Human parvovirus B19 infection in organ transplant recipients

Abstract

We report a 61-yr-old kidney transplant recipient with human Parvovirus B19 (HPV B19) infection presenting as a severe pancytopenia 1 month after transplantation. Bone marrow aspiration revealed severe erythroid hypoplasia with giant and dystrophic proerythroblasts. Bone marrow cells were positive for HPV B19 DNA detected by polymerase chain reaction (PCR). Pancytopenia resolved shortly after administration of intravenous immunoglobulins. Nineteen cases of HPV B19 infection in organ transplant recipients have been so far reported in the literature. Immunocompromised patients should be considered at risk from developing symptomatic HPV B19 infections. In such patients, specific anti-HPV B19 IgM and IgG antibodies may be absent or transient and therefore their negativity cannot rule out the diagnosis of HPV B19 infestation. Bone marrow smear morphological findings may suggest the diagnosis but testing for viral DNA by PCR is mandatory. Patients may spontaneously recover. However, since specific anti-viral therapy is not currently available, intravenous immunoglobulin administration appears to be the more efficacious treatment.

Parvovirus B19 and the Kidney

“…The mechanism for this difference, if it is real, remains unknown. Spontaneous recovery has also been reported in some patients without therapy (77,83).…”

“…Therefore, B19 is often not considered in the very long list of causes of anemia, which include acute and chronic blood loss, generalized bone marrow suppression from immunosuppressants and antiviral medications, allograft dysfunction, iron deficiency, hyperparathyroidism, use of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, and other, more common viral infections, such as cytomegalovirus. Furthermore, neutropenia, thrombocytopenia, or pancytopenia may occasionally accompany the anemia, further broadening the differential diagnosis (77). Other clinical complications that have been linked with B19 infection in renal transplant recipi-ents include liver dysfunction (84), fibrosing cholestatic hepatitis (85), encephalitis (86), and cerebral vasculitis (87).…”

“…Because of the inability to mount an efficient humoral and/or cellular immune response, viral clearance is significantly delayed, or, in some cases, infection remains persistent, resulting in prolonged suppression of erythropoiesis. Therefore, it is not surprising that both acute anemia and chronic pure red blood cell aplasia are the most frequently reported consequences of B19 infection in organ transplant recipients (21,77,78,81,83). Several case series have evaluated the incidence of active B19 infection in renal transplant patients who present with anemia.…”

Advances in Human B19 Erythrovirus Biology

“…B19V infection can also cause acute anemia by aplastic crisis in patients whose red blood cells have shortened survival times (i.e., patients with sickle cell disease, thalassemia, spherocytosis, or any disorder of hemoglobin gene expression or red cell membrane constitution), chronic anemia in patients with congenital immunodeficiencies or human immunodeficiency virus (HIV) infection or who are undergoing chemotherapy for malignancies or organ transplants (48,58), and hydrops fetalis or intrauterine death in infected fetuses (86). Recently, cases of neurological manifestations have been associated with B19V infection (22), as have myocardium infections (4,5,47,83), and the spectrum of B19V-linked diseases may further increase.…”

Passive Immunity in Prevention and Treatment of Infectious Diseases

“…Since the immune response to parvovirus includes the development of neutralizing antibodies, immunodeficient pa-tients may become chronically infected, usually manifested by pure red cell aplasia. Patients with congenital or acquired immunodeficiencies, including HIV-infected individuals (38,95,194), organ transplant recipients (105), and patients receiving cytotoxic or immunosuppressive therapy (194), may develop chronic parvovirus infection. IVIG is an excellent source of parvovirus B19-specific IgG (151), and many case reports attest to its value in the treatment of parvovirus infection.…”