Atypical exanthems associated with Parvovirus B19 (B19V) infection in children and adults

Abstract

Parvovirus B19 (B19V) infection may differently manifest in various age groups. Erythema infectiosum ('fifth disease') is the most common B19V manifestations in children. Arthralgias and arthritis, with or without rash, are common manifestations of B19V infection in adults. Pruritus is usually present in adults and children. However, other cutaneous manifestations and atypical exanthems have been occasionally reported during B19V infection. To investigate the putative role of B19V infection in atypical exanthems, a total of 390 consecutive patients with atypical exanthems were analysed for B19V infection by determining B19V IgG and IgM antibodies titres in acute and convalescent phase as well as B19V DNA detection in serum by polymerase chain reaction (PCR). Atypical exanthems resulted related to B19V infection in 6 of the 120 pediatric (5%) and 14 of the 270 adult patients (5.2%). In conclusion this study reveals that atypical exanthems related to B19V infection are possible both in children and in adults, with a similar prevalence.

Detection of human parvovirus B19 DNA in 22% of 1815 cutaneous biopsies of a wide variety of dermatological conditions suggests viral persistence after primary infection and casts doubts on its pathogenic significance

“…Other dermatological conditions were later on associated with B19V infection in the light of serological proof of recent infection and/or PCR detection of B19V DNA (either in serum, tissue or both). There is no doubt that acute B19V infection brings about either atypical exanthemas or a variety of dermatological patterns, recently grouped by Mage et al . into exanthema (reticulated and annular), gloves‐and‐socks syndrome, periflexural and palpable purpura .…”

Prevalence and genotypic characterization of Human Parvovirus B19 in children with measles‐ and rubella‐like illness in Iran

“…This observation is in line with other studies that indicated the seroprevalence of B19V IgG ranged from 2 to 30% in children below 5 years old, 15–60% in children aged 5–19 years old, and up to 60% in adults. [Brown and Young, ; Shmoys and Kaplan, ; Servant‐Delmas et al, ; Drago et al, ].…”

“…The data from Real‐Time PCR demonstrated a decline in mean viral loads from early to late phase of acute infection (Table ). This decline can be attributed to the development of humoral immune responses against B19V, as the emergence of anti‐B19V IgM antibodies is associated with virus clearance [Drago et al, ]. In addition, commercial antibodies have been shown to be highly effective for treating B19V infection in immunocompromised patients [Mouthon et al, ].…”

Human Parvoviruses

“…Variants in the stereotypical pattern of cutaneous eruption (416)(417)(418)(419) have attracted the attention of dermatologists, usually as "glove-and-socks" syndromes (420,421). The characteristic distribution of glove and socks can be seen with papular, petechial, pustular, and bullous morphologies (422)(423)(424)(425)(426)(427)(428), even desquamation (429); concurrently in family members (430); and with oral lesions (431), lymphangitis (432), and vasculitic features (see below).…”