Manifestations and treatment of human parvovirus B19 infection in immunocompromised patients.
We diagnosed infections from human parvovirus B19 in three patients by using dot-blot hybridization and a polymerase chain reaction to detect B19 DNA and using an enzyme immunoassay to detect IgG and IgM to B19. For 5 months a 5-year-old boy with acute lymphoblastic leukemia in remission had anemia without reticulocytes or bone marrow erythrocyte precursors. His serum lacked IgG and IgM to B19 but contained B19 DNA. He received gamma globulin intravenously (0.4 gm/kg/day for 5 days); his viremia promptly cleared and reticulocytosis developed. A 14-year-old boy with acute lymphoblastic leukemia in remission had fever, rash, neutropenia (less than 300 leukocytes/mm3), and a hemophagocytic syndrome lasting 3 weeks. His serum contained IgM to B19 and B19 DNA. Without therapy, IgG to B19 developed; although low levels of B19 DNA persisted, the leukocyte count returned to normal. In a 19-year-old patient with systemic lupus erythematosus and hemolytic anemia, an aplastic crisis lasted 2 weeks. Her serum lacked IgG and IgM to B19 but contained B19 DNA. Without therapy, IgG and IgM to B19 appeared, viremia diminished, and reticulocytosis occurred. These patients illustrate the varied manifestations of chronic B19 infections, the importance of DNA detection for diagnosis, and the possible efficacy of gamma globulin therapy.
Department of Pediatrics, Children's Medical Center, Medical College of Virginia, Richmond.
W C
WC
Koch
G
G
Massey
C E
CE
Russell
S P
SP
Adler
D000293:Adolescent; D000328:Adult; D002675:Child, Preschool; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D006801:Humans; D007108:Immune Tolerance; D007124:Immunoenzyme Techniques; D008180:Lupus Erythematosus, Systemic / Q000150:complications; D008297:Male; D010322:Parvoviridae Infections / Q000175:diagnosis* / Q000209:etiology / Q000276:immunology / Q000628:therapy; D016133:Polymerase Chain Reaction; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications; D005719:gamma-Globulins / Q000627:therapeutic use
D004279:DNA, Viral; D005719:gamma-Globulins