Diagnosing human parvovirus B19 infection: Guidelines for test selection

doi:10.1054/modi.2001.28632

Molecular Diagnosis

Volume 6, Issue 4, December 2001, Pages 307-312

https://doi.org/10.1054/modi.2001.28632 Get rights and content

Abstract

Human parvovirus B19 is the cause of a common childhood disease that usually has a mild and self-limited course. Complete viral replication and subsequent cell lysis are limited to early erythroid precursor cells expressing the globoside receptor. Individuals with shortened red blood cell half-lives and immunocompromised or immunosuppressed patients, as well as pregnant women and developing fetuses, are at risk for severe anemia and/or persistent infection from human parvovirus B19. Selection of the diagnostic test(s) to use to detect parvovirus B19 is patient dependent. Serological testing is most appropriate in immunocompetent individuals, including children and pregnant women, who have symptoms consistent with parvovirus B19 infection or a history of recent exposure. Conversely, a molecular amplification assay should be chosen to detect parvovirus B19 DNA in individuals lacking an adequate antibody-mediated immune response. In summary, it is critical that clinicians are educated about the most appropriate diagnostic test to detect parvovirus B19 infection in their patients because selecting an inappropriate or inaccurate test for parvovirus B19 can lead to misinformation and/or misdiagnosis.

References (0)

Cited by (29)

Evaluation of Biotrin, Serion and Euroimmun commercial assays for the detection of parvovirus B19-specific IgM and IgG antibodies
2022, Diagnostic Microbiology and Infectious Disease
Citation Excerpt :
Moreover, PCR methodology can assist in identifying cases of persistent infections in immunodeficient patients. In many small laboratories that cannot rely on large and automated instruments like the Liaison (DiaSorin) used with the dedicated Biotrin parvovirus B19 serological assays, the nonautomatic ELISA version of Biotrin IgM and IgG assays (Biotrin; Dublin, Ireland), was used as a method of choice, and has been practically considered to be the gold standard for detection of acute (IgM assay) and previous (IgG assay) infection [4–6]. As these kits have recently been discontinued in Europe and Israel, validated replacements are urgently needed.
Diagnosis of parvovirus B19 (B19) infection in small-medium size clinical laboratories is most often done by nonautomated enzyme immunoassays (EIAs). Using 195 specimens we compared the analytical performance of Biotrin (Dublin, Ireland), Euroimmun (Lubeck, Germany), and Serion (Würzburg, Germany) EIAs. Sensitivity, specificity, and concordance to Biotrin assay were calculated. Overall complete agreement in the IgG and IgM results was 88.7% (173/195) and 75.9% (148/195) samples, respectively. When equivocal results were considered positive, Serion and Euroimmun highly agreed (>93.8%) with Biotrin in the IgG serology. Serion had better IgM sensitivity and specificity than Euroimmun when compared to Biotrin, although more Serion IgM equivocal results needed reflex testing. Clinical interpretation by all three assays was identical in 83% of the samples. We concluded that overall the performance of these assays was similar and both Serion and Euroimmun could be a suitable replacement for the Biotrin.
Kidney Diseases Associated With Parvovirus B19, Hanta, Ebola, and Dengue Virus Infection: A Brief Review
2019, Advances in Chronic Kidney Disease
Citation Excerpt :
Serologic testing for virus-specific antibodies against capsid antigens using enzyme-linked immunosorbent assay (ELISA) testing is the most common method of diagnosis in immunocompetent patients. Identification of viral DNA by PCR is the preferred method for diagnosis in immunocompromised patients.17 Nonrenal manifestations include hydrops fetalis (in utero infection)18; erythema infectiosum (“fifth disease”), which is characterized by fever, “slapped cheek” facies, and maculopapular rash in children19; arthropathies in adults20; pure red cell aplasia21; and transient aplastic crisis.22
Viral infection-associated kidney diseases are an emerging public health issue in both developing and developed countries. Many new viruses have emerged with new paradigms of kidney injury, either directly through their cytopathic effect or indirectly through immune-mediated glomerulopathy, tubulointerstitial disease, and acute kidney injury as part of multiorgan failure. Herein, we will discuss Parvovirus, which causes glomerulopathy, and Hanta, Ebola, and Dengue viruses, which cause viral hemorrhagic fever and acute kidney injury. Clinical manifestations also depend on extrarenal organ systems involved. Diagnosis of these viral infections is mainly based on a high index of suspicion, serologic testing, and isolation of viral DNA/RNA. Management is largely conservative, as specific antiviral agents are unavailable.
Parvovirus B19 infection after kidney transplantation
2012, Nephrologie et Therapeutique
La prévalence de l’infection à parvovirus B19 après transplantation rénale est estimée entre 2 et 30 %. Il peut s’agir d’une primo-infection ou de la réactivation d’une infection latente en dialyse. La contamination se fait habituellement par voie respiratoire mais l’infection peut aussi être transmise par le donneur ou par transfusion de produits sanguins infectés. Les co-infections à HHV-6 et à CMV sont fréquentes. Les symptômes les plus fréquents sont hématologiques avec une anémie profonde, parfois complétée d’une pancytopénie. Un syndrome d’activation macrophagique peut aussi survenir. Sur le plan néphrologique, l’infection à parvovirus B19 se complique d’une dysfonction du greffon rénal dans 10 % des cas. Des microangiopathies et des formes de glomérulopathies collapsantes ont été rapportées au cours d’une infection à parvovirus B19 mais le lien causal avec le virus n’est pas clairement établi. Les autres complications sont plus rares : hépatite, encéphalite, myocardite. Le diagnostic repose sur le statut sérologique pré et post-transplantation alors que le suivi chez le patient immunodéprimé repose sur la mesure de la charge virale par PCR dans le sang. Le traitement associe une baisse de l’immunosuppression et des immunoglobulines intraveineuses. L’infection est chronique avec des rechutes dans 30 % des cas.
Prevalence for human parvovirus B19 infection is estimated to be between 2% and 30% in renal transplant recipients. In post-transplant settings, parvovirus B19 infection may occur either as a primary infection or a reactivation. Parvovirus transmission most commonly occurs through respiratory tract but may also result from graft or blood packs contamination. Co-infections with HHV-6 and CMV viruses are frequent. The hallmark symptom is anemia, more rarely pancytopenia and hemophagocytic syndrome. In respect to renal involvement, parvovirus B19 infection has been associated with graft dysfunction in 10% of cases. Both thrombotic microangiopathies and collapsing glomerulopathies have been reported concomitantly with parvovirus B19 infection but the causal link remains unclear. Other complications are seldomly reported, including hepatitis, encephalitis, and myocarditis. Diagnosis is based on pre and post-transplant serological status. In addition, the management of parvovirus B19 infection in immunocompromised patients requires quantitative assessment of blood viral load by PCR. The treatment relies primarily on reduction of immunosuppression combined with intravenous immunoglobulin infusions. Relapses occur in 30% of cases.
Detection of the human Parvovirus B19 in nonimmune hydrops fetalis using immunohistochemistry and nested-PCR in formalin-fixed and paraffin-embedded placenta and fetal tissues
2009, Pathologie Biologie
The aim of the present study was to determine whether there is an association between Parvovirus B19 infection and hydrops fetalis setting in fetus and neonate. Twenty-nine samples were analyzed by three methods. Each sample was histologically examined for viral nuclear inclusions in fetal organs and placenta, then immunohistochemical study using Parvovirus B19 antibody that recognized the VP2 protein of the Parvovirus B19 capsid was done in tissue embedded in paraffin (lungs, liver, thymus, kidneys, heart and placenta). Nested-PCR analysis was done after DNA extraction from paraffin blocks and using specific primers of the Parvovirus B19 VP1 gene. Apparent causes of hydrops were eliminated such as metabolic diseases, cardiac failure or malformation. The standard histological study objectivates viral inclusion in one case (lung tissue). However, the immunohistochemical study was negative in all cases. Nested-PCR demonstrates the presence of the viral DNA in five cases. Our study demonstrates that the implication of Parvovirus B19 in hydrops fetalis must be affirmed by the use of more than one method. Nested-PCR is the most sensitive method in our study and can be easily used for the detection of Parvovirus B19 in formalin-fixed paraffin-embedded tissues.
L’objectif de notre étude est de déterminer s’il y a une association entre l’infection virale au Parvovirus B19 et l’anasarque fœtale non immunologique chez les fœtus et les nouveau-nés. Vingt-neuf cas ont été analysés par trois techniques. L’examination histologique a été réalisée pour chaque cas à la recherche des inclusions virales nucléaires dans les tissus fœtaux et placentaires. L’étude immunohistochimique a été faite sur tissus inclus en paraffine (poumons, foie, thymus, reins, cœur et placenta), par l’anticorps anti-Parvovirus B19 dirigé contre la protéine VP2 de la capside du Parvovirus B19. La PCR-nichée a été réalisée après l’extraction de l’ADN à partir de tissus inclus en paraffine, en utilisant des amorces spécifiques du gène VP1 du Parvovirus B19. Les causes apparentes de l’anasarque fœtale ont été éliminées, à savoir les maladies métaboliques, l’insuffisance ou les malformations cardiaques. L’étude histologique standard a révélé l’inclusion virale dans un cas (au niveau du poumon). En revanche, l’étude immunohistochimique était négative dans tous les cas. La PCR-nichée a montré la présence de l’ADN viral dans cinq cas. Notre étude montre que l’implication du Parvovirus B19 dans l’anasarque fœtale non immunologique doit être confirmée par l’utilisation de plusieurs méthodes. La PCR-nichée est la technique la plus sensible dans notre étude et peut être appliquée facilement pour la détection du Parvovirus B19 dans des tissus fixés au formol et inclus en paraffine.
Commonly Encountered Medical Problems in Pregnancy
2008, Family Medicine Obstetrics
Parvovirus B19 infection in pregnancy
2006, Journal of Clinical Virology
Parvovirus B19 is a small single-stranded DNA virus and a potent inhibitor of erythropoiesis, due to its cytotoxicity to erythroid progenitor cells. Infection with parvovirus B19 during pregnancy can cause several serious complications in the fetus, such as fetal anemia, neurological anomalies, hydrops fetalis, and fetal death. Early diagnosis and treatment of intrauterine parvovirus B19 infection is essential in preventing these fetal complications. Testing maternal serum for IgM antibodies against parvovirus B19 and DNA detection by PCR can confirm maternal infection. If maternal infection has occurred, ultrasound investigation of the fetus and measurement of the peak systolic flow velocity of the middle cerebral artery are sensitive non-invasive procedures to diagnose fetal anemia and hydrops. Intrauterine transfusion is currently the only effective treatment to alleviate fetal anemia, but if the fetus is (near) term, induction of delivery should be considered. Most maternal infections with parvovirus B19 occur through contact with infected children at home. Individual counseling of susceptible pregnant women will reduce unnecessary fetal deaths.

View all citing articles on Scopus

View full text

Special Section: Infectious DiseasesDiagnosing human parvovirus B19 infection: Guidelines for test selection

Abstract

Special Section: Infectious Diseases
Diagnosing human parvovirus B19 infection: Guidelines for test selection