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[Congenital aplastic anemia caused by parvovirus B19 infection]
L Vepreková1, J Jelínek, J Zeman
1Oddĕlení klinické hematologie I. interní kliniky 1. LF UK a VFN, Praha.
Insights
Human parvovirus B19 can cause congenital aplastic anemia in newborns. Intravenous immunoglobulin therapy, alongside PCR monitoring, proved effective in treating a severe case in a 2.5-year-old girl.
Area of Science:
- Pediatrics
- Virology
- Immunology
Background:
- Human parvovirus B19 is a known cause of fifth disease in children.
- Intrauterine parvovirus B19 infection can lead to severe congenital aplastic anemia in fetuses.
Observation:
- A 2.5-year-old girl presented with hydrops, congenital aplastic anemia, and low IgG/IgM levels, indicative of intrauterine parvovirus B19 infection.
- The patient required frequent blood transfusions and did not respond to erythropoietin therapy.
- Parvovirus B19 infection was confirmed in bone marrow via PCR.
Findings:
- Treatment with intravenous immunoglobulins (IVIG) led to normalized hemoglobin levels after one year.
- Parvovirus B19 DNA remained detectable for six months post-initial IVIG treatment, necessitating a second course of IVIG.
- Following the second IVIG course, parvovirus B19 DNA became undetectable, and the patient's health improved significantly.
Implications:
- This case highlights the effectiveness of IVIG in managing severe congenital parvovirus B19 anemia.
- Continuous PCR monitoring of parvovirus B19 DNA is crucial for guiding rational therapy and preventing relapse.
- Congenital parvovirus B19 infection requires long-term surveillance due to potential for recurrence.
Abstract:
Human parvovirus B19 causes the fifth disease (erythema infectiosum) in childhood. Intrauterine infection by parvovirus in immunocompromised fetus can lead to the severe congenital aplastic anemia. Here we report the case of 2.5-year-old girl with congenital infection with parvovirus B19. The girl was born as a pre-term baby with hydrops, congenital aplastic anemia, and low level of immunoglobulins IgG and IgM. She depended on the repeated blood transfusions and she did not respond to erythropoietin therapy. The parvovirus B19 infection in bone marrow was detected by polymerase chain reaction and its therapy started with intravenous administration of immunoglobulins. Hemoglobin reached normal level one year later, but low levels of parvovirus B19 were detectable for another 6 months. Immunoglobulin treatment was finished when the virus could not be detected in the circulation. However, one-month later parvovirus B19 DNA was detected again. The two months course of immunoglobulin treatment was repeated, and the DNA analysis of blood cells for parvovirus B19 has been negative since then. Five months after the final withdrawal of the immunoglobulin therapy the girl is in a good shape and all lab tests, except for the decreased levels of IgM, are within the normal range. The PCR monitoring of the presence of parvovirus B19 DNA in blood and bone marrow cells during and after the treatment of congenital aplastic anemia caused by parvovirus B19 chronic infection becomes the necessity for the rational therapy.