Fortnightly Review: Parvovirus B19: an expanding spectrum of disease

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Bernard Cohen, clinical scientista

Public Health Laboratory Service, Central Public Health Laboratory, Virus Reference Division, London NW9 5HT

Summary points

Infection with parvovirus B19 is common and is usually spread by the respiratoryroute
In immunocompetent individuals with normal red cells B19 infection is benign and self limiting, usually presenting as erythema infectiosum(the slapped cheeked syndrome) in children
In adults, especially women, B19 infection is often complicated by acute polyarthritis, which may persist in some cases
Parvovirus B19 may also be transmitted across the placenta. Severe fetal B19 infection may result in hydrops fetalis and fetal death
Parvovirus B19 causes transient aplastic crisis in patients with chronic haemolytic anaemia; such patients pose a risk of nosocomial transmission of the virus
Severe anaemia, prolonged or relapsing, may develop in immunocompromised patients infected with parvovirus B19. This can be treated with normal immunoglobulin
Parvovirus B19 may be transmitted by blood components or blood products

Parvoviruses are small round viruses with a single stranded DNA genome that lack a lipid envelope (fig 1). They are widespread, and in veterinary medicine several are recognised as notable pathogens causing a range of diseases that includes reproductive failure. Animal parvoviruses are not, however, transmissible to humans, and pregnant women are not at risk. The first human parvoviruses to be recognised were adeno-associated viruses. These viruses replicate only in the presence of a helper virus, a function provided by adenoviruses or other large DNA viruses. Antibodies to adenoviruses are found in human populations, but the viruses are not pathogenic. They cause latent infection by integrating into the human chromosome and have attracted interest as potential vectors for human gene therapy.

fig1

Electron micrograph of B19 isolate showing morphology typical of a parvovirus (final magnification x157000)

The virus

Parvovirus B19, the first known pathogenic human parvovirus, was discovered by chance in healthy blood donors being screened for hepatitis B.1 The name comes from the single isolate within a panel of hepatitis …