Clinical impact & pathogenic mechanisms of human parvovirus B19: A multiorgan disease inflictor incognito

Abstract

Human parvovirus B19 (B19V) causes myriads of clinical diseases; however, owing to lack of awareness and undetermined clinical impact, it has failed to become a virus pathogen of global concern. Cryptically, B19V causes significant morbidity and mortality. Half of the world population and 60 per cent of Indians are known to be serologically naive and are at risk of acquiring B19V infections. Cumulatively, our data showed 21.3 per cent B19V-infected patients with juvenile chronic arthropathy, recurrent abortions, multi-transfused thalassaemia and leukaemia. In addition, B19V-infected cases that ended fatally included patients with pure red cell aplasia, fulminant hepatitis and haemophagocytic syndrome. Novel clinical associations of B19V observed were amegakaryocytic thrombocytopaenia, myositis and non-occlusive ischaemic gangrene of bowel. B19V possesses multiple receptors which are distributed widely in human tissues. Vascular endothelial cell infection by B19V causes endothelialitis and vasculitic injuries besides antibody-dependent enhancement which empowered B19V to cause multiorgan diseases. Owing to lack of suitable animal model for B19V, true causal role remains to be determined, but numerous reports on B19V infections substantiate a causal role in multiorgan diseases. Hence, B19V infections need to be recognized, investigated and treated besides making efforts on vaccine developments.

Acute human parvovirus B19 infection triggers immune‐mediated transient bone marrow failure syndrome, extreme direct hyperbilirubinaemia and acute hepatitis in patients with hereditary haemolytic anaemias: multicentre prospective pathophysiological study

“…Regarding haematological affliction, a higher incidence of BMF was noted in the present study compared to previous reports. 3,15 BM examinations of our present cohort with pancytopenia showed several forms. Our findings support the previous reports that HPV-B19 did not target erythroid progenitor cells only, which may lead to TAC 16 and myelodysplasia, 17 but also non-erythroid cells such as megakaryocytes and leucocytic cells could be affected.…”

“…2 The presence and distribution of the P antigen may reflect a wide spectrum of disease manifestations and multiorgan affection. 3 Exposure to respiratory secretions is the most common means of transmission of this virus. Infection is associated with a variety of manifestations ranging from asymptomatic, common manifestations (pyrexia, malaise, erythema infectiosum, arthralgia or arthritis or subclinical erythroid aplasia, and pure red cell aplasia in immunocompromised patients) to severe complications (myocarditis, glomerulonephritis, acute hepatitis, vasculitis, myositis and nervous system involvement).…”

“…It can also cause a sudden decrease in haemoglobin (Hb), reticulocytopenia, and erythropoiesis suppression translated into a life-threatening transient aplastic crisis (TAC) in patients with HHA. 3 Although many studies investigated the prevalence and manifestations of HPV-B19 infection in patients with SCA, 7,8 thalassaemia 9,10 and HS [11][12][13] separately, there is limited information about the extent to which HPV-B19 infection leads to severe complications and chronic infection. There are no prospective comparative studies that have investigated the risks associated with this pathogenic virus and predicted the course of disease and morbidity among patients with HHA categorised by their underlying diseases.…”

A Meta-Analysis on the Seroprevalence of Parvovirus B19 among Patients with Sickle Cell Disease

“…It is a very stable virus and resistant to standard procedures for physical inactivation with detergents or heat [7–10]. B19 V infection had been reported globally, and it is most commonly transmitted as droplet infections through the respiratory secretion, or vertically through the placenta to the fetus, and through bone marrow and organ transplantations [10–12]. Diagnostic tests used for confirmation of B19 V include serum specific IgG antibodies testing which is used to confirm an exposure to B19 V infection, serum IgM antibodies testing which is recommended to diagnose acute viral infection and remain detectable several months after infection, and other diagnostic tests such as viral DNA detection by using the PCR technique [7, 11, 13].…”

“…B19 V infection had been reported to be more frequent with serious clinical outcomes in SCD patients than in the general population [5, 8, 11, 12, 14]. In SCD patients, an acute B19 V infection can precipitate prolonged vaso-occlusive crisis resulting in splenic sequestration, glomerulonephritis, cerebrovascular accident, myocarditis, and fatal bone marrow embolism [15].…”