title: Human parvovirus B19 infection in children: uncommon clinical presentations.
abstract: BACKGROUND
  Human parvovirus B19 is responsible for a variety of clinical syndromes, such as erythema infectiosum, non-immune hydrops fetalis, transient aplastic anemia, and arthropathies. HPV is also suspected of playing a role in the pathogenesis of various chronic inflammatory and autoimmune diseases, such as systemic lupus erythematosus, rheumatoid arthritis, Kawasaki disease and multiple sclerosis.
  
  
  OBJECTIVE
  To study the age distribution and clinical presentation of patients hospitalized for human parvovirus B19 infection.
  
  
  METHODS
  We reviewed the case records of all pediatric patients with serologic evidence of HPV infection who were admitted during a 20 month period to a major community hospital.
  
  
  RESULTS
  Of 128 children tested for HPV, 48 had evidence of acute infection based on the presence of immunoglobulin M antibodies; 8 patients who also had positive IgM for other viruses were excluded, thus 40 case records were studied. The mean age of the patients was 5.21 years, but 22 patients were under 4. The clinical presentations included 25 patients with fever, either recurrent or prolonged, accompanied in some by enlarged spleen, liver and lymph nodes, skin rash and arthropathy; the remaining patients were investigated for anemia, skin rash, joint complaints and hepatitis. In addition, HPV infection was documented in several well-defined clinical conditions, such as SLE, vasculitic skin lesions, acute lymphoblastic leukemia, pure red cell aplasia, and optic neuritis.
  
  
  CONCLUSIONS
  In a group of 40 pediatric patients exhibiting anti-HPV IgM antibodies, a younger age and less common clinical presentations were observed, furthermore 5 patients had clinical syndromes in which the causative role of HPV infection was not clear.
authors.affiliation: Division of Pediatrics, Kaplan Medical Center, Rehovot, Israel. barashj@inter.net.il
authors.forename: Judith
authors.initials: J
authors.lastname: Barash
authors.forename: Doron
authors.initials: D
authors.lastname: Dushnitzky
authors.forename: Dalia
authors.initials: D
authors.lastname: Sthoeger
authors.forename: Rita
authors.initials: R
authors.lastname: Bardenstein
authors.forename: Yigal
authors.initials: Y
authors.lastname: Barak
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000367:Age Factors; D000740:Anemia / Q000209:etiology; D000914:Antibodies, Viral / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003937:Diagnosis, Differential; D016731:Erythema Infectiosum / Q000175:diagnosis / Q000453:epidemiology; D005076:Exanthema / Q000209:etiology; D005260:Female; D005334:Fever / Q000209:etiology; D019084:Fluorescent Antibody Technique, Indirect; D006505:Hepatitis / Q000209:etiology; D006801:Humans; D007075:Immunoglobulin M / Q000032:analysis; D007223:Infant; D007557:Israel / Q000453:epidemiology; D007592:Joint Diseases / Q000209:etiology; D008297:Male; D009902:Optic Neuritis / Q000209:etiology; D010322:Parvoviridae Infections / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D016732:Parvovirus B19, Human / Q000276:immunology; D012621:Seasons; D012737:Sex Factors; D013577:Syndrome; D013997:Time Factors
chemical_list: D000914:Antibodies, Viral; D007075:Immunoglobulin M