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Detection of parvovirus B19 infection in formalin-fixed and paraffin-embedded placenta and fetal tissues
Paulo Roberto Veiga Quemelo1, Danielle Malta Lima, Benedito Antônio Lopes da Fonseca
1Department of Pathology, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, SP, 14049-900, Brazil. pquemelo@hotmail.com
Abstract:
Parvovirus B19 infection was first discovered in 1975 and it is implicated in fetal death from hydrops fetalis the world over. Diagnosis is usually made through histological identification of the intranuclear inclusion in placenta and fetal organs. However, these cells may be scarce or uncharacteristic, making definitive diagnosis difficult. We analyzed histologically placentas and fetal organs from 34 cases of non-immune hydrops fetalis, stained with Hematoxylin and Eosin (HE) and submitted to immunohistochemistry and polymerase chain reaction (PCR). Of 34 tissue samples, two (5.9%) presented typical intranuclear inclusion in circulating normoblasts seen in Hematoxylin and Eosin stained sections, confirmed by immunohistochemistry and PCR. However, PCR of fetal organs was negative in one case in which the placenta PCR was positive. We concluded that parvovirus B19 infection frequency is similar to the literature and that immunohistochemistry was the best detection method. It is highly specific and sensitive, preserves the morphology and reveals a larger number of positive cells than does HE with the advantage of showing cytoplasmic and nuclear positivity, making it more reliable. Although PCR is more specific and sensitive in fresh or ideally fixed material it is not so in formalin-fixed paraffin-embedded tissues, frequently the only one available in such cases.
Insights
Parvovirus B19 infection can cause fetal hydrops fetalis. Immunohistochemistry is the most reliable method for diagnosing this infection in placental tissues, offering higher sensitivity and specificity than traditional methods.
Area of Science:
- Medical Microbiology
- Fetal Pathology
- Virology
Background:
- Parvovirus B19 is a significant cause of fetal hydrops fetalis globally.
- Current diagnostic methods, like histological identification of intranuclear inclusions, can be challenging due to scarce or uncharacteristic cells.
Purpose of the Study:
- To evaluate diagnostic methods for Parvovirus B19 infection in non-immune hydrops fetalis cases.
- To compare the efficacy of Hematoxylin and Eosin (HE) staining, immunohistochemistry (IHC), and polymerase chain reaction (PCR) in detecting Parvovirus B19.
Main Methods:
- Histological analysis of placentas and fetal organs from 34 hydrops fetalis cases.
- Staining with Hematoxylin and Eosin (HE).
- Application of immunohistochemistry (IHC) and polymerase chain reaction (PCR) on tissue samples.
Main Results:
- Two out of 34 cases (5.9%) showed typical intranuclear inclusions, confirmed by IHC and PCR.
- PCR was negative in fetal organs in one case where placental PCR was positive.
- IHC demonstrated higher sensitivity and specificity, revealing more positive cells with both nuclear and cytoplasmic staining compared to HE.
Conclusions:
- The frequency of Parvovirus B19 infection in hydrops fetalis aligns with existing literature.
- Immunohistochemistry is the preferred diagnostic method due to its high specificity, sensitivity, morphological preservation, and ability to detect more positive cells.
- PCR's effectiveness can be limited in formalin-fixed paraffin-embedded tissues, which are often the only available samples.
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