Cynomolgus monkeys (Macaca fascicularis) experimentally infected with B19V and hepatitis A virus: no evidence of the co-infection as a cause of acute liver failure

This study was conducted to analyse the course and the outcome of the liver disease in the co-infected animals in order to evaluate a possible synergic effect of human parvovirus B19 (B19V) and hepatitis A virus (HAV) co-infection. Nine adult cynomolgus monkeys were inoculated with serum obtained from a fatal case of B19V infection and/or a faecal suspension of acute HAV. The presence of specific antibodies to HAV and B19V, liver enzyme levels, viraemia, haematological changes, and necroinflammatory liver lesions were used for monitoring the infections. Seroconversion was confirmed in all infected groups. A similar pattern of B19V infection to human disease was observed, which was characterised by high and persistent viraemia in association with reticulocytopenia and mild to moderate anaemia during the period of investigation (59 days). Additionally, the intranuclear inclusion bodies were observed in pro-erythroblast cell from an infected cynomolgus and B19V Ag in hepatocytes. The erythroid hypoplasia and decrease in lymphocyte counts were more evident in the co-infected group. The present results demonstrated, for the first time, the susceptibility of cynomolgus to B19V infection, but it did not show a worsening of liver histopathology in the co-infected group.

HCMV gB genotypes in cervical secretion and placenta tissues in the state of Espírito Santo, Southeastearn Brazil

Human cytomegalovirus (HCMV) displays genetic variability in several regions, supposed to be related with strain-specific tissue tropism and immunopathogenesis. Based on sequence variation in the UL55 gene that encodes gB glycoprotein, HCMV strains can be assigned to one of four genotypes. Previous studies have addressed gB genotyping mostly by investigating strains derived from immunosuppressed patients, sometimes without previous knowledge about genotype distribution in a geographic area. The present study verified the distribution of HCMV gB genotypes of strains obtained from immunocompetent women at Vitória City, Espírito Santo State, Southeastern, Brazil. The HCMV genome was extracted from their cervical secretion, fetal and maternal placenta tissues (chorionic villous and decidua) from abortion cases and from white blood cells (WBCs). HCMV genotyping was performed by restriction fragment length polymorphism analyses of amplified product from the high variability site of the UL55 gene. All four genotypes were observed in both cervical secretion and placenta, whereas in WBCs a single gB1 genotype was detected. HCMV gB1 and gB2 genotypes were detected, respectively, in nine and in six of the 23 studied samples, while gB3 and gB4 were each found in four separate samples of the total. The differences in genotype frequency were not considered statistically significant. No mixed genotype infection was observed. The results indicated that the four gB HCMV genotypes had no particular tropism for placenta tissues and that all genotypes circulated within immunocompetent women at the time and in the region of study.

O citomegalovírus humano (HCMV) apresenta variabilidade em diversas regiões do genoma, supostamente relacionada ao tropismo tecidual e imunopatogênese viral. Baseando-se na variação de seqüência do gene UL55 que codifica a glicoproteína gB, o HCMV pode ser classificado em um dos quatro genótipos. Estudos prévios têm investigado a associação destes genótipos a partir de cepas obtidas de pacientes imunossuprimidos. O presente estudo determinou os genótipos gB de cepas de HCMV obtidas de mulheres imunocompetentes em Vitória, Espírito Santo, Sudeste do Brasil. O genoma do HCMV foi extraído de secreção cervical, tecidos placentários fetais e maternos (vilosidade coriônica e decídua) obtidos de casos de aborto e de leucócitos do sangue periférico. A genotipagem foi realizada através da análise de polimorfismo de fragmentos de restrição do produto amplificado da região de alta variabilidade do gene UL55. Todos os quatro genótipos foram detectados na secreção cervical e na placenta, enquanto que somente o genótipo gB1 foi detectado em leucócitos. Genótipos gB1 e gB2 foram detectados em nove e seis das 23 cepas estudadas, respectivamente, enquanto gB3 e gB4 foram encontrados cada um em quatro casos. A diferença na freqüência de genótipos não foi estatisticamente significante. Infecção mista não foi detectada. Estes resultados indicam que os quarto genótipos de HCMV apresentam tropismo para os tecidos placentários e que todos eles circularam nas mulheres imunocompetentes no período e região geográfica do estudo.

Prevalência de anticorpos IgG antiparvovírus B19 em gestantes durante o atendimento pré-natal e casos de hidropisia fetal não imune atribuídos ao parvovírus B19, na Cidade do Rio de Janeiro / Anti-parvovirus B19 IgG antibody prevalence in pregnant women during antenatal follow-up and cases of non-immune hydropsis fetalis due to parvovirus B19, in the City of Rio de Janeiro

Com o objetivo de medir a prevalência de anticorpos IgG contra o parvovírus B19 em gestantes com até 24 semanas de idade gestacional e detectar a ocorrência de casos de hidropisia fetal não-imune atribuídos a esse vírus, coletamos 249 amostras de soro em uma maternidade de referência na cidade do Rio de Janeiro, entre junho de 2003 e março de 2005. As gestantes foram acompanhadas até o termo da gestação, sendo detectados 17 casos de hidropisia fetal. Quatro casos foram atribuídos ao parvovírus B19 e dois destes ocorreram em gestantes residentes na zona oeste da cidade, em fevereiro de 2005. Resultados positivos para anticorpos IgG antiparvovírus B19 foram encontrados em 172 (71,6 por cento) gestantes (IC 95 por cento 65,5-77,7 por cento), sendo esta prevalência de anticorpos comparável à encontrada em outras cidades brasileiras. A única variável associada com aquisição prévia de anticorpos IgG foi número de gestações anteriores maior que um(p= 0,02, IC 95 por cento 0,36-0,94).

With the aim of measuring the prevalence of anti-parvovirus B19 IgG antibodies during pregnancy up to 24 weeks of gestation and detecting cases of nonimmune hydrops fetalis, 249 sera from pregnant women attending a reference hospital in Rio de Janeiro city, from June 2003 to November 2004 were collected. They were followed-up until the end of pregnancy, with 17 cases of fetal hydrops detected. Four cases were caused by parvovirus B19 and two of them occurred in pregnant women living in the western zone of the city, during February 2005. Anti-parvovirus B19 IgG antibodies were found in 172 (71.6 percent) pregnant women (CI 95 percent 65.5 percent-77.7 percent); this antibody prevalence is similar to results found for others Brazilian cities. The only variable associated with previous acquisition of IgG antibodies to parvovirus B19 was number of pregnancies greater than one (p= 0.02, CI 95 percent 0.36-0.94).

Erythrovirus B19 infection in acquired immunodeficiency syndrome: screening by histopathology, immunohistochemistry, and in situ hybridization

Erythrovirus B19 infects erythrocytic progenitors, transiently interrupting erythropoiesis. In AIDS patients it causes chronic anemia amenable to treatment. We looked for evidences of B19 infection in stored bone marrow material from patients with acquired immunodeficiency syndrome. Histological sections were made from stored paraffin blocks from 33 autopsies (39 blocks) and 35 biopsies (45 blocks, 30 patients) performed from 1988 to 2002. They were examined after hematoxylin-eosin (HE) staining, immunohistochemical (IHC), and in situ hybridization. HE revealed intra-nuclear inclusion bodies ("lantern cells") suggesting B19 infection in 19 sections corresponding to 19 of 63 patients examined with this test. Seven of 78 sections subjected to immunohistochemistry were positive, corresponding to 7 of 58 patients examined with this test. Fourteen sections corresponding to 13 of the 20 HE and/or IHC positive patients were subjected to in situ hybridization, with six positives results. Among the 13 patients subjected to the three techniques, only one gave unequivocal positive results in all and was considered a true positive. The frequency of B19 infection (1/63 patients) in the material examined can be deemed low.

False positive reaction due to endogenous biotin activity in glandular epithelium of decidua

Sondas marcadas com biotina foram utilizadas neste trabalho para deteccão de infeccão viral por hibridizacão in situ em tecidos fixados com formalina e embebidos em parafina de 11 casos obtidos de abortamento. Sondas para citomegalovírus humano (HCMV), parvovírus B19 humano (B19) e adenovírus humano tipo 2 (HAd2), foram marcadas com biotina-11-dUTP através da reacão de nick-translation. Estreptavidina conjugada com fosfatase alcalina (SAP) seguida por solucão de 4-nitro-azul de tetrazolio/5-bromo-4-cloro-3-indolil fosfato (NBT/BCIP) foram utilizadas para deteccão da biotina após a reacão de hibridizacão. Reacão positiva foi observada no núcleo de células do epitélio glandular da decídua tanto no controle positivo quanto no negativo em tecidos de primeiro e segundo trimestre gestacional. Esta reacão não foi inibida com solucão bloqueadora da atividade endógena de fosfatase alcalina e persistiu mesmo com a omissão das sondas. O uso de controles negativos permitiu revelar atividade endógena de biotina nuclear em epitélio glandular da decídua, responsável por reacões falso positivas em sistemas de deteccão estreptavidina-biotina (StrepABC). Os resultados obtidos neste estudo fortemente recomendam que a deteccão de ADN por hibridizacão in situ em endométrio gestacional seja feita com outro sistema de deteccão que não o StrepABC.

Hidropisia fetal: Análise de 80 casos / Fetal hydrops: Analysis of 80 cases

OBJETIVO: descrever a etiologia, evolução e prevalência de hidropisia fetal em coorte de gestantes em 10 anos de acompanhamento (1992 a 2002), em uma maternidade terciária. MÉTODOS: estudo retrospectivo foi realizado em pacientes referidas para a maternidade do Instituto Fernandes Figueira com o diagnóstico de hidropisia fetal, detectado pelo exame de ultra-sonografia, durante o período compreendido entre 1992 e 2002. Os casos foram selecionados quanto à etiologia (imune ou não-imune), sendo comparados quanto à evolução, procedimentos invasivos realizados e sobrevivência. A análise das variáveis foi realizada por meio do programa Epi-Info 6.0, sendo considerado valor de significância estatística um valor de p<0,05. RESULTADOS: durante o período de estudo, 80 gestantes foram atendidas com diagnóstico inicial de hidropisia fetal. A freqüência de hidropisia nesta população foi de 1 para 157 nascidos vivos. Isoimunização Rh (grupo imune - GI) foi diagnosticada em 13 casos (16,2 por cento), restando portanto 67 casos (83,8 por cento) considerados como devidos a causas não imunes (grupo não imune - GNI). As causas mais comuns de hidropisia fetal não imune são: idiopáticas (40,2 por cento), genéticas (20,8 por cento), infecciosas (20,7 por cento) e cardiopatia fetal (7,4 por cento). Foi encontrada diferença em relação à idade materna do grupo imune (média = 32,8 anos) quando comparada com o grupo não imune (média=28,7) (p=0,03), porém a idade gestacional ao nascimento foi similar em ambos os grupo, (média de 33,6 semanas no grupo imune e de 33,1 semanas no grupo não imune (p=0,66). Amniocentese e transfusão sanguínea in utero foram realizadas com maior freqüência no grupo imune (p<0,001) e a letalidade perinatal encontrada foi de 53,8 por cento no grupo imune e 68,6 por cento no grupo não imune (p=0,47). A pesquisa complementar de anticorpos IgG anti-parvovírus B19 foi realizada em 41 dos 67 casos de hidropisia fetal não imune e somente 16 apresentaram resultado pos...

Reactogenicity of yellow fever vaccines in a randomized, placebo-controlled trial

OBJETIVO: Comparar a reatogenicidade de três vacinas contra a febre amarela (FA) das sub-cepas WHO-17D e 17DD (diferentes lotes-semente), e placebo. MÉTODOS: Foram recrutados 1.087 adultos elegíveis para vacinação contra FA no Rio de Janeiro, RJ, Brasil. Vacinas produzidas por Bio-Manguinhos, Fiocruz (Rio de Janeiro, RJ) foram administradas ("dia zero") seguindo procedimentos adaptados para alocação randômica em blocos e "cega" para o tipo de vacina. Eventos adversos pós-vacinação foram registrados em questionários e diários preenchidos pelos participantes. Enzimas hepáticas foram medidas nos dias 0, 4-20 e 30 do estudo. A viremia foi medida nos dias 4-20. A resposta imune foi verificada em testes sorológicos nos dias 0 e 30. RESULTADOS: Os participantes eram predominantemente homens jovens. A taxa de soroconversão foi superior a 98% no grupo soronegativo antes da vacinação. Comparado ao placebo, a diferença de risco de eventos adversos locais variou de 0,9% a 2,5%, e de 3,5% a 7,4% para eventos adversos sistêmicos nos grupos vacinados. A diferença de risco desses eventos com assistência médica e/ou falta ao trabalho variou de 2,0% a 4,5%. Viremia foi detectada em 3% a 6% dos vacinados até 10 dias após a vacinação. As variações nos níveis de enzimas hepáticas pós-vacinação foram semelhantes nos grupos vacinados e placebo. CONCLUSÕES: Foi demonstrada pela primeira vez a semelhança do perfil de reatogenicidade das vacinas contra FA das cepas 17D e 17DD, comparados entre si e com placebo. As variações das enzimas hepáticas constituem evidência contra o potencial de viscerotropismo do vírus vacinal.

RS virus diagnosis: comparison of isolation, immunofluorescence and enzyme immunoassay

Duas técnicas para diagnóstico rápido, imunofluorescência (IF) e ensaio imunoenzimático (EIE), foram comparadas com isolamento viral em cultura de tecidos para a detecçäo do vírus respiratório sincicial (VRS) em secreçöes de nasofaringe. Os espécimens foram obtidos de crianças abaixo de cinco anos de idade, com doença respiratória aguda, durante um período de seis meses, de janeiro a junho de 1982. Dos 471 espécimens examinados, 54 (11,5%) foram positivos por isolamento viral e 180 (38,2%) foram positivos por imunofluorescência. A contaminaçäo bacteriana das culturas de tecidos inoculadas prejudicou o isolamento viral em muitas amostras. Espécimens de 216 crianças foram testados para comparar EIE e IF. Destes, 60 (27,0%) foram positivos pelo ensaio imunoenzimático e 121 (56,0%) foram positivos por imunofluorescência. Nossos resultados sugerem que o ensaio imunoenzimático embora altamente específico é pouco sensível. Isto pode ter ocorrido pois quando estes testes foram feitos as secreçöes de nasofaringe originais estavam consideravelmente diluídas e continham mais fragmentos de muco do que as suspensöes celulares usadas para imunofluorescência. Das três técnicas a imunofluorescência forneceu os melhores resultados, embora o ensaio imunoenzimático possa ser útil onde a imunofluorescência näo for realizável

Aplastic crisis caused by parvovirus B19 in an adult patient with sickle-cell disease / Crise aplástica por parvovírus B19 em um paciente adulto com doença falciforme

Descreve-se um caso de crise aplástica devida ao parvovírus B19 num paciente adulto, manifestando-se por palidez, cansaço, lipotímias e dispnéia. A ausência de reticulócitos chamou a atençäo para o diagnóstico. Detectaram-se IgM e IgG anti-B19. Reticulocitopenia em pacientes com anemia hemolítica hereditária sugere infecçäo por B19

The prevalence of antibody to human parvovirus B19 in Rio de Janeiro, Brasil

Amostras de soros coletadas da populaçäo do Rio de Janeiro durante os anos de 1985/1986 foram examinadas para a presença de anticorpos da classe IgG contra o parvovirus humano B19. Nenhuma diferença foi encontrada com relaçäo ao sexo. A prevalência de anticorpos aumenta a partir de 35% em crianças menores que 5 anos de idade até 80% nos indivíduos na faixa etária entre 11 e 15 anos. A prevalência de anticorpos seguiu aumentando até mais de 90% entre os indivíduos acima de 50 anos de idade

Two family members with a syndrome of headache and rash caused by human parvovirus B19

Human parvovirus B19 infection can cause erythema infectiosum (EI) and several other clinical presentations. Central nervous system (CNS) involvement is rare, and only a few reports of encephalitis and aseptic meningitis have been published. Here, we describe 2 cases of B19 infection in a family presenting different clinical features. A 30 years old female with a 7-day history of headache, malaise, myalgias, joint pains, and rash was seen. Physical examination revealed a maculopapular rash on the patient's body, and arthritis of the hands. She completely recovered in 1 week. Two days before, her 6 year old son had been admitted to a clinic with a 1-day history of fever, headache, abdominal pain and vomiting. On admission, he was alert, and physical examination revealed neck stiffness, Kerning and Brudzinski signs, and a petechial rash on his trunk and extremities. Cerebrospinal fluid analysis was normal. He completely recovered in 5 days. Acute and convalescent sera of both patients were positive for specific IgM antibody to B19. Human parvovirus B19 should be considered in the differential diagnosis of aseptic meningitis, particularly during outbreaks of erythema infectiosum. The disease may mimic meningococcemia and bacterial meningitis.

Papular-purpuric "gloves and socks" syndrome due to parvovirus B19: report of a case with unusual features

We present a case of papular-purpuric "gloves and socks" syndrome (PPGSS) in an adult male with acute parvovirus B19 infection. The patient displayed the classical features of fever, oral lesions, and purpura on hands and feet, but the purpuric lesions on the feet evolved to superficial skin necrosis, a feature not previously described in this syndrome. We believe this is the first reported case of PPGSS occurring in Brazil

Anti-VP1 and anti-VP2 antibodies detected by immunofluorescence assays in patients with acute human parvovirus B19 infection

Acute human parvovirus B19 infection is followed by an antibody response to the structural proteins of the viral capsid (VP1 and VP2). We used 80 sera collected from 58 erythema infectiosum and 6 transient aplastic crisis patients to test IgM and IgG antibodies against these two proteins in an immunofluorescence assay (IFA) using Sf9 cells infected with recombinant baculovirus expressing either VP1 or VP2 antigen. Although less sensitive than IgM capture enzyme immunoassay using native antigen (MACEIA), we could detect anti-VP1 or anti-VP2 IgM antibodies by IFA in 49 patients with acute infection (76.6 percent). Detection of IgG anti-VP1 and anti-VP2 by IFA, however, was as sensitive as IgG detection by indirect enzyme immunoassay. By applying IgG avidity IFA to sera of the 15 IgM IFA negative patients we were able to confirm acute infection in further 12 cases by IFA. Overall, acute infection was confirmed by IFA in 61 (95.3 percent) of the 64 patients

Viremic blood donor found by a rapid screening method in a season of high human parvovirus B19 activity in Niterói, Rio de Janeiro, Brazil

Erythrovirus B19 infection is usually benign but may have serious consequences in patients with hemolytic anemia (transient aplastic crisis), immunodeficiency (in whom persistent infection can lead to chronic bone marrow failure with anemia), or who are in the first or second trimester of gestation (spontaneous abortion, hydrops fetalis, and fetal death). Being non-enveloped, B19 resists most inactivation methods and can be transmitted by transfusion. B19 is difficult to cultivate and native virus is usually obtained from viremic blood. As specific antibodies may be absent, and there is no reliable immunological method for antigen detection, hybridization or polymerase chain reaction are needed for detecting viremia. A rapid method, gel hemagglutination (Diamed ID-Parvovirus B19 Antigen Test), can disclose highly viremic donations, whose elimination lessens the viral burden in pooled blood products and may even render them non-infectious. In order to obtain native antigen and to determine the frequency of viremic donors, we applied this test to blood donors in a period of high viral activity in our community. Positive or indeterminate results were re-tested by dot-blot hybridization. We tested 472 donors in 1998 and 831 ones in 1999. One viremic donor was found in 1999. We suggest that in periods of high community viral activity the gel hemagglutination test may be useful in avoiding highly viremic blood being added to plasma pools or directly transfused to patients under risk.

Genetic and antigenic analysis of adenovirus type 3 strains showing intermediate behavior in standard seroneutralization test

During an epidemiological survey of acute respiratory infection in Rio de Janeiro, among 208 adenovirus isolates, we found two strains that we were not able, by a standard neutralization procedure, to distinguish between type 3 or 7. However, DNA restriction pattern for the two strains with different enzymes were analysed and showed a typical Ad3h profile. Using a cross-neutralization test in which both Ad3p and Ad7p antisera were used in different concentration against 100 TCID 50 of each adenovirus standard and both isolates, we were able to confirm that the two isolates belong to serotype 3. An hemagglutination inhibition test also corroborated the identification of both strains as adenovirus type 3. Comparing Ad3h and Ad3p genome, we observed 16 different restriction enzyme sites, three of which were located in genomic regions encoding polypeptides involved in neutralization sites.

Serological findings during a measles outbreak occurring in a population with high vaccine coverage

No periodo de marco/1991 a abril/1992, foram escolhidas 112 amostras sanguineas para a deteccao de anticorpos da classe IgM de casos de sarampo notificados a Divisao de Epidemiologia da Fundacao Municipal de Saude de Niteroi, Estado do Rio de Janeiro. A positividade ultrapassou 90 por cento para os especimens escolhidos entre o 5º e o 29º dia apos o inicio da doenca. A partir do 30º dia foi observado um declinio na deteccao de IgM, embora positividade tenha sido constatada ate noventa dias do inicio dos sintomas. Historia de vacinacao previa estava presente em 48,9 por cento destes pacientes. Dos 22 casos restantes, em 5 a infeccao era devido a outros agentes (rubeola: 4 casos, dengue: 1 caso). Estes resultados demonstram que a sensibilidade do teste empregado para confirmacao de casos suspeitos de sarampo e elevada mesmo em pacientes vacinados.

Clinical presentation of parvovirus B19 infection in HIV-infected patients with and without AIDS

Human parvovirus B19 replicates in erythrocyte precursors. Usually, there are no apparent hematological manifestations. However, in individuals with high erythrocyte turnover, as in patients with sickle-cell disease and in the fetus, the infection may lead to severe transient aplasia and hydrops fetalis, respectively. In AIDS patients, persistent infection may result in chronic anemia. By contrast, in HIV-positive patients without AIDS the infection evolves as a mild exanthematous disease. Two clinical descriptions exemplify these forms of presentation. In the first, an AIDS patient presented with bone marrow failure that responded to immunoglobulin. In the second, an HIV-positive patient without AIDS had a morbilliform rash, and needed no treatment. Knowing that an AIDS patient has chronic B19 anemia lessens concern about drug anemia; protects the patient from invasive diagnostic maneuvers; and prevents the patient from disseminating the infection. In AIDS patients with pure red cell aplasia, a search for parvovirus B19 DNA in the serum or in the bone marrow is warranted

Clinical and epidemiological aspects of human parvovirus B19 infection in an urban area in Brazil (Niterói city area, State of Rio de Janeiro, Brazil)

This study was designed to analyse the clinical and epidemiological data from human parvovirus B19 cases in a six-year study of rash diseases conduct in an urban area in Brazil (Niterói city area, State of Rio de Janeiro). A total of 673 patients with acute rash diseases were seen at two primary health care units and at a general hospital. A clotted blood sample was collected from all subjects at the time of consultation. Forty-nine per cent (330 cases) of the patients were negative for dengue, rubella and measles IgM or for low avidity IgG to HHV-6. Of these 330, 105 (31.8 percent) were identified as IgM positive to parvovirus B19 by using an antibody capture EIA. During the study period, three distinct peaks of parvovirus infection were detected, suggesting that the disease appears to cycle in approximately 4-5 years. B19 infection was characterized by variable combinations of fever, flu-like symptoms, arthropathy, and gastrointestinal symptoms. Frequency of fever and arthropathy was substantially higher in adults, 75 percent [chi2 (1 D.F.) = 11.39, p = 0.0007] and 62.5 percent [chi2 (1 D.F.) = 29.89, p = 0.0000], respectively. "Slapped-cheek" appearance and reticular or lace-like rash were seen in only 30.1 percent of the children. No adult presented this typical rash. The lack of the typical rash pattern in a large proportion of parvovirus B19 and the similarity of clinical manifestations to other rash diseases, specially to rubella, highlight the difficulty of diagnosing B19 infection on clinical grounds alone

Human parvovirus B19 infections among exanthematic diseases notified as measles

A total of 1397 sera collected from 1095 cases of exanthematic disease notified as measles in ES and RJ states during July 1992 to December 1994 were investigated. These sera were first tested for measles and rubella specific IgM. When they proved negative, they were tested for B19 specific IgM by an enzyme immunoassay. B19 infection was confirmed in 27 (2.5 per cent) of these cases. Sera from 194 negative cases for measles and rubella IgM received from other Brazilian states were also investigated and B19 infection was confirmed for 11 of them. Sera from these 38 IgM positive cases for B19, were tested for anti-B19 IgG by an enzyme immunoassay and for B19 DNA by dot blot hybridization. Anti-B19 IgG antibodies were detected in most of the acute sera. B19 DNA was detected in the acute serum of one patient that had been splenectomized before. As the exanthem caused by human parvovirus infection may be clinically diagnosed as rubella, it could be important to diagnose B19 infection in Brazil since it is becoming prevalent as the cause of rash in countries where rubella is controlled by vaccination.

Human parvovirus B19 infection: clinical and epidemiological study of 24 cases

No periodo de maio/94 a novembro/95, 24 casos de parvovirose humana foram atendidos no Servico de Doencas Infecciosas e Parasitarias do Hospital Universitario Antonio Pedro, Niteroi - RJ. Amostras sanguineas para a deteccao de IgM (ensaio imunoenzimatico por captura) foram positivas do primeiro ao vigesimo setimo dia apos o inicio do exantema. Os sinais e sintomas classicos do eritema infeccioso foram observados em 8 (33,3 por cento) dos casos e apenas em criancas. Oito pacientes (6 adultos e 2 criancas) apresentaram poliartropatia simetrica, vista mais frequentemente em mulheres. Os resultados deste trabalho demonstram que o diagnostico da parvovirose humana e dificil quando a doenca nao apresenta quadro clinico classico e, devido ao frequente envolvimento das articulacoes, tal infeccao deve ser considerada no diagnostico diferencial da artrite reumatoide na sua fase inicial