title: Differential transmission of parvovirus B19 in a twin gestation: a case report.
abstract: Maternal infection with parvovirus B19 during pregnancy can cause aplastic anemia in the fetus. Severe anemia may lead to nonimmune hydrops or fetal demise. In the case reported, the demise of one twin was diagnosed by ultrasonography in an asymptomatic 21-year-old para 1-0-2-1 African American at the gestational age of 25 weeks. The deceased twin (A) was grossly hydropic with anasarca, ascites, pleural and pericardial effusions, and a thickened placenta. Parvovirus B19 DNA was found in the amniotic fluid of Twin A using the polymerase chain-reaction technique. Serial scans of Twin B showed normal growth and no evidence of hydrops. The pregnancy was managed expectantly until 29 weeks when delivery was indicated by maternal disseminated intravascular coagulation. Maternal IgM antiparvovirus B19 antibodies were detected at the time of delivery. Antiparvovirus B19 IgM antibodies were not present in Twin B. These serologic studies suggest a recent acute maternal infection and refute such an infection in Twin B. We present a case of differential transmission of parvovirus B19 in a twin pregnancy with in utero death of the infected twin and subsequent maternal disseminated intravascular coagulation.
authors.affiliation: Department of Obstetrics and Gynecology, Scott and White Hospital and Clinics, Texas A&M University System Health Science Center College of Medicine, Temple, USA. raymond.foster@duke.edu
authors.forename: Raymond T
authors.initials: RT
authors.lastname: Foster
authors.forename: Steven R
authors.initials: SR
authors.lastname: Allen
mesh_terms: D000328:Adult; D004200:Diseases in Twins / Q000175:diagnosis; D004211:Disseminated Intravascular Coagulation / Q000821:virology; D005260:Female; D005313:Fetal Death / Q000000981:diagnostic imaging; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D018445:Infectious Disease Transmission, Vertical; D010322:Parvoviridae Infections / Q000150:complications / Q000175:diagnosis / Q000635:transmission*; D016732:Parvovirus B19, Human; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000503:physiopathology*; D016216:Ultrasonography, Prenatal