Molecular and clinical evaluation of the acute human parvovirus B19 infection: comparison of two cases in children with sickle cell disease and discussion of the literature

Abstract

Human parvovirus B19 is a well-known cause of severe conditions in patients with sickle cell disease, but the molecular mechanisms of the infection are insufficiently understood. The different clinical outcome of the acute parvovirus B19 infection in two pediatric patients with sickle cell disease has been examined. One of them developed life-threatening condition requiring emergency transfusions, while the other had asymptomatic infection, diagnosed occasionally. Both cases had high viral load and identical subgenotype, indicating that the viral molecular characteristics play a minimal role in the infection outcome.

Transient red cell aplasia in two brothers with sickle cell anemia and erythrovirus B19 infection

“…Different degrees of baseline hemoglobin concentration, virus load, virus genotypes or other unknown factors could explain this observation, although genotype and virus load were the same in both children during a nosocomial B19V outbreak, one child with very severe manifestations and the other with an asymptomatic course 11 . It is interesting to note that the diagnosis of acute transient aplastic crisis in children with SCA who are being treated with hydroxyurea is not different to those who are not being treated with hydroxyurea.…”

Review: Pathogenesis of Parvovirus Infections in Children

“…However, they found a decrease in viral excretion at the onset of this skin manifestation, reflecting the fact that antibodies have been formed at this stage of disease and children are normally no longer infectious by the time the diagnosis is made [18]. On the contrary, Slavov et al [27] found no correlation between viral load and disease severity, though based on only 2 cases. For HBoV1 up to this point, no correlation has been found between viral load and clinical presentation [29].…”

“…As described in the introduction, multiple genotypes of the parvovirus B19, HBoV and PARV4 have been found to date. In parvovirus B19 infection this genetic heterogeneity has not been linked to differences in clinical presentation [26,27]. In HBoV the different genotypes do give different clinical manifestations; respiratory symptoms in HBoV1 and gastrointestinal tract symptoms in HBoV2-4 [15].…”

Characterization of Markers of the Progression of Human Parvovirus B19 Infection in Virus DNA-Positive Plasma Samples

“…B19V has a tropism to the progenitor cells of erythrocytes and replicates in erythrocyte precursor cells in the bone marrow. Although virus replication is associated with a cytopathic effect [1], the majority of B19V infections take a clinical asymptomatic course; however, in some patient groups (e.g., pregnant women, patients with hemophilia, immunodeficient patients, and fetuses) B19V infection may take a more severe course [2,3]. B19V is a prevalent worldwide infection common in humans.…”