Journal of Global Infectious DiseasesOfficial Publishing of INDUSEM and OPUS 12 Foundation, Inc. Users online:767  
Print this pageEmail this pageSmall font sizeDefault font sizeIncrease font size     
Home About us Editors Ahead of Print Current Issue Archives Search Instructions Subscribe Advertise Login 
 


 
   Table of Contents     
LETTER TO EDITOR  
Year : 2013  |  Volume : 5  |  Issue : 3  |  Page : 124
Parvovirus B19 infection in pediatric patients with hematological disorders


1 Department of Virology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
2 Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
3 Department of Hematology, Post Graduate Institute of Medical Education and Research, Chandigarh, India

Click here for correspondence address and email

Date of Web Publication23-Aug-2013
 

How to cite this article:
Singhal L, Mishra B, Trehan A, Varma N, Marwaha R K, Ratho RK. Parvovirus B19 infection in pediatric patients with hematological disorders. J Global Infect Dis 2013;5:124

How to cite this URL:
Singhal L, Mishra B, Trehan A, Varma N, Marwaha R K, Ratho RK. Parvovirus B19 infection in pediatric patients with hematological disorders. J Global Infect Dis [serial online] 2013 [cited 2019 Oct 20];5:124. Available from: http://www.jgid.org/text.asp?2013/5/3/124/116881


Sir,

Parvovirus B19 (PVB19) is a childhood infectious disease of global proportions. It has specificity for red blood cell precursors and acute infection causes cessation of erythropoiesis for 5-7 days. Apoptosis of red cell precursors in the bone marrow decreases the hemoglobin level for 1-2 weeks until the bone marrow recovers. [1] Children with hematological malignancies receiving chemotherapy and children with chronic hemolytic disorders are at a higher risk of acquiring PVB19 infection. [1] We aimed to study the frequency of acute PVB19 infection and its implications in 50 children (age ≤ 15 years) with various hematological disorders in the period between January 2009 and July 2011. These included: aplastic anemia/pancytopenia 31), thalassemia (2), immune thrombocytopenia (ITP) (8), Henoch-Schönlein purpura (HSP) (2), leukemia (6), and Hodgkins lymphoma (1). Fifty febrile children with no hematological disorders were included as a control group. These children were assessed clinically and the serum samples were collected and tested for presence of anti-PVB19-specific IgM antibody by ELISA (NovaTec Immunodiagnostics, Germany). Recent PVB19 infection, as determined by the presence of serum IgM antibodies, was found in 20 percent (10/50) of these children with hematological disorders compared to none in the control group. All PVB19-infected children presented with fever and a sudden unexplained worsening of anemia. PVB19 infection was considered when the children had a sudden increase in need of blood transfusions of up to once a week during the non-intensive phase of chemotherapy in the absence of any obvious infection/blood loss. There was no other symptom. No child with PVB19 died. All patients showed marked improvement with increase in hemoglobin over a period of 3-6 weeks. Management was supportive in the form of blood transfusions. One child was given Intra Venous Immunoglobulin (IVIg). It is known that individuals with decreased erythrocytosis seen in chronic hemolytic disorders, such as thalassemia, autoimmune hemolytic anemia, and in children with hematological malignancies who are anemic due to malignant infiltration of bone marrow and cytotoxic drugs, can develop transient aplastic crisis if infected with PVB19. [2],[3],[4] This virus has specificity for red blood cell precursors and can cause a complete cessation of erythrocyte production. This can aggravate anemia, worsen the general condition of patients, and in severe cases can lead to life-threatening complications such as circulatory collapse, congestive heart failure, cerebrovascular accident, or acute splenic sequestration [1] Serum PVB19-DNA and specific IgM can be determined for accurate diagnosis. However, since DNA may circulate for a few days (7-12 days) only, detection of IgM antibodies is a more reliable indicator of recent PVB19 infection. [5]

In the present study, 20% of children with hematological disorders were found to be PVB19 IgM positive and this infection likely contributed to aggravation of anemia. Acute PVB19 should be suspected when there is unexplained worsening of anemia requiring increased frequency of blood transfusions or in aplastic crisis in children with hematological disorders. Early detection and treatment are essential to limit the effects of associated complications.

 
   References Top

1.Heegaard ED, Brown KE. Human parvovirus B19. Clin Microbiol Rev 2002;15:485-505.  Back to cited text no. 1
[PUBMED]    
2.El-Mahallawy HA, Mansour T, El-Din SE, Hafez M, Abd-el-Latif S. Parvovirus B19 infection as a cause of anemia in pediatric acute lymphoblastic leukemia patients during maintenance chemotherapy. J Pediatr Hematol Oncol 2004;26:403-6.  Back to cited text no. 2
[PUBMED]    
3.Pattison JR, Jones SE, Hodgson J, Davis LR, White JM, Stroud CE, et al. Parvovirus infections and hypoplastic crisis in sickle-cell anaemia. Lancet 1981;1:664-5.  Back to cited text no. 3
[PUBMED]    
4.Lefrere JJ, Courouce AM, Girot R, Cornu P. Human parvovirus and thalassaemia. J Infect 1986;13:45-9.  Back to cited text no. 4
[PUBMED]    
5.Arya LS, Seth R, Seth T. Childhood malignancies. In: Ghai OP, Paul VK, Bagga A, editors. Essential Pediatrics. New Delhi: CBS Publisher; 2009. p. 580-97.  Back to cited text no. 5
    

Top
Correspondence Address:
Baijayantimala Mishra
Department of Virology, Post Graduate Institute of Medical Education and Research, Chandigarh
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-777X.116881

Rights and Permissions




 

Top
  
 
  Search
 
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Email Alert *
    Add to My List *
* Registration required (free)  


    References

 Article Access Statistics
    Viewed1191    
    Printed29    
    Emailed1    
    PDF Downloaded14    
    Comments [Add]    

Recommend this journal

Sitemap | What's New | Feedback | Copyright and Disclaimer | Contact Us
2008 Journal of Global Infectious Diseases | Published by Wolters Kluwer - Medknow
Online since 10th December, 2008