Unusual manifestations of parvovirus B19 infection in children

Summary

Purpose of the study:
Parvovirus B19 is known as the cause of the „fifth disease” in preschool children, febrile infection with arthralgias, transient aplastic crisis in patients with hemolytic anemia and nonimmune hydrops fetalis. The aim of the work is to evaluate the course of parvovirus B19 infection in children with less common clinical manifestations that are not routinely described with respect to this infection.

Methods:
Parvovirus B19 infection was found in 8 patients with the following diagnoses: pericarditis with pleural effusions and thrombocytopenia, severe anemia with neutropenia, myocarditis with fulminant course and sudden onset of severe anemia requiring transfusion. Test for IgG and IgM antibodies (ELISA) and/or detection of the virus DNA by polymerase chain reaction were used to prove the infection.

Results:
In a patient with pericarditis, pleural effusions and thrombocytopenia, the parvovirus DNA was found in bone marrow and peripheral blood. Severe and protracted course of the infection led to the detection of congenital immunodeficiency: common variable immunodeficiency. Chronic iron deficiency anemia with increased demands on the turnover of erythropoiesis in another patient contributed to the development of severe anemia accompanied by neutropenia. In the patient with severe myocarditis, parvovirus infection was proven as late as from autopsy material. The course of parvoviral myocarditis in children can, in rare cases, be very severe and can have a fatal outcome. Parvovirus infection was, serologically and/or by evidence of the virus DNA, demonstrated in 5 patients with acute severe anemia, in whom previously unrecognized hereditary spherocytosis was found later.

Conclusion:
The abovementioned cases demonstrate the variability of clinical symptoms of parvovirus B19 infection which mainly depend on the immunological profile of the host and the current demands on the turnover of erythropoiesis.

Key words:
parvovirus B19, polymerase chain reaction, pericarditis, pleural effusions, myocarditis, transient aplastic crisis, anemia, neutropenia, hereditary spherocytosis