The parvovirus family includes many...

The parvovirus family includes many viruses that infect a variety of animal species. In humans, parvovirus B19 has the most numerous clinical significance. It can cause a number of different disease states (see accompanying table forward page 1980), which Young and Brown detail in their review article.

Infection with parvovirus B19 is used by all across the globe. By 15 years of age, about single in kind half of adolescents have detectable antibodies against the virus. Infection is spread through respiratory droplets and occurs greatest in quantity commonly in springtime. Parvoviruses are resistant to heat or menstrum solutions.

The majority of children infected with parvovirus B19 are asymptomatic, on the other hand when detectable disease occurs, the presentation is known as erythema infectiosum or fifth disease. ferment and typical viral symptoms are followed about sum of two units weeks later by the characteristic "slapped cheek" rash. This rash may wax and wane, with exacerbations caused by the agency of sunlight exposure, heat, and exercise.

When parvovirus B19 infection offers in adults, it is more symptomatic. An inflammatory arthritis take places in about 50 percent of older characters who become infected. This arthropathy typically not absents with symmetric involvement of the hands and, occasionally, the wrists, knee and ankles. Rheumatoid factor testing during infection may be positive, on the contrary the arthritis caused by parvovirus B19 melts over several weeks and does not cause joint destruction.

Patients with sickle lonely dwelling or other hemolytic anemias have an increased demand for erythrocyte production. Parvovirus B19 infection suppresse r enclosed space production and may lead to transient aplastic anemia in these patients. While the aplastic crisis is self-limited, the authors note that the accurate anemia precipitated by parvovirus infection may be fatal without appropriate transfusion support. In addition to the censorious anemia, aplastic crises also may lead to decreased white solitary abode; squalid or platelet counts.

Immunocompromised bodys (e.g., those with human immunodeficiency virus [HIV] infection) may not create enough neutralizing antibodies to combat parvovirus B19 infection and may be acted upon from a prolonged, severe anemia. Fetal parvovirus infection also may lead to cruel sequelae. Population-based studies indicate that about single in kind half of pregnant women do not have protective antibodies from prior infection. If infection is acquired during pregnancy, the risk of transplacental spread to the fetus is estimated at about 30 percent with a 5 to 9 percent risk of fetal loss

Diagnosis of acute parvovirus B19 infection may be confirmed through elevated IgM antibody titers. IgG titers, upon the other hand, vary widely after infection. According to the authors, chronic infection is diagnosed best from testing for the presence of parvovirus DNA and should not be inferred solely at the lack of virus-specific IgG antibodies.

Treatment usually is not necessary, because in the greatest degree infections are self-limited. Removing immunosuppressive therapy or starting highly active antiretroviral therapy in HIV-infected patients may be helpful when immunocompromise has l to chronic infection. Immune globulins that act against parvovirus are available and may be helpful in treating persistent infection. Effective vaccines exist for a number of animal parvoviruses. The authors note that lack of commercial interest, not efficacy or safety issues, has limited the exhibition of a human vaccine for parvovirus B19

BILL ZEPF MD Young N Brown KE Parvovirus B19 N Engl J M February 5 2004;350:586-97

COPYRIGHT 2004 American Academy of Family Physicians

COPYRIGHT 2004 Gale Group