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Published on: July 24, 2016
Parvovirus B19 Infection in Children With Arterial Ischemic Stroke
Heather J Fullerton1, Jorge M Luna1, Max Wintermark1
1From the Department of Neurology (H.J.F.), Department of Pediatrics (H.J.F.), and Department of Biostatistics and Epidemiology (N.K.H.), University of California, San Francisco; Department of Epidemiology (J.M.L., R.T., W.I.L., M.S.V.E.) and Department of Neurology (M.S.V.E.), Columbia University College of Physicians and Surgeons, New York, NY; Department of Radiology, Stanford University, Palo Alto, CA (M.W., Y.L.); Department of Pediatrics (Infectious Disease), Kaiser Permanente, Oakland, CA (C.G.); and Department of Neurology, Hospital for Sick Children, Toronto, Canada (G.A.D.).
Insights
Infectious agents, particularly parvovirus B19, were identified in children with arterial ischemic stroke. This study highlights a potential link between viral infections and pediatric stroke, opening new research avenues.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Vascular Biology
Background:
- Childhood arterial ischemic stroke risk is linked to acute infections.
- Pathogen discovery methods are crucial for understanding stroke etiology.
- MassTag-polymerase chain reaction offers an unbiased approach for pathogen identification.
Purpose of the Study:
- To identify pathogens in the blood of children with arterial ischemic stroke using MassTag-polymerase chain reaction.
- To investigate the role of specific pathogens in pediatric stroke pathogenesis.
- To explore potential associations between identified pathogens and stroke characteristics.
Main Methods:
- The VIPS study enrolled pediatric arterial ischemic stroke cases and controls.
- MassTag-polymerase chain reaction tested plasma for 28 common bacterial and viral pathogens.
- Parental interviews collected data on recent infections.
Main Results:
- Pathogen DNA was detected in 8.7% of cases but no controls.
- Parvovirus B19 was the most frequent pathogen (n=10), followed by herpesvirus 6, adenovirus, and rhinovirus 6C.
- Parvovirus B19 infection was subclinical in most cases and associated with congenital heart disease or arteriopathy in some.
Conclusions:
- MassTag-polymerase chain reaction identified parvovirus B19 in childhood arterial ischemic stroke cases.
- This pathogen discovery approach can generate novel hypotheses on pediatric stroke pathogenesis.
- Further research is warranted to elucidate the causal role of parvovirus B19 in pediatric stroke.
Background And Purpose:
Case-control studies suggest that acute infection transiently increases the risk of childhood arterial ischemic stroke. We hypothesized that an unbiased pathogen discovery approach utilizing MassTag-polymerase chain reaction would identify pathogens in the blood of childhood arterial ischemic stroke cases.
Methods:
The multicenter international VIPS study (Vascular Effects of Infection in Pediatric Stroke) enrolled arterial ischemic stroke cases, and stroke-free controls, aged 29 days through 18 years. Parental interview included questions on recent infections. In this pilot study, we used MassTag-polymerase chain reaction to test the plasma of the first 161 cases and 34 controls enrolled for a panel of 28 common bacterial and viral pathogens.
Results:
Pathogen DNA was detected in no controls and 14 cases (8.7%): parvovirus B19 (n=10), herpesvirus 6 (n=2), adenovirus (n=1), and rhinovirus 6C (n=1). Parvovirus B19 infection was confirmed by serologies in all 10; infection was subclinical in 8. Four cases with parvovirus B19 had underlying congenital heart disease, whereas another 5 had a distinct arteriopathy involving a long-segment stenosis of the distal internal carotid and proximal middle cerebral arteries.
Conclusions:
Using MassTag-polymerase chain reaction, we detected parvovirus B19-a virus known to infect erythrocytes and endothelial cells-in some cases of childhood arterial ischemic stroke. This approach can generate new, testable hypotheses about childhood stroke pathogenesis.
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