Neurological aspects of human parvovirus B19 infection: a systematic review

Abstract

Parvovirus B19 has been linked with various clinical syndromes including neurological manifestations. However, its role in the latter remains not completely understood. Although the last 10 years witnessed a surge of case reports on B19-associated neurological aspects, the literature data remains scattered and heterogeneous, and epidemiological information on the incidence of B19-associated neurological aspects cannot be accurately extrapolated. The aim of this review is to identify the characteristics of cases of B19-associated neurological manifestations. A computerized systematic review of existing literature concerning cases of B19-related neurological aspects revealed 89 articles describing 129 patients; 79 (61.2%) were associated with CNS manifestations, 41 (31.8%) were associated with peripheral nervous system manifestations, and 9 (7.0%) were linked with myalgic encephalomyelitis. The majority of the cases (50/129) had encephalitis. Clinical characteristic features of these cases were analyzed, and possible pathological mechanisms were also described. In conclusion, B19 should be included in differential diagnosis of encephalitic syndromes of unknown etiology in all age groups. Diagnosis should rely on investigation of anti-B19 IgM antibodies and detection of B19 DNA in serum or CSF. Treatment of severe cases might benefit from a combined regime of intravenous immunoglobulins and steroids. To confirm these outcomes, goal-targeted studies are recommended to exactly identify epidemiological scenarios and explore potential pathogenic mechanisms of these complications. Performing retrospective and prospective and multicenter studies concerning B19 and neurological aspects in general, and B19 and encephalitic syndromes in particular, are required. © 2014 The Authors. Reviews in Medical Virology published by John Wiley & Sons, Ltd.

Acute Parvovirus B19 Infection in Adults: A Retrospective Study of 49 Cases

“…13 Little has been published on the treatment of acute parvovirus B19 infection, probably because when the infection does cause symptoms, these tend to be self-limiting. 34 In our series, clinical improvement occurred rapidly in patients treated with systemic corticosteroids. 13,31 Long-term administration of systemic corticosteroids has been associated with an increased risk of infections.…”

“…Possible signs of persistent infection were present in immunodepressed patients, coinciding with observations in the majority of reports published. 33 However, in a systematic review of parvovirus B19 infection associated with neurological manifestations, Barah et al 34 reported that a combined regimen of systemic corticosteroids and immunoglobulin infusion therapy was effective. A number of articles have described the successful use of immunoglobulin infusion therapy in the treatment of persistent infection.…”

Extra-haematological manifestations related to human parvovirus B19 infection: retrospective study in 25 adults

“…In our series, 52% patients presented manifestations other than joint or cutaneous features (i.e., renal, neurological, muscular, hepatic, pleuro-pericardial or splenic involvement), which highlights the need to seek these complications in patients with HPV-B19 infection. Of note, the present study adds a fifth case of Guillain-Barré syndrome related to HPV-B19 infection (patient 22) [31]. …”

Estudio retrospectivo de 49 casos de infección aguda por parvovirus B19 en adultos

“…Los corticoides sistémicos se relacionan, cuando son administrados durante largos periodos, con un aumento de la predisposición a padecer infecciones 33 . Sin embargo, en la revisión de Barah et al de los casos descritos en la literatura de infección por parvovirus B19 asociada a afectación neurológica, los corticoides sistémicos asociados a infusión de inmunoglobulinas aparecen como un tratamiento eficaz 34 . En nuestro estudio los pacientes que recibieron corticoterapia sistémica mejoraron clínicamente en un corto periodo de tiempo.…”