Distinct clinical features of transplanted children with Parvovirus B19 infection
Ran Jia1, Lingfeng Cao1, Lijuan Lu1
1Department of Clinical Laboratory, Children's Hospital of Fudan University & National Children's Medical Center, Shanghai, 201102, China.
Insights
Transplanted children are highly susceptible to Parvovirus B19 (PVB19) infection, leading to significant graft dysfunction. Hematopoietic stem cell transplant recipients face greater risks, highlighting distinct clinical features in pediatric cases.
Area of Science:
- Pediatric Infectious Diseases
- Transplant Immunology
- Virology
Background:
- Transplanted children possess immature and suppressed immune systems, rendering them particularly vulnerable to Parvovirus B19 (PVB19) infections.
- Clinical manifestations of PVB19 infection in pediatric transplant recipients require comprehensive description.
Purpose of the Study:
- To comprehensively describe the clinical features of Parvovirus B19 infection in pediatric transplant recipients.
- To compare clinical characteristics between hematopoietic stem cell transplant (HSCT) and solid-organ transplant (SOT) recipients.
Main Methods:
- Retrospective review of medical records for 201 transplant recipients at Children's Hospital of Fudan University (Oct 2020 - May 2023).
- Literature search for additional cases of PVB19 infection in transplanted children.
- Analysis of clinical data, viral load, immune markers (IgM/IgG), and graft outcomes.
Main Results:
- Fifty unique cases of PVB19 infection in transplanted children were identified (10 from the institution, 40 from literature).
- Median time to PVB19 DNA detection was 14 weeks post-transplantation; PVB19 IgM/IgG positivity rates were low (26% and 24%).
- Graft loss/dysfunction occurred in 36% of cases; HSCT recipients exhibited higher viral load, lower hemoglobin, greater platelet damage, lower antibody rates, and more graft dysfunction compared to SOT recipients.
Conclusions:
- Transplanted children present distinct clinical features of PVB19 infection compared to adults, including lower antibody detection rates and more significant graft dysfunction.
- The impact on hematopoietic cell lines is broader in children, especially in HSCT recipients, warranting increased clinical attention.
Background:
The immature and suppressed immune response makes transplanted children a special susceptible group to Parvovirus B19 (PVB19). However, the clinical features of transplanted children with PVB19 infection haven't been comprehensively described.
Methods:
We searched the medical records of all the transplant recipients who attended the Children's Hospital of Fudan University from 1 Oct 2020 to 31 May 2023, and reviewed the medical literature for PVB19 infection cases among transplanted children.
Results:
A total of 10 cases of PVB19 infection were identified in 201 transplanted children at our hospital, and the medical records of each of these cases were shown. Also, we retrieved 40 cases of PVB19 infection among transplanted children from the literature, thus summarizing a total of 50 unique cases of PVB19 infection. The median time to the first positive PVB19 DNA detection was 14 weeks post-transplantation. PVB19 IgM and IgG were detected in merely 26% and 24% of the children, respectively. The incidence of graft loss/dysfunction was as high as 36%. Hematopoietic stem cell transplant (HSCT) recipients showed higher PVB19 load, lower HGB level, greater platelet damage, lower PVB19 IgM/IgG positive rates, and more graft dysfunction than solid-organ transplant (SOT) recipients, indicating a more incompetent immune system.
Conclusions:
Compared with the published data of transplanted adults, transplanted children displayed distinct clinical features upon PVB19 infection, including lower PVB19 IgM/IgG positive rates, more graft dysfunction, and broader damage on hematopoietic cell lines, which was even more prominent in HSCT recipients, thus should be of greater concern.
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