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The emergence of parvovirus B19 as a pathogen in acute encephalitis syndrome
Sayantika Dey1, Monalisa Mohanty1, Prabhudutta Mamidi1
1Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, 751019, Odisha, India.
Abstract:
Despite scarcity of data, in recent years, human parvovirus B19 (PVB19) has been emerging as an important pathogen in acute encephalitis syndrome (AES). But, PVB19 virus is mostly looked for only after the exclusion of other common pathogens implicated in AES. Hence, this study was conducted to correlate clinical, radiological, and sequencing data to establish the crucial role of PVB19 in AES. Cerebrospinal fluid and/or serum samples were collected from AES patients as per WHO criteria and tested by ELISA, real-time PCR and bacterial culture sensitivity for various pathogens. PVB19 positive samples were subjected to sequencing. PVB19 attributed to 5% of total AES cases in the present study with fatalities in two of eight cases. Two isolates of PVB19 belonged to Genotype 1 A whereas one belonged to Genotype 3B. On multivariate analysis of predictive symptoms of PVB19 AES cases, blurring of vision (odds ratio [OR] 20.67; p = 0.001) was found to be significant independent predictor of PVB19 AES. Six of eight patients (two encephalitis specific and four nonspecific) had abnormal radiological findings. Hence, being an emerging viral pathogen, PVB19 should be included in the diagnostic algorithm of AES for prompt diagnosis and definitive management to prevent undesired neurological sequelae.
Insights
Human parvovirus B19 (PVB19) is an emerging cause of acute encephalitis syndrome (AES). Early inclusion in diagnostic testing is crucial for prompt management and preventing neurological damage.
Area of Science:
- Neurovirology
- Infectious Diseases
Background:
- Human parvovirus B19 (PVB19) is increasingly recognized as a cause of acute encephalitis syndrome (AES).
- PVB19 is often tested for only after other common pathogens are ruled out.
Purpose of the Study:
- To correlate clinical, radiological, and sequencing data to establish the role of PVB19 in AES.
- To identify predictive symptoms and outcomes associated with PVB19 in AES cases.
Main Methods:
- Cerebrospinal fluid and/or serum samples from AES patients were tested using ELISA, real-time PCR, and bacterial culture.
- PVB19 positive samples underwent sequencing.
- Multivariate analysis was performed to identify predictive symptoms.
Main Results:
- PVB19 accounted for 5% of AES cases, with a 25% fatality rate (2 of 8 cases).
- PVB19 isolates were Genotype 1A (two) and Genotype 3B (one).
- Blurred vision was a significant predictor of PVB19 AES (OR 20.67, p=0.001).
- Six of eight patients showed abnormal radiological findings.
Conclusions:
- PVB19 is an emerging viral pathogen contributing to AES.
- PVB19 should be incorporated into the diagnostic algorithm for AES for timely diagnosis and management.
- Prompt diagnosis and management can prevent neurological sequelae.
