Identification and characterization of acute infection with parvovirus B19 genotype 2 in immunocompromised patients in Poland

Abstract

Parvovirus B19 (B19V) is divided into three genotypes. Genotypes 2 and 3 may cause diagnostic difficulties and their epidemiology is not well understood. In the present study the prevalence of B19V genotypes in patients with symptomatic infection in Poland was evaluated and the course of infection in patients infected with non-genotype 1 strains is described. Real-time PCR, able to detect all three genotypes of B19V was used to screen patient plasma samples. Sixty-nine, mainly acute-phase B19V DNA positive cases were identified in patients from hematological and obstetric/gynecological wards between 2004 and 2008. Thirty patients were studied in greater detail and genotyping was performed by analysis of the NS1/VP1u region. The majority of samples were genotype 1. However two (6.6%) strains were identified as genotype 2, associated with high viremia and identified in a kidney transplant recipient with anemia and a leukemia patient, following chemotherapy, with pancytopenia. A change of immunosuppression treatment in the former and treatment with intravenous immunoglobulin in latter, resulted in normalization of clinical parameters, and whilst viral loads fell, B19V DNA was still detectable. The kidney transplant recipient subsequently became pregnant with no clinical complications, although persistently infected with B19V genotype 2. This is the first description of symptomatic cases of genotype 2 B19V infection in Eastern Europe suggesting that acute infection, particularly among immunocompromised patients with these virus strains may be more prevalent than thought.

Human parvovirus B19: A review

“…Reduction of immunosuppressive medication is often recommended in addition to IVIG (or without IVIG in less severe cases) to allow the patient's own immune response to mature and neutralize the virus (Bertoni et al, 1997;Lamont et al, 2011). Several reports have concluded that symptomatic B19V infection is linked specifically to the use of tacrolimus rather than the overall state of immunosuppression (Grabarczyk et al, 2011). This is based on the observations that a switch from tacrolimus to cyclosporine was followed by viral clearance and complete resolution of anemia in some patients (Pamidi et al, 2000).…”

Parvovirus B19 Achievements and Challenges

“…The prototype genotype 1a is the major circulating genotype and is present in all geographic areas [27]. The variant genotype 2 is rare but can be sporadically detected in different geographic settings including Europe [29][30][31]. The variant genotype 3, in its two subtypes, can be detected at higher frequency in western Africa, where it may constitute the prevalent genotype [23], and at lower frequencies in other geographic areas.…”

Human parvovirus B19 genotype 3 associated with chronic anemia after stem cell transplantation, missed by routine PCR testing

“…15,16 Genotype 2 was presumably endemic in Northern Europe until half a century ago 16,17 and is sporadically found nowadays, e.g. in Poland, 18 South-Africa, 19 and Germany. 3 Genotype 3 was the only human Erythrovirus genotype detected in 13 DNA positive blood samples from 1000 volunteer blood donors in Ghana.…”