High Prevalence of Human Parvovirus B19 DNA in Myocardial Autopsy Samples from Subjects without Myocarditis or Dilative Cardiomyopathy

Abstract

Human parvovirus B19 has been linked to a variety of cardiac diseases, as well as to erythema infectiosum, acute arthropathy, and fetal hydrops. A causal association between viral infection and cardiac disease was frequently postulated following the detection of B19 DNA by PCR in endomyocardial biopsy specimens. Since the lifelong persistence of B19 DNA in bone marrow, skin, synovia, tonsils, and liver was previously reported, the aim of our study was to investigate the possibility of asymptomatic B19 DNA persistence in heart tissue. Myocardial autopsy and postmortem blood samples were prospectively collected from 69 bodies sent to the Department of Forensic Medicine, Freiburg University Medical Center, for inquests. All study subjects were screened for B19-specific antibodies using a commercial enzyme immunoassay. Tissue samples were analyzed by real-time PCR for the presence of viral DNA. Since the presence of B19 genotype 2, known to have been circulating before 1960, would prove long-lasting persistence, the presence of the B19 genotype was retrospectively determined in seven of the study subjects by melting temperature analysis and sequencing of the PCR product. B19 DNA was found in myocardial samples from 46 of 48 seropositive and in none of 21 seronegative individuals. B19 genotype 1 was found in three patients born between 1950 and 1969. Genotype 2 was found in four patients born between 1927 and 1957. Our findings suggest lifelong persistence of B19 DNA in heart tissue. Thus, the detection of B19 DNA in myocardial biopsy specimens alone is not sufficient to postulate a relationship between B19 infection and cardiac disease.

The effects of co-infection with human parvovirus B19 and Plasmodium falciparum on type and degree of anaemia in Ghanaian children

“…In the absence of B19 IgG and IgM data in this study and in view of the current consensus that the duration of B19V viraemia is much longer than expected [73][74][75][76][77] . A box plot was generated to determine the distribution of B19V infection (Figure 3).…”

DCMP as a Clinical Syndrome: Results of Nosological Diagnostics With Myocardial Biopsy and Differentiated Treatment in Virus-Positive and Virus-Negative Patients

“…Однако в литера-туре неоднократно показано, что у пациентов без воспалительных заболеваний сердца (врожденные пороки сердца, ишемическая КМП, любая диастоли-ческая ХСН, операции на открытом сердце у пациен-тов без ДКМП), и даже в общей популяции, частота обнаружения вирусного генома, особенно парвови-руса В19, составляет 17-95% [21][22][23][24][25] и едва ли не пре-восходит таковую у пациентов с синдромом ДКМП. В собственном исследовании мы получили этому подтверждение [4]: в группе сравнения у больных без систолической дисфункции, оперированных на открытом сердце по поводу ИБС, пороков сердца и ГКМП, вирусный геном был выявлен в 66% био-птатов, однако морфологические признаки миокар-дита -только в 24%.…”

Pathophysiological Mechanisms of Parvovirus B19 Infection

“…The presence of B19V DNA was highly associated with B19V immunoglobulin G (IgG) seropositivity, and the prevalence corresponded to the previously reported prevalence in patients presenting with AMC and DCM, who had viral loads comparable to those in the samples evaluated by Schenk et al The distribution of B19V genotypes was age related according to the known epidemiological shift. The authors conclude that the detection of B19V genomes in myocardial tissues by PCR has to be interpreted carefully and is not proof of a causal relationship between B19V infection and cardiac disease (14). These data indicate the necessity of additional diagnostic parameters apart from the mere PCR amplification of B19V DNA, the quantification of the B19V load, and genotype analysis for establishing the etiopathogenic link of B19V infection to AMC and DCM.…”

“…The publication by Schenk et al (14) will likely induce more holistic investigations to unravel the still intriguing link between B19V and AMC/DCM. The differentiation of biologically relevant B19V infections from asymptomatic B19V persistence may ultimately be of paramount importance for the selection of patients with B19V myocardial infections, who may be suitable candidates for antiviral treatment strategies.…”