Long-term parvovirus B19 viraemia associated with pure red cell aplasia after allogeneic bone marrow transplantation.
BACKGROUND
Parvovirus B19 infection is associated with a variety of symptoms like erythema infectiosum, anaemia and arthritis. In immunocompetent persons, viraemia is usually cleared a few weeks after infection.


OBJECTIVE
An immunocompromised adult female patient was persistently infected with B19 after allogenic bone marrow transplantation (BMT) and developed chronic anaemia.


METHODS
B19-specific antibodies were determined by ELISA and viral load was assessed using a quantitative real time B19 PCR. The patient was evaluated clinically.


RESULTS
Two years after successful BMT, the patient received intensified immunosuppressive treatment, erythropoetin and erythrocyte concentrates due to chronic graft-versus-host disease with renal failure. Despite of this treatment, the aplastic anaemia worsened. PCR revealed B19 viraemia with 10(12) geq/ml serum. After 7 months of repeated applications of immunoglobulins and reduction of immunosuppressive treatment, reticulocyte counts and haemoglobin levels normalized and the viral load finally dropped to 10(3) geq/ml serum. One of the back-up samples of the erythrocyte concentrates tested positive, the respective transfusion had been applied 2 months after the beginning of viraemia.


CONCLUSIONS
The source of the primary infection remained unclear, but at least re-infection by blood transfusion is likely. Treatment did not result in virus elimination from peripheral blood but in resolvement of symptoms.
Plentz
Annelie
A
Institute of Medical Microbiology and Hygiene, University of Regensburg, 93042, Germany. annelie.plentz@klinik.uni-regensburg.de
Hahn
Joachim
J
Holler
Ernst
E
Jilg
Wolfgang
W
Modrow
Susanne
S
D000741:Anemia, Aplastic / Q000209:etiology; D000914:Antibodies, Viral / Q000097:blood; D001483:Base Sequence; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D004279:DNA, Viral / Q000032:analysis; D017707:Erythrocyte Transfusion / Q000009:adverse effects; D005260:Female; D006086:Graft vs Host Disease / Q000628:therapy; D006801:Humans; D016867:Immunocompromised Host; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007165:Immunosuppression Therapy; D008875:Middle Aged; D008969:Molecular Sequence Data; D016732:Parvovirus B19, Human / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification*; D017354:Point Mutation; D016133:Polymerase Chain Reaction; D012010:Red-Cell Aplasia, Pure / Q000150:complications* / Q000628:therapy; D051437:Renal Insufficiency / Q000209:etiology; D017422:Sequence Analysis, DNA; D014766:Viremia / Q000209:etiology* / Q000821:virology
D000914:Antibodies, Viral; D004279:DNA, Viral; D016756:Immunoglobulins, Intravenous