title: Parvovirus B19 infection in Tunisian patients with sickle-cell anemia and acute erythroblastopenia.
abstract: BACKGROUND
  Human parvovirus B19 is the etiologic agent of erythema infectiosum in children. It is also associated with other clinical manifestations in different target groups. Patients with chronic hemolytic anemia are at high risk of developing acute erythroblastopenia following infection by the virus. They usually become highly viremic and pose an increased risk of virus transmission. Close monitoring of such high risk groups is required for epidemiologic surveillance and disease prevention activities. Here we report a molecular epidemiological study on B19 virus infection in Tunisian patients with chronic hemolytic anemia.
  
  
  METHODS
  This study was conducted on 92 young chronic hemolytic anemia patients who attended the same ward at the National Bone Marrow Transplantation Center of Tunis and 46 controls from a different hospital. Screening for IgM and IgG anti-B19 antibodies was performed using commercially available enzyme immunoassays and B19 DNA was detected by nested PCR in the overlapping VP1/VP2 region. DNA was sequenced using dideoxy-terminator cycle sequencing technology.
  
  
  RESULTS
  Anti-parvovirus B19 IgG antibodies were detected in 26 of 46 sickle-cell anemia patients, 18 of 46 beta-thalassemia and 7 of 46 controls. Anti-parvovirus B19 IgM antibodies were detected only in 4 of the sickle-cell anemia patients: two siblings and two unrelated who presented with acute erythroblastopenia at the time of blood collection for this study and had no history of past transfusion. B19 DNA was detected only in sera of these four patients and the corresponding 288 bp nested DNA amplicons were sequenced. The sequences obtained were all identical and phylogenetic analysis showed that they belonged to a new B19 virus strain of Genotype1.
  
  
  CONCLUSIONS
  A new parvovirus B19 strain of genotype1 was detected in four Tunisian patients with sickle-cell anemia. Virus transmission appeared to be nosocomial and resulted in acute erythroblastopenia in the four patients. The possibility of independent transmission of this B19 variant to the patients is unlikely in light of the present epidemiological data. However this possibility cannot be ruled out because of the low genetic variability of the virus.
authors.affiliation: Viral and Molecular Tumor Diagnostics Unit, Habib Thameur Hospital, 1008 Tunis, Tunisia. faouzi.regaya@rns.tn
authors.forename: Faouzi
authors.initials: F
authors.lastname: Regaya
authors.forename: Lassad
authors.initials: L
authors.lastname: Oussaief
authors.forename: Mohamed
authors.initials: M
authors.lastname: Bejaoui
authors.forename: Mongi
authors.initials: M
authors.lastname: Karoui
authors.forename: Mohamed
authors.initials: M
authors.lastname: Zili
authors.forename: Ridha
authors.initials: R
authors.lastname: Khelifa
mesh_terms: D000293:Adolescent; D000328:Adult; D000755:Anemia, Sickle Cell / Q000150:complications*; D001483:Base Sequence; D002648:Child; D003428:Cross Infection / Q000150:complications / Q000453:epidemiology / Q000821:virology; D004279:DNA, Viral / Q000737:chemistry; D004900:Erythroblasts / Q000166:cytology; D006801:Humans; D008297:Male; D008969:Molecular Sequence Data; D010322:Parvoviridae Infections / Q000150:complications / Q000453:epidemiology* / Q000821:virology; D016732:Parvovirus B19, Human / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D010802:Phylogeny; D012010:Red-Cell Aplasia, Pure / Q000821:virology*; D016415:Sequence Alignment; D014416:Tunisia / Q000453:epidemiology
chemical_list: D004279:DNA, Viral