Severe Anemia Caused by Human Parvovirus in a Leukemia Patient on Maintenance Chemotherapy

Smith, Malcolm A.; Shah, Narayan R.; Lobel, Jeffrey S.; Peter, J.; Gary, G. William; Anderson, Larry J.

doi:10.1177/000992288802700806

Cited by 52 publications

(22 citation statements)

References 22 publications

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“…18:97-98, 1996), and anemia may promptly remit after immunoglobulin (109,262) or antiviral chemotherapy (in HIV patients) (1,56,219,290). Temporary cessation of maintenance chemotherapy has also led to resolution of anemia (315).…”

Section: Infection In the Immunodeficient Hostmentioning

confidence: 99%

Human Parvovirus B19

2002

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Parvovirus B19 (B19) was discovered in 1974 and is the only member of the family Parvoviridae known to be pathogenic in humans. Despite the inability to propagate the virus in cell cultures, much has been learned about the pathophysiology of this virus, including the identification of the cellular receptor (P antigen), and the control of the virus by the immune system. B19 is widespread, and manifestations of infection vary with the immunologic and hematologic status of the host. In healthy immunocompetent individuals B19 is the cause of erythema infectiosum and, particularly in adults, acute symmetric polyarthropathy. Due to the tropism of B19 to erythroid progenitor cells, infection in individuals with an underlying hemolytic disorder causes transient aplastic crisis. In the immunocompromised host persistent B19 infection is manifested as pure red cell aplasia and chronic anemia. Likewise, the immature immune response of the fetus may render it susceptible to infection, leading to fetal death in utero, hydrops fetalis, or development of congenital anemia. B19 has also been suggested as the causative agent in a variety of clinical syndromes, but given the common nature, causality is often difficult to infer. Diagnosis is primarily based on detection of specific antibodies by enzyme-linked immunosorbent assay or detection of viral DNA by dot blot hybridization or PCR. Treatment of persistent infection with immunoglobulin reduces the viral load and results in a marked resolution of anemia. Vaccine phase I trials show promising results

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Section: Infection In the Immunodeficient Hostmentioning

confidence: 99%

Human Parvovirus B19

2002

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“…We could not detect B19 IgM and B19 DNA in our B19 IgG-seropositive patients, indicating that their B19 infection likely occurred at least 2 months before blood sampling. Unexplained anemia frequently developed 3 to 4 months after the start of chemotherapy in our patients, and the timing appeared to correlate approximately with the development of B19 infection in immunocompromised hosts (4,7,17,25,28,30). Since the mean duration between the onset of unexplained anemia and the date of blood sampling was 6.5 Ϯ 2.7 months in this study, IgM tests and nested PCR may both yield negative results for sera from patients with B19 infection that began 2 to 6 months earlier.…”

Section: Discussionmentioning

confidence: 51%

Increased Risk of Parvovirus B19 Infection in Young Adult Cancer Patients Receiving Multiple Courses of Chemotherapy

Kuo

Lin²,

Chang

et al. 2002

J Clin Microbiol

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An increased human parvovirus B19 infection rate has been observed in immunocompromised hosts. In this study, we sought to determine the prevalence of parvovirus B19 infection in adult cancer patients receiving multiple courses of systemic chemotherapy. From March 1999 through April 2000, 59 men and 68 women, with a median age of 49 (18 to 79) years, were enrolled in this study. They had received an average of 7.1 (4 to 32) courses of systemic chemotherapy. The median duration from the date of starting chemotherapy to the date of blood sampling was 11 (4 to 88) months. Serum B19 immunoglobulin G (IgG) and IgM levels were examined by an enzyme-linked immunosorbent assay, and B19 DNA was examined by a nested PCR. A group of 400 healthy blood donors served as the control group. The overall prevalences of anti-B19 IgG in adult cancer patients and healthy blood donors were 61.4 and 25.0%, respectively (P < 0.01). Anti-B19 IgM and B19 DNA were not detectable in these anti-B19 IgG-seropositive individuals. A further age-stratified comparison revealed that only patients younger than 40 years had a significantly higher anti-B19 IgG seropositivity rate than the controls (19 of 39 versus 53 of 310; P < 0.001). The increased prevalence of B19 infection in these 39 adult patients younger than 40 years might be clinically significant, since unexplained anemia, a common sequela of B19 infection, was detected in 3 of 20 seronegative patients (15.0%) and in 12 of 19 seropositive patients (63.2%) (P < 0.005). The results of this study suggest that adult patients younger than 40 years and receiving multiple courses of systemic chemotherapy may have a significantly increased risk of B19 infection. Prospective studies to define the time course and clinical consequence of B19 infection in this group of patients are needed.Human parvovirus B19, the only parvovirus known to be pathogenic for humans, is a small DNA virus with a singlestranded linear genome which encodes one nonstructural protein, NS-1, and two viral capsid proteins, VP1 (83 kDa) and VP2 (58 kDa) (23). The virus exhibits a remarkable tropism for erythroid progenitor cells (6) and is frequently associated with anemia. Parvovirus B19 infection has also been implicated in a wide range of clinical manifestations, the outcome of which depends heavily on the physiologic status of the individual and the immune response against the virus (29).In immunologically healthy hosts, B19 may cause a number of acute, generally self-limiting diseases, notably, fifth disease or erythema infectiosum in children, acute polyarthritis in adults, and aplastic crisis in patients with chronic hemolytic anemia such as sickle cell anemia or hereditary spherocytosis (3,15,24,26). In pregnant women, B19 infection may result in the lysis of nucleated fetal red cells, hydrops fetalis, and subsequent spontaneous abortion and fetal death (16). B19 also has been found to be associated with glomerulonephritis, vasculitis, peripheral neuropathies, myocarditis, and fulminant hepatic failure (31). In immunoco...

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“…Administration of Ig can be beneficial but is not always curative. Temporary cessation of maintenance chemotherapy has also led to resolution of the anemia [80,, 81].…”

Section: Chronic Bone Marrow Failurementioning

confidence: 99%

Parvoviruses and Bone Marrow Failure

Brown

Young

1996

STEM CELLS

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Parvovirus B19, the only known human pathogenic parvovirus, is highly tropic to human bone marrow and replicates only in erythroid progenitor cells. The basis of this erythroid tropism is the tissue distribution of the B19 cellular receptor, globoside (blood group P antigen). In individuals with underlying hemolytic disorders, infection with parvovirus B19 is the primary cause of transient aplastic crisis. In immunocompromised patients, persistent B19 infection may develop that manifests as pure red cell aplasia and chronic anemia. B19 infection in utero can result in fetal death, hydrops fetalis or congenital anemia. Diagnosis is based on examination of the bone marrow and B19 virological studies. Treatment of persistent infection with immunoglobulin leads to a rapid, marked resolution of the anemia.

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Severe Anemia Caused by Human Parvovirus in a Leukemia Patient on Maintenance Chemotherapy

Cited by 52 publications

References 22 publications

Human Parvovirus B19

Human Parvovirus B19

Increased Risk of Parvovirus B19 Infection in Young Adult Cancer Patients Receiving Multiple Courses of Chemotherapy

Parvoviruses and Bone Marrow Failure

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