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

Oliveira, Solange A.; Brandão, Antonio B.; Fernandes, Daniele G.; Bettini, Lilian R.; Carvalho, Anamaria B.; Pereira, Antonio Carlos M.; Azevedo, Kátia M.; Nascimento, Jussara P.

doi:10.1590/S0036-46651996000500002

Abstracts

From March 1994 to November 1995 24 cases of human parvovirus B19 infection were seen at the Infectious Diseases Department of the Hospital Universitário Antônio Pedro, Niterói - RJ. Serum samples for IgM detection (capture enzyme immunoassay) were positive from the 1st to the 27th day after the onset of the exathema. The classical features of erythema infectiosum (slapped cheecked syndrome) were observed in 8 (33.3%) cases all of them children. Eight patients (6 adults and 2 children) presented a symmetrical polyartropathy, seen more frequently in women. These results show that B19 infection diagnosis is difficult when the disease does not present the classical features and because of the frequent involvement of the joints this infection should be considered in the differential diagnosis of early rheumatoid arthritis.

Human parvovirus B19 infection; Exanthema; Arthropathy

No período de maio / 94 a novembro / 95, 24 casos de parvovirose humana foram atendidos no Serviço de Doenças Infecciosas e Parasitárias do Hospital Universitário Antonio Pedro, Niterói - RJ. Amostras sangüíneas para a detecção de IgM (ensaio imunoenzimático por captura) foram positivas do 1º ao 27º dia após o início do exantema. Os sinais e sintomas clássicos do eritema infeccioso foram observados em 8 (33,3%) dos casos e apenas em crianças. Oito pacientes (6 adultos e 2 crianças) apresentaram poliartropatia simétrica, vista mais freqüentemente em mulheres. Os resultados deste trabalho demonstram que o diagnóstico da parvovirose humana é difícil quando a doença não apresenta quadro clínico clássico e, devido ao freqüente envolvimento das articulações, tal infecção deve ser considerada no diagnóstico diferencial da artrite reumatóide na sua fase inicial.

VIROLOGY

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

Parvovirose humana: estudo clínico e epidemiológico de 24 casos

Solange A. Oliveira^I; Antonio B. Brandão^II; Daniele G. Fernandes^I; Lilian R. Bettini^I; Anamaria B. Carvalho^III; Antonio Carlos M. Pereira^I; Kátia M. Azevedo^I; Jussara P. Nascimento^{III, IV}

^IDisciplina de Doenças Infecciosas e Parasitárias, Departamento de Medicina Clínica, Universidade Federal Fluminense, Niterói, RJ, Brazil

^IIDepartamento Materno Infantil, Universidade Federal Fluminense, Niterói, RJ, Brazil

^IIIDepartamento de Virologia, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil

^IVDepartamento de Microbiologia e Parasitologia, Universidade Federal Fluminense, Niterói, RJ, Brazil

^{Correspondence to} Correspondence to: Dra. Solange Artimos de Oliveira Disciplina de Doenças Infecciosas e Parasitárias, Hospital Universitário Antônio Pedro Rua Marques do Paraná, 303/2º andar 24030-210, Niterói, Rio de Janeiro, Brazil Tel/Fax (021) 719-7262

SUMMARY

From March 1994 to November 1995 24 cases of human parvovirus B19 infection were seen at the Infectious Diseases Department of the Hospital Universitário Antônio Pedro, Niterói - RJ. Serum samples for IgM detection (capture enzyme immunoassay) were positive from the 1^st to the 27^th day after the onset of the exathema. The classical features of erythema infectiosum (slapped cheecked syndrome) were observed in 8 (33.3%) cases all of them children. Eight patients (6 adults and 2 children) presented a symmetrical polyartropathy, seen more frequently in women.

These results show that B19 infection diagnosis is difficult when the disease does not present the classical features and because of the frequent involvement of the joints this infection should be considered in the differential diagnosis of early rheumatoid arthritis.

Keywords: Human parvovirus B19 infection; Exanthema; Arthropathy.

RESUMO

No período de maio / 94 a novembro / 95, 24 casos de parvovirose humana foram atendidos no Serviço de Doenças Infecciosas e Parasitárias do Hospital Universitário Antonio Pedro, Niterói RJ. Amostras sangüíneas para a detecção de IgM (ensaio imunoenzimático por captura) foram positivas do 1º ao 27º dia após o início do exantema. Os sinais e sintomas clássicos do eritema infeccioso foram observados em 8 (33,3%) dos casos e apenas em crianças. Oito pacientes (6 adultos e 2 crianças) apresentaram poliartropatia simétrica, vista mais freqüentemente em mulheres.

Os resultados deste trabalho demonstram que o diagnóstico da parvovirose humana é difícil quando a doença não apresenta quadro clínico clássico e, devido ao freqüente envolvimento das articulações, tal infecção deve ser considerada no diagnóstico diferencial da artrite reumatóide na sua fase inicial.

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ACKNOWLEDGEMENTS

This work was supported by CNPq grant Nº 520406/94 - 0 and Nº 520901/94 - 0. It would not be possible without the aid of the health workers of the Municipality of Niterói, State of Rio de Janeiro. The authors thank Drs. Matilda M. Siqueira and Rita M. Nogueira from Fundação Oswaldo Cruz, Rio de Janeiro, RJ, for kindly performing, respectively, measles and dengue diagnosis.

Recebido para publicação em 06/08/1996

Aceito para publicação em 09/10/1996

1. AGER, E.A.; CHIN. T.D.Y. & POLAND, J.R. - Epidemic erythema infectiosum. New Eng. J. Med.. 275: 1326-1331, 1996.
2. ANDERSON, M.J.; LEWIS, E.; KIDD, I.M.; HALL, S.M. & COHEN, B.J. - An outbreak of erythema infectiosum associated with human parvovirus infection. J. Hyg. (Lond.), 93: 85-93, 1984.
3. BROWN, T.; ANAND, A.; RITCHIE, L.D.; CLEWLEY, J.P. & REID. T.M.S. - Intrauterine parvovirus infection associated with hydrops fetalis. Lancet, 2: 1033-1034, 1984.
4. COHEN, B. - Human parvovirus B19 and fifth disease. In: MORTIMER, P.P. Public health virology: 12 reports. London, Public Health Laboratory Service, 1986. p. 130-143.
5. COHEN, B. - Parvovirus B19: an expanding spectrum of disease. Brit. med. J., 311: 1549-1552, 1995.
6. COSSART, Y.E.; FIELD, A.M.; CANT, B. & WIDDOWS, D. - Parvovirus - like particles in human sera. Lancet, 1: 72-73, 1975.
7. CRUZ, AS.; ANDRADE-SERPA, M.J.; BARTH, O.M. & NASCIMENTO, J.P. - Detection of the human parvovirus B19 in a blood donor plasma in Rio de Janeiro. Mem. Inst. Oswaldo Cruz, 84: 279-280, 1989.
8. CUBEL, R.C.N.; ALFERES, A.C.R.; COHEN, B.J. & NASCIMENTO, J.P. - Application to immunoglobulin M capture hemadherence assays of hemagglutination of monkey erythrocytes by native and recombinant human parvovirus B19 antigen. J. clin. Microbiol., 32: 1997-1999, 1994.
9. CUBEL, R.C.N.; SIQUEIRA, M.M.; SANTOS, E.O. et al. - Human parvovirus B19 infections among exanthematic diseases notified as measles. Rev. Soc. bras. Med. trop., (in press).
10. CUBEL, R.C.N.; VALADĂO, M.C.; PEREIRA, W.V.; MAGALHĂES, M.C. & NASCIMENTO, J.P. - Aplastic crisis due to human parvovirus B19 infection in hereditary hemolytic anaemia. Rev. Inst. Med. trop. S. Paulo, 34: 479-482, 1992.
11. EDWARDS, J.B.M.; KESSEL, I.; GARDNER, S.D. et al. - A search for a characteristic illness in children with serological evidence of viral or toxoplasma infection. J. Infection, 3: 316-323, 1981.
12. FREITAS, R.B.; LINHARES, A.C.; MIRANDA, M.F.R. & GABBAY, I.V. - Novo agente de doença exantemálica na Amazônia: o parvovírus "B 19". Bol. Epidem., 20: 1-4, 1988.
13. FREITAS, R.B.; MIRANDA, M.F.; SHIRLEY, J. et al. - Parvovirus B19 antibodies in sera of patients with unexplained exanthemata from Belém, Pará, Brazil. Mem. Inst. Oswaldo Cruz, 48: 497-499, 1993.
14. FREITAS, R.B.; WONG, D.; BOSWELL, F. et al. - Prevalence of human parvovirus B19 and rubellavirus infections in urban and remote rural areas in Northern Brazil. J. med. Virol., .32: 203-208, 1990.
15. JOSEPH, P.R. - Fifth disease: the frequency of joint involvement in adults. N. Y. St. J. Med., 86: 560-563, 1986.
16. KURTZMAN, G.J.; COHEN, B.J.; FIELD, A.M. et al. - Immune (response to B19 parvovirus and an antibody defect in persistent viral infection. J. clin. Invest., 84: 1114-1123, 1989.
17. MIELLE, A.; NOGUEIRA, M.B.; LISBOA, C. et al. - Infecçăo por parvovírus: apresentaçăo atípica em tręs crianças. Pediatria (S. Paulo), 17: 197-201, 1995.
18. MIRANDA, M.F.R.; LINHARES, A.C. & SHIRLEY, J.A. - Fifth disease in children living in Belém, Brazil. Rev. lnst. Med. trop. S. Paulo, 31: 359-362, 1989.
19. MORI, J.; FIELD, A.J.; CREWLEY, J.P. & COHEN, B.J. - Dot Blot hybridization assay of B19 virus DNA in clinical specimens. J. clin. Microbiol., 27: 459-464, 1989.
20. MORTIMER, P.P. - The 80th year of fifth disease. Brit. med. J., 289: 338-339, 1984.
21. MUSIANI, M.; ZERBINI, M.; GENTILOMI, G. et al. - Parvovirus B19 clearance from peripheral blood after acute infection. J. infect. Dis., 172: 1360-1363, 1995.
22. NAIDES, S.J.; FOTO, F.; MARSH, J.L.; SCHAROSCH, L.L. & HOWARD, E.J. - Synovial tissue analysis in patients with chronic parvovirus B19 arthropathy. Clin. Res., 39: 733A, 1991.
23. NAIDES, S.J.; SCHAROSCH, L.L.; FOTO, T. & HOWARD, E.J. - Rheumatologic manifestations of human parvovirus B19 infection in adults. Initial two years experience. Arthr. Rheum., 33: 1297-1309, 1990.
24. NASCIMENTO, J.P.; BUCKLEY, M.M.; BROWN, K.E. & COHEN, B.J. - The prevalence of antibody to human parvovirus B19 in Rio de Janeiro,Brazil. Rev. Inst. Med. trop. S. Paulo, 32: 41-45, 1990.
25. NIKKARI, S.; ROIVAINEN, A.; HANNONEN, P. et al. - Persistence of parvovirus B19 in synovial fluid and bone marrow. Ann. rheum. Dis., 54: 597-600, 1995.
26. PATTISON, J.R. - Disease caused by the human parvovirus B19. Arch. Dis. Child., 63: 1426-1427, 1988.
27. PLUMMER, F.A.; HAMMOND, G.W.; FORWARD, K. et al. - An erythema - like illness caused by human parvovirus infection. New Engl.J. Med., 313: 74-79, 1985.
28. REID, D.M.; REID, T.M.; BROWN, T.; RENNIE, J.A.N. & EASTMOND, C.J. - Human parvovirus-associated arthritis: a clinical and laboratory description. Lancet, 1: 422-425, 1985.
29. SAAL, J.G.; STEILE, M.; EINSELE, H. et al. - Persistence of B19 parvovirus in synovial membranes in patients with arthritis. Rheum. Int., 12: 147-151, 1992.
30. SAMII, K., CASSINOTTI, P.; FREUDENREICH, J. et al. - Acute bilateral carpal tunnel syndrome associated with human parvovirus B19 infection. Clin. infect. Dis., 22: 162-164, 1996.
31. SERJEANT, G.R.; MANSON, K.; TOPLEY, J.M.et al. Outbreak of aplastic crises in sickle cell anaemia associated with parvovirus-like agent. Lancet, 2: 595-597, 1981.
32. TUCKERMAN, J.C.; BROWN, T. & COHEN, B.J. - Erythema infectiosum in a village primary school: clinical and virological studies. J. roy. Coll. gen. Practit., 36: 267-270, 1986.
33. WHITE, D.G.; WOOLF, A.D.; MORTIMER, P.P. et al. - Human parvovirus arthropathy. Lancet, 1: 419-421, 1985.
34. YOUNG, N.S. - Hemalologic and hematopoietic consequences of B19 parvovirus infection. Semin. Hemat., 25: 159-172, 1988.

Correspondence to:

Dra. Solange Artimos de Oliveira

Disciplina de Doenças Infecciosas e Parasitárias, Hospital Universitário Antônio Pedro

Rua Marques do Paraná, 303/2º andar

24030-210, Niterói, Rio de Janeiro, Brazil

Tel/Fax (021) 719-7262

Publication Dates

Publication in this collection
22 Sept 2006
Date of issue
Oct 1996

History

Accepted
09 Oct 1996
Received
06 Aug 1996

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. AGER, E.A.; CHIN. T.D.Y. & POLAND, J.R. - Epidemic erythema infectiosum. New Eng. J. Med.. 275: 1326-1331, 1996.

[2] 2. ANDERSON, M.J.; LEWIS, E.; KIDD, I.M.; HALL, S.M. & COHEN, B.J. - An outbreak of erythema infectiosum associated with human parvovirus infection. J. Hyg. (Lond.), 93: 85-93, 1984.

[3] 3. BROWN, T.; ANAND, A.; RITCHIE, L.D.; CLEWLEY, J.P. & REID. T.M.S. - Intrauterine parvovirus infection associated with hydrops fetalis. Lancet, 2: 1033-1034, 1984.

[4] 4. COHEN, B. - Human parvovirus B19 and fifth disease. In: MORTIMER, P.P. Public health virology: 12 reports. London, Public Health Laboratory Service, 1986. p. 130-143.

[5] 5. COHEN, B. - Parvovirus B19: an expanding spectrum of disease. Brit. med. J., 311: 1549-1552, 1995.

[6] 6. COSSART, Y.E.; FIELD, A.M.; CANT, B. & WIDDOWS, D. - Parvovirus - like particles in human sera. Lancet, 1: 72-73, 1975.

[7] 7. CRUZ, AS.; ANDRADE-SERPA, M.J.; BARTH, O.M. & NASCIMENTO, J.P. - Detection of the human parvovirus B19 in a blood donor plasma in Rio de Janeiro. Mem. Inst. Oswaldo Cruz, 84: 279-280, 1989.

[8] 8. CUBEL, R.C.N.; ALFERES, A.C.R.; COHEN, B.J. & NASCIMENTO, J.P. - Application to immunoglobulin M capture hemadherence assays of hemagglutination of monkey erythrocytes by native and recombinant human parvovirus B19 antigen. J. clin. Microbiol., 32: 1997-1999, 1994.

[9] 9. CUBEL, R.C.N.; SIQUEIRA, M.M.; SANTOS, E.O. et al. - Human parvovirus B19 infections among exanthematic diseases notified as measles. Rev. Soc. bras. Med. trop., (in press).

[10] 10. CUBEL, R.C.N.; VALADĂO, M.C.; PEREIRA, W.V.; MAGALHĂES, M.C. & NASCIMENTO, J.P. - Aplastic crisis due to human parvovirus B19 infection in hereditary hemolytic anaemia. Rev. Inst. Med. trop. S. Paulo, 34: 479-482, 1992.

[11] 11. EDWARDS, J.B.M.; KESSEL, I.; GARDNER, S.D. et al. - A search for a characteristic illness in children with serological evidence of viral or toxoplasma infection. J. Infection, 3: 316-323, 1981.

[12] 12. FREITAS, R.B.; LINHARES, A.C.; MIRANDA, M.F.R. & GABBAY, I.V. - Novo agente de doença exantemálica na Amazônia: o parvovírus "B 19". Bol. Epidem., 20: 1-4, 1988.

[13] 13. FREITAS, R.B.; MIRANDA, M.F.; SHIRLEY, J. et al. - Parvovirus B19 antibodies in sera of patients with unexplained exanthemata from Belém, Pará, Brazil. Mem. Inst. Oswaldo Cruz, 48: 497-499, 1993.

[14] 14. FREITAS, R.B.; WONG, D.; BOSWELL, F. et al. - Prevalence of human parvovirus B19 and rubellavirus infections in urban and remote rural areas in Northern Brazil. J. med. Virol., .32: 203-208, 1990.

[15] 15. JOSEPH, P.R. - Fifth disease: the frequency of joint involvement in adults. N. Y. St. J. Med., 86: 560-563, 1986.

[16] 16. KURTZMAN, G.J.; COHEN, B.J.; FIELD, A.M. et al. - Immune (response to B19 parvovirus and an antibody defect in persistent viral infection. J. clin. Invest., 84: 1114-1123, 1989.

[17] 17. MIELLE, A.; NOGUEIRA, M.B.; LISBOA, C. et al. - Infecçăo por parvovírus: apresentaçăo atípica em tręs crianças. Pediatria (S. Paulo), 17: 197-201, 1995.

[18] 18. MIRANDA, M.F.R.; LINHARES, A.C. & SHIRLEY, J.A. - Fifth disease in children living in Belém, Brazil. Rev. lnst. Med. trop. S. Paulo, 31: 359-362, 1989.

[19] 19. MORI, J.; FIELD, A.J.; CREWLEY, J.P. & COHEN, B.J. - Dot Blot hybridization assay of B19 virus DNA in clinical specimens. J. clin. Microbiol., 27: 459-464, 1989.

[20] 20. MORTIMER, P.P. - The 80th year of fifth disease. Brit. med. J., 289: 338-339, 1984.

[21] 21. MUSIANI, M.; ZERBINI, M.; GENTILOMI, G. et al. - Parvovirus B19 clearance from peripheral blood after acute infection. J. infect. Dis., 172: 1360-1363, 1995.

[22] 22. NAIDES, S.J.; FOTO, F.; MARSH, J.L.; SCHAROSCH, L.L. & HOWARD, E.J. - Synovial tissue analysis in patients with chronic parvovirus B19 arthropathy. Clin. Res., 39: 733A, 1991.

[23] 23. NAIDES, S.J.; SCHAROSCH, L.L.; FOTO, T. & HOWARD, E.J. - Rheumatologic manifestations of human parvovirus B19 infection in adults. Initial two years experience. Arthr. Rheum., 33: 1297-1309, 1990.

[24] 24. NASCIMENTO, J.P.; BUCKLEY, M.M.; BROWN, K.E. & COHEN, B.J. - The prevalence of antibody to human parvovirus B19 in Rio de Janeiro,Brazil. Rev. Inst. Med. trop. S. Paulo, 32: 41-45, 1990.

[25] 25. NIKKARI, S.; ROIVAINEN, A.; HANNONEN, P. et al. - Persistence of parvovirus B19 in synovial fluid and bone marrow. Ann. rheum. Dis., 54: 597-600, 1995.

[26] 26. PATTISON, J.R. - Disease caused by the human parvovirus B19. Arch. Dis. Child., 63: 1426-1427, 1988.

[27] 27. PLUMMER, F.A.; HAMMOND, G.W.; FORWARD, K. et al. - An erythema - like illness caused by human parvovirus infection. New Engl.J. Med., 313: 74-79, 1985.

[28] 28. REID, D.M.; REID, T.M.; BROWN, T.; RENNIE, J.A.N. & EASTMOND, C.J. - Human parvovirus-associated arthritis: a clinical and laboratory description. Lancet, 1: 422-425, 1985.

[29] 29. SAAL, J.G.; STEILE, M.; EINSELE, H. et al. - Persistence of B19 parvovirus in synovial membranes in patients with arthritis. Rheum. Int., 12: 147-151, 1992.

[30] 30. SAMII, K., CASSINOTTI, P.; FREUDENREICH, J. et al. - Acute bilateral carpal tunnel syndrome associated with human parvovirus B19 infection. Clin. infect. Dis., 22: 162-164, 1996.

[31] 31. SERJEANT, G.R.; MANSON, K.; TOPLEY, J.M.et al. Outbreak of aplastic crises in sickle cell anaemia associated with parvovirus-like agent. Lancet, 2: 595-597, 1981.

[32] 32. TUCKERMAN, J.C.; BROWN, T. & COHEN, B.J. - Erythema infectiosum in a village primary school: clinical and virological studies. J. roy. Coll. gen. Practit., 36: 267-270, 1986.

[33] 33. WHITE, D.G.; WOOLF, A.D.; MORTIMER, P.P. et al. - Human parvovirus arthropathy. Lancet, 1: 419-421, 1985.

[34] 34. YOUNG, N.S. - Hemalologic and hematopoietic consequences of B19 parvovirus infection. Semin. Hemat., 25: 159-172, 1988.

Brasil

Brasil

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

Parvovirose humana: estudo clínico e epidemiológico de 24 casos

Abstracts

Correspondence to:

Publication Dates

History