Human parvovirus B19-associated early postoperative acquired pure red cell aplasia in simultaneous pancreas-kidney transplantation:A case report

BACKGROUND Acquired pure red cell aplasia(aPRCA)related to human parvovirus B19(HPV B19)is rarely reported in simultaneous pancreas-kidney transplantation(SPKT)recipients;there has yet to be a case report of early postoperative infection.In this current study,we report the case of a Chinese patient who experienced the disease in the early postoperative period.CASE SUMMARY A 63-year-old man,with type 2 diabetes and end-stage renal disease,received a brain dead donor-derived SPKT.Immunosuppression treatment consisted of tacrolimus,prednisone,enteric-coated mycophenolate sodium(EC-MPS),and thymoglobulin combined with methylprednisolone as induction.The hemoglobin(Hb)level declined due to melena at postoperative day(POD)3,erythropoietinresistant anemia persisted,and reticulocytopenia was diagnosed at POD 20.The bone marrow aspirate showed decreased erythropoiesis and the presence of giant pronormoblasts at POD 43.Metagenomic next-generation sequencing(mNGS)of a blood sample identified HPV B19 infection at POD 66.EC-MPS was withdrawn;three cycles of intravenous immunoglobulin(IVIG)infusion therapy were administered;and tacrolimus was switched to cyclosporine.The HPV B19-associated aPRCA resolved completely and did not relapse within the 1-year follow-up period.The diminution in mNGS reads was correlated with Hb and reticulocyte count improvements.CONCLUSION HPV B19-associated aPRCA can occur at an early period after SPKT.An effective therapy regimen includes IVIG infusion and adjustment of the immunosuppressive regimen.Moreover,mNGS can be used for the diagnosis and to reflect disease progression.

Human parvovirus B19-associated hematopathy in HIV disease:need for clinicopathological revisit

Persons living with HIV infection occasionally suffer from anemia due to varying causes.These include the use of zidovudine,malnutrition especially vitamin B12and iron deficiency,opportunistic infections by Mycobacterium tuberculosis,Pneumocystis jiroveci,and direct hematological effects of HIV infection itself within the marrow microenvironment.Persistent Parvovirus B19（B19V）infection is a clinically important and treatable etiology of anemia in HIV-infected persons.

Investigation on the Maternal-Infantile Infection with Human Parvovirus B19

To investigate the maternal-infantile infection with human parvovirus B19, the IgG and IgM antibodies against human parvovirus and the B19-DNA in serum and peripheral blood mononuclear cells (PBMC) of pregnant women as well as the serum IgM antibody against B19 and the B19-DNA in serum and cord blood nucleated cells (CBNC) of newborns were determined by ELISA and nested PCR respectively. It was found that the positive rate of the IgG antibody against human parvovirus B19 in sera of 92 pregnant women was 38.04% (35/92), and that of the IgM antibody in 720 pregnant women was 9.03% (65/720). However, the IgM antibody against human parvovirus B19 was negative in the cord blood sera of 95 newborns. As to the human parvovirus B19 DNA, none of 720 pregnant women and 95 newborns was proved to be positive in their sera. Nevertheless, the positive rate of the parvovirus B19 DNA in PBMC was 3.06% (3/98) in 98 pregnant women and 1.12% (1/89) in CBNC of 89 newborns. It is concluded that the history of infection with human parvovirus B19 exists in certain pregnant women with a small percentage of pregnant women infected with recent or acute infections of B19 virus. The detection rates of the B19 viral DNA in PBMC of pregnant women and CBNC of newborns were higher than those in sera, indicating that the risk for vertical transmission is very low.

Detection of Human Parvovirus B19 Nonstrutural Protein DNA by Nested-Polymerase Chain Reaction in Gravida Serum and Pregnant Tissues

A new nested-polymerase chain reaction （nested-PCR） assay was developed to detect human parvovirus B19 DNA corresponding to the nonstructural protein in clinical specimens in a routine diagnostic laboratory. The sensitivity of this highly specific assay was up to 0. 005 fg of B19 DNA. Parvovirus B19 was identified in sera of 20 pregnant women with abnormal pregnant outcome. Among these 20 cases, intrauterine parvovirus infection did exist in 7 pregnant women because parvovirus B19 DNA was detected in the pregnant tissues of them such as placenta tissues, chorionic villi, amniotic fluid, fetal spleen, liver and abdominal fluids.

Focal seizure associated with human parvovirus B19 infection in a non-encephalopathic child

Background:The incidence of acute symptomatic(at the time of documented brain insult)seizures and single unprovoked seizures are 29-39 and 23-61 per 100000 per year,respectively.After stabilization of the patient,fi nding the etiology of the seizure is of paramount importance.A careful history and physical examination may allow a diagnosis without need for further evaluation.Methods:In the literature,severe central nervous system involvement has been reported from human parvovirus B19 infection.We reported a previously healthy 7-year-old girl who presented after an episode of focal seizure.She was afebrile and didn't have any focal neurological abnormalities.She had erythematous malar rash along with reticulating pattern of rash over her both upper extremities.Results:Parvovirus infection was suspected due to the characteristic erythematous malar rash.Serum human parvovirus B19 DNA polymerase chain reaction was positive which was consistent with acute parvovirus infection.Further confirmation of current infection was done with Sandwich enzyme immunoassays showing positive anti-B19 IgM Index(>1.1).IgG index was equivocal(0.9-1.1).Conclusions:We report an extremely rare presentation of non-febrile seizure from acute parvovirus infection in a child without encephalopathy who had an excellent recovery.Timely diagnosis can provide counselling regarding future seizure recurrence risk,curtail expenditure from expensive diagnostic work up and provide additional recommendations about potential risks to a pregnant caregiver.