was admitted to Kyoto University Hospital because of a weakness in the lower extremities and "cloth-wearing" sensation of the trunk and legs. One month before admission, she became febrile and developed a symmetrical erythema on the extremities. At the same time she noticed a slight weakness of the legs and numbness in her fingers and toes, which disappeared next few days. A week later, she again developed a fever, severe weakness of the legs and "cloth-wearing" sensation on the trunk, and erythema appeared on the cheek. Physical examination on admission revealed a weakness and hyperreflexia in the extremities, in particular, knee and ankle jerk, and hypesthesia of the trunk and legs below the level of Th6. Cerebrospinal fluid (CSF) examination revealed 181/mm3 cells (mononuclear cell dominant) and 30 mg/dl protein. Magnetic resonance imaging, CT and electrophysiological studies indicated no abnormalities. IgM antibody against human parvovirus (B19) was detected in the serum and CSF. She was diagnosed as transverse myelitis with parvovirus infection and was medicated with prednisolone 40-60 mg/day, and improved gradually with the residua of a mild weakness of the legs and hypesthesia on the trunk between the level of Th6 and Th10.