Fetal Brain Injury Associated with Parvovirus B19 Congenital Infection Requiring Intrauterine Transfusion

Abstract

Background: Infection with parvovirus B19 (B19V) during pregnancy may cause severe fetal anemia, hydrops, and fe tal death. Furthermore, neurodevelopmental impairment among survivors may occur despite appropriate prenatal management, including intrauterine transfusion (IUT). Objectives: Our primary objective was to describe cerebral lesions on MRI in fetuses with severe anemia requiring IUT for B19V infection. Our secondary objective was to search for clinical and biological characteristics associated with the occurrence of such lesions. Study Design: We performed a retrospective review of data on fetuses infected with B19V and requiring at least one IUT between 2005 and 2016. Fetuses with abnormal cerebral MRI results in the 3rd trimester were compared to those with normal MRI results. Results: Of 34 transfused fetuses, 26 children were born at full term. Five intrauterine fetal deaths, 1 neonatal death, and 2 terminations of pregnancy occurred. Cerebral anomalies were observed in 7/27 fetuses on MRI, including cerebellar hemorrhage or a small cerebellum. Only viral load in fetal blood appeared to be associated with brain lesions (11.5 log₁₀ copies/mL [10.5–12.5] in case of abnormal MRI results vs. 9.5 log₁₀ copies/mL [7.8–10.0]; p = 0.05). Conclusions: Among the fetuses transfused for B19V infection, 26% presented with prenatal abnormal cerebral imaging results. In our study, viral load in fetal blood appeared to be the only factor associated with fetal brain lesions.

Fetal MRI assessment of posterior fossa anomalies: A review

“…The presence of additional supratentorial clastic lesions, such as porencephalic cyst, supports the disruptive origin of the UCH and additional abnormalities of the eye and heart should raise the possibility of PHACE (posterior fossa anomalies, hemangioma, arterial anomalies, cardiac abnormalities/aortic coarctation, eye abnormalities) syndrome. Other published causes that may result in unilateral or asymmetric cerebellar hypoplasia include infection with parvovirus B19 (B19V) during pregnancy which may cause severe fetal anemia, hydrops, brain hemorrhage, and fetal death; 59 autosomal recessively inherited mutations in WNT1, 60,61 which plays a critical role in mid-hindbrain development and has recently been identified as a severe cause of osteogenesis imperfecta. This genetic correlation partially refutes the tendency to consider cerebellar hypoplasia as suggestive of a prenatal acquired (disruptive) origin in all cases.…”

Neurologic infections during pregnancy

“…Specifically there are case reports of neurologic anomalies from congenital parvovirus B19 infection, including hydrocephalus, cerebellar hemorrhage, and polymicrogyria ( Ornoy and Ergaz, 2017 ). In a retrospective review of 27 fetuses infected with parvovirus B19 who required at least 1 intrauterine transfusion for severe anemia, 26% had abnormal cerebral imaging in the third trimester, such as cerebellar biometry below the third percentile and uni- or bilateral cerebellar hemorrhage ( Maisonneuve et al, 2018 ). Viral load in fetal blood correlated with the presence of brain lesions, suggesting that there is direct brain injury caused by the virus.…”

Biometric assessments of the posterior fossa by fetal MRI: A systematic review

“…A total of 804 studies were initially screened and 59 publications were included in the final systematic review 4,5,7,15‐69 (Figure 1) (Table S1). Separate publications with duplicated data from those included were assessed 51,70‐80 …”