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.
Institute of Medical Microbiology and Hygiene, University of Regensburg, 93042, Germany. annelie.plentz@klinik.uni-regensburg.de
Annelie
A
Plentz
Joachim
J
Hahn
Ernst
E
Holler
Wolfgang
W
Jilg
Susanne
S
Modrow
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