Secondary Symptomatic Parvovirus B19 Infection in a Healthy Adult

Abstract

Parvovirus B19 is a common infection in adults and children. There are reports of secondary parvovirus infection in immunocompromised persons, but no reports of symptomatic secondary infection in healthy persons. We describe a healthy 39-year-old woman who presented with fever, rash, and arthralgia. Her symptoms were thought most compatible with parvovirus B19 infection, but she reported prior positive parvovirus antibody 2 years earlier during prenatal care. Tests were therefore also sent for HIV, streptococcal infection, hepatitis C, and Lyme disease. Testing revealed both elevated IgG and IgM antibodies for parvovirus B19; previously, the patient was positive only for IgG. On a subsequent visit she related that a community outbreak of parvovirus developed in her town and church group. We believe this case demonstrates that a symptomatic secondary infection with parvovirus can occur in healthy persons, and that prior positive antibody test does not preclude the development of acute infection.

Sample size calculation for estimating key epidemiological parameters using serological data and mathematical modelling

“…The precision of the estimated overall force of infection was better when using the survey-based age structure for VZV infection, in both models used (Figure 3, Tables S8-9) and for parvovirus B19 infection under the MSIRWb-ext AW model, and using a uniform or population-based age structure for parvovirus B19 infection in the two other models used (Figure 4, Tables S10-12). 15 For all the pathogens, as could be expected given the oversampling in children and adolescents in the survey-based age structure, the precision of the estimated seroprevalence by age group was better when using the survey-based age structure in the young age groups and the uniform or population-based age structure for the oldest age groups (see Tables S5-S12 in the Supplementary Material). The same pattern was observed for the force of infection of VZV and parvovirus B19 by age group (see Tables S8-S12 in the Supplementary Material).…”

“…We considered a third model for parvovirus B19 infection, a mathematical model allowing for boosting and waning immunity, since lifelong protection against infection upon recovery from parvovirus B19 is questionable. [14][15][16][17] Goeyvaerts et al 18 considered several extensions of the MSIR model to account for waning of disease-acquired antibodies and/or for boosting of low immunity by exposure to infectious individuals. Here, we used the model with the best Akaike information criterion (AIC) value which was the compartmental model allowing for age-specific waning of disease-acquired antibodies and boosting of low immunity, denoted by "MSIRWb-ext AW" (see the Supplementary Material).…”

Parvovirus B19 Infection in Solid Organ Transplantation: Report of A Case and A Review

“…It is less clear how to define instances of secondary parvovirus B19 infection in which there is production of IgM and high viral load despite pre-existing evidence of IgG antibodies. In such cases, experts have offered conflicting explanations of latent viral reactivation versus secondary infection [25,[31][32][33][34][35][36][37]. One case report [35] performed genomic sequencing of the parvovirus B19 DNA and found that the patient was infected with the same rare genotype 2 on multiple occasions of viremia, which supports the explanation of reactivation, as it would be unlikely to encounter genotype 2 on multiple occasions.…”

“…One case report [35] performed genomic sequencing of the parvovirus B19 DNA and found that the patient was infected with the same rare genotype 2 on multiple occasions of viremia, which supports the explanation of reactivation, as it would be unlikely to encounter genotype 2 on multiple occasions. Other case reports describe a second acute parvovirus infection (with IgM and DNA viremia) in a healthy individual with existing IgG in the setting of community outbreak, but the higher incidence of recurrent infections in immunocompromised individuals suggests an immune defect (or immunosuppression effect) leading to susceptibility [31,32,34,36]. A study of 126 serum samples analyzed with real-time multiplex viral PCR quantification assays found a low level B19 viremia of 0.8% among the cohort, suggesting that this virus can become latent, similar to related DNA viruses [37,38] One argument against the potential for parvovirus B19 to reactivate is that the virus seems uncommon in elderly individuals, unlike other DNA viruses that are known to reactivate, such as VZV and adenovirus.…”

“…Parvovirus is one of the viruses, along with herpesviruses, adenoviruses, and polyoma viruses, which can establish latency and reactivate when the host immune system is depressed [38]. Secondary symptomatic infection may also occur in patients with prior infection, and this has been reported in both immune competent and immune deficient individuals [31]. Acute primary infection in adults, including transplant patients, can also occur.…”