[Systemic manifestations of Parvovirus B19 infections].
OBJECTIVE
Parvovirus B19 (B19) causes many clinical disorders, of which the most common are erythema infectiosum, aplastic crisis complicating chronic hemolytic anemia, and hydrops fetalis. In young adults, the skin eruption caused by B19 is accompanied by polyarthritis and polyarthralgia in 60% of the cases. Rheumatoid factors and other antibodies including antinuclear antibodies, anti-ADN, and antiphospholipids can be produced in the wake of B19 infection.


BACKGROUND
These features may simulate systemic diseases as rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) (lupus-like eruption over the cheeks, cytopenia, etc.) or vasculitis (purpura, renal involvement). In addition, there have been a few reports of SLE, vasculitis and other connective tissue diseases developing shortly after a B19 infection associated with virus clearance suggesting that B19 can act as a trigger of systemic disease. However, studies in large series indicate that in fact B19 is probably an extremely rare cause of RA, SLE or vasculitis.


CONCLUSIONS
In fundamental studies B19 interacts with inflammatory cells by regulation of cytokines. More recently, two studies suggest that viral infection due to B19 may affect the course of SLE, leading to specific biological subsets. These preliminary findings require confirmation to elucidate the significance of the presence of B19 in systemic disease.
Service de médecine interne, Hôtel-Dieu, 1 place de l'Hôpital, 69288 Lyon cedex 02, France. pascal.seve@chu-lyon.fr
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Broussolle
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000914:Antibodies, Viral / Q000032:analysis; D001170:Arthritis, Infectious / Q000175:diagnosis / Q000209:etiology / Q000821:virology; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000209:etiology / Q000821:virology; D001323:Autoantibodies / Q000032:analysis; D001327:Autoimmune Diseases / Q000175:diagnosis / Q000276:immunology / Q000821:virology; D001379:Azathioprine / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003520:Cyclophosphamide / Q000627:therapeutic use; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008180:Lupus Erythematosus, Systemic / Q000175:diagnosis* / Q000209:etiology / Q000821:virology; D008297:Male; D008875:Middle Aged; D010322:Parvoviridae Infections / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology / Q000821:virology; D016732:Parvovirus B19, Human / Q000302:isolation & purification / Q000472:pathogenicity; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis; D017193:Skin Diseases, Viral / Q000175:diagnosis / Q000209:etiology; D016896:Treatment Outcome; D014657:Vasculitis / Q000175:diagnosis* / Q000209:etiology / Q000821:virology
D000305:Adrenal Cortex Hormones; D000914:Antibodies, Viral; D001323:Autoantibodies; D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D001379:Azathioprine