RESUMEN
Parvovirus B19 (PB19) is a common infection among solid transplant recipients. Usually, it is asymptomatic, but sometimes it can become a real therapeutic challenge. We report a case of a kidney transplant recipient with relapsing pure red cell aplasia due to PB19 infection. Our patient was initially managed with standard treatment consisting of intravenous immunoglobulins and minimization of immunosuppressive treatment. However, when this approach became ineffective, conversion from tacrolimus to everolimus was done, with favorable results. This paper explores infection by PB19 in kidney transplant recipients and the potential benefits of a calcineurin inhibitor-free immunosuppression and the antiviral properties of mTOR inhibitors.
Asunto(s)
Anemia/virología , Eritema Infeccioso/complicaciones , Trasplante de Riñón , Receptores de Trasplantes , Enfermedad Crónica , Eritema Infeccioso/tratamiento farmacológico , Everolimus/uso terapéutico , Humanos , Recurrencia , Aplasia Pura de Células Rojas/virologíaAsunto(s)
Eritema Infeccioso/diagnóstico , Parvovirus B19 Humano/aislamiento & purificación , Anticuerpos Antivirales/sangre , Proteína C-Reactiva/análisis , Niño , Diagnóstico Diferencial , Erupciones por Medicamentos/diagnóstico , Emolientes/administración & dosificación , Eritema Infeccioso/sangre , Eritema Infeccioso/tratamiento farmacológico , Eritema Infeccioso/virología , Exantema/diagnóstico , Antagonistas de los Receptores Histamínicos/administración & dosificación , Humanos , Inmunoglobulina M/sangre , Masculino , Parvovirus B19 Humano/inmunología , Resultado del TratamientoRESUMEN
Impaired cell-mediated, as well as antibody-mediated immunity predisposes a renal transplant recipient to a wide variety of atypical infection. With an increasing number of re-transplant, the balance between immunosuppression and the risk of recurrent disease poses a clinical and therapeutic challenge. Here, we report a successful re-transplantation in a case of parvovirus B19 infection leading to anaemia and collapsing glomerulopathy in the allograft managed with intravenous immunoglobulin (IVIG) and reduction of immunosuppression. This case emphasizes re-consideration to renal transplant after clearance of the virus in a previous renal allograft lost to PVB19 infection.
Asunto(s)
Eritema Infeccioso/tratamiento farmacológico , Rechazo de Injerto/terapia , Inmunoglobulinas Intravenosas/uso terapéutico , Trasplante de Riñón/efectos adversos , Parvovirus B19 Humano/aislamiento & purificación , Aplasia Pura de Células Rojas/etiología , Aloinjertos/inmunología , Aloinjertos/virología , Eritema Infeccioso/complicaciones , Eritema Infeccioso/inmunología , Eritema Infeccioso/virología , Glomerulonefritis/inmunología , Glomerulonefritis/cirugía , Rechazo de Injerto/inmunología , Rechazo de Injerto/virología , Humanos , Huésped Inmunocomprometido , Inmunosupresores/efectos adversos , Riñón/inmunología , Riñón/virología , Donadores Vivos , Masculino , Parvovirus B19 Humano/inmunología , Recurrencia , Aplasia Pura de Células Rojas/tratamiento farmacológico , Reoperación , Trasplante Haploidéntico/efectos adversos , Resultado del Tratamiento , Adulto JovenRESUMEN
Parvovirus B19 (B19V) is a human pathogenic virus, responsible for an ample range of clinical manifestations. Infections are usually mild, self-limiting, and controlled by the development of a specific immune response, but in many cases clinical situations can be more complex and require therapy. Presently available treatments are only supportive, symptomatic, or unspecific, such as administration of intravenous immunoglobulins, and often of limited efficacy. The development of antiviral strategies against B19V should be considered of highest relevance for increasing the available options for more specific and effective therapeutic treatments. This field of research has been explored in recent years, registering some achievements as well as interesting future perspectives. In addition to immunoglobulins, some compounds have been shown to possess inhibitory activity against B19V. Hydroxyurea is an antiproliferative drug used in the treatment of sickle-cell disease that also possesses inhibitory activity against B19V. The nucleotide analogues Cidofovir and its lipid conjugate Brincidofovir are broad-range antivirals mostly active against dsDNA viruses, which showed an antiviral activity also against B19V. Newly synthesized coumarin derivatives offer possibilities for the development of molecules with antiviral activity. Identification of some flavonoid molecules, with direct inhibitory activity against the viral non-structural (NS) protein, indicates a possible line of development for direct antiviral agents. Continuing research in the field, leading to better knowledge of the viral lifecycle and a precise understanding of virus-cell interactions, will offer novel opportunities for developing more efficient, targeted antiviral agents, which can be translated into available therapeutic options.
Asunto(s)
Antivirales/farmacología , Desarrollo de Medicamentos , Eritema Infeccioso/virología , Parvovirus B19 Humano/fisiología , Animales , Antivirales/uso terapéutico , Susceptibilidad a Enfermedades , Eritema Infeccioso/tratamiento farmacológico , Eritema Infeccioso/prevención & control , Genoma Viral , Genómica/métodos , Interacciones Huésped-Patógeno/inmunología , Humanos , Inmunización Pasiva , Parvovirus B19 Humano/efectos de los fármacos , Replicación ViralRESUMEN
BACKGROUND: Parvovirus B19 is a small, non-enveloped, single-stranded DNA virus with a special affinity for the erythroid progenitor cells of the bone marrow. The first case of parvovirus B19 infection in a kidney transplant recipient (KTR) was reported in 1986. Data on the risk factors and specific clinical characteristics of parvovirus B19 infection remain insufficient. METHODS: We screened 602 KTRs for parvovirus B19 infection using parvovirus B19 polymerase chain reaction (PCR) from January 1990 to April 2016, and the clinical characteristics of patients with positive results were compared to those of age- and gender-matched patients with negative PCR results. RESULTS: A total of 39 KTRs tested positive for parvovirus B19, and they were compared to 78 age- and gender-matched patients among 563 KTRs who had negative PCR results. In all, 89.7% of positive cases were reported within the first year after kidney transplantation. In multivariate analyses, deceased-donor kidney transplantation (odds ratio [OR] 9.067, 95% confidence interval [CI] 1.668-49.275, P = .011), use of tacrolimus (OR 3.607, 95% CI 1.024-12.706, P = .046), PCR test within 1 year of kidney transplantation (OR 12.456, 95% CI 2.674-58.036, P = .001), and hemoglobin levels (OR 0.559, 95% CI 0.351-0.889, P = .014) showed significant correlations with parvovirus B19 infection. Graft survival did not differ between the two groups during the follow-up period of 111.68 ± 54.54 months (P = .685 by log-rank test). CONCLUSION: The identification of factors related to positive parvovirus B19 PCR results may promote the early detection of parvovirus B19 infection. Further studies are needed to elucidate the characteristics of parvovirus B19 infection in kidney transplantation.
Asunto(s)
Eritema Infeccioso/diagnóstico , Eritema Infeccioso/virología , Trasplante de Riñón/efectos adversos , Adulto , Eritema Infeccioso/tratamiento farmacológico , Femenino , Humanos , Inmunoglobulinas Intravenosas/uso terapéutico , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Estudios Retrospectivos , Factores de RiesgoRESUMEN
Parvovirus B19 infection is undiagnosed in recipients undergoing solid organ transplantation. It is usually responsible for unexplained acute and chronic red blood cell aplasia that does not respond to erythropoietin therapy. Cases of parvovirus B19 infection associated with pancytopenia, solid organ dysfunction, and allograft rejection have been described in the literature. The deterioration of the immune system as a result of severe immunotherapy favors the reactivation of a previous infection or the acquisition of a new one. We present a case of a 32-year-old woman with a 1-year history of renal allograft transplant and previous cytomegalovirus (CMV) infection who presented with chest pain, polyarthritis, pancytopenia, and renal dysfunction. A serum sample using polymerase chain reaction showed a parvovirus titer of 13.8 trillion IU/mL and a CMV titer of 800 IU/mL. The renal biopsy revealed nucleomegaly with focal viral inclusions, along with changes associated with immunotherapy toxicity. Electron microscopy demonstrated capillary and tubular epithelial cells with "viral factories," thereby confirming the diagnosis. Thus, screening for parvovirus B19 is advised in high-risk patients who present with refractory anemia to avoid the complications of a chronic infection associated with the fatal rejection of the transplanted organ.
Asunto(s)
Artritis/patología , Dolor en el Pecho/patología , Eritema Infeccioso/sangre , Eritema Infeccioso/patología , Trasplante de Riñón/efectos adversos , Pancitopenia/patología , Parvovirus B19 Humano/aislamiento & purificación , Adulto , Aloinjertos/patología , Aloinjertos/ultraestructura , Aloinjertos/virología , Artritis/tratamiento farmacológico , Artritis/virología , Biopsia con Aguja , Inhibidores de la Calcineurina/uso terapéutico , Dolor en el Pecho/tratamiento farmacológico , Dolor en el Pecho/virología , Citomegalovirus/aislamiento & purificación , ADN Viral/aislamiento & purificación , Eritema Infeccioso/tratamiento farmacológico , Eritema Infeccioso/virología , Femenino , Humanos , Inmunoglobulinas Intravenosas/uso terapéutico , Inmunosupresores/uso terapéutico , Riñón/patología , Riñón/ultraestructura , Riñón/virología , Microscopía Electrónica , Pancitopenia/tratamiento farmacológico , Pancitopenia/virología , Parvovirus B19 Humano/genética , Reacción en Cadena de la PolimerasaAsunto(s)
Eritema Infeccioso/virología , Inmunosupresores/efectos adversos , Fallo Renal Crónico/cirugía , Trasplante de Riñón/efectos adversos , Infecciones Oportunistas/virología , Aplasia Pura de Células Rojas/virología , Adolescente , Transfusión Sanguínea , Resistencia a Medicamentos , Eritema Infeccioso/diagnóstico , Eritema Infeccioso/tratamiento farmacológico , Eritema Infeccioso/inmunología , Eritropoyetina/uso terapéutico , Hematínicos/uso terapéutico , Humanos , Huésped Inmunocomprometido , Inmunoglobulinas Intravenosas/uso terapéutico , Fallo Renal Crónico/diagnóstico , Fallo Renal Crónico/etiología , Masculino , Nefritis Hereditaria/complicaciones , Infecciones Oportunistas/diagnóstico , Infecciones Oportunistas/tratamiento farmacológico , Infecciones Oportunistas/inmunología , Aplasia Pura de Células Rojas/diagnóstico , Aplasia Pura de Células Rojas/tratamiento farmacológico , Aplasia Pura de Células Rojas/inmunología , Resultado del TratamientoRESUMEN
BACKGROUND: Chronic viral infections of the heart are considered one antecedent event leading to progressive dysfunction of the myocardium, often with an impaired prognosis due to a virus- or immune-mediated myocardial injury. Symptomatic treatment does not influence the viral cause of heart failure, and the effect of antiviral treatment has not been determined, yet. METHODS AND RESULTS: In this phase II study 143 patients with symptoms of heart failure and biopsy-based confirmation of the enterovirus (EV), adenovirus, and/or parvovirus B19 genomes in their myocardial tissue were randomly assigned to double-blind treatment, and received either placebo (n = 48) or 4 × 10(6) (n = 49) and 8 × 10(6) IU (n = 46) interferon beta-1b (IFN-ß-1b) for 24 weeks, in addition to standard heart failure treatment. Patients with active myocarditis or other specific causes of heart failure were excluded. Compared to placebo, virus elimination and/or virus load reduction was higher in the IFN-ß-1b groups (odds ratio 2.33, p = 0.048), similarly in both interferon groups and both strata. IFN-ß-1b treatment was associated with favourable effects on NYHA functional class (p = 0.013 at follow-up week 12), improvement in quality of life (Minnesota Heart Failure score; p = 0.032 at follow-up week 24) and patient global assessment (follow-up week 12 to follow-up week 24; p = 0.039). The frequency of adverse cardiac events was not higher in the IFN-ß-1b groups compared to the placebo group. CONCLUSIONS: Immunomodulatory IFN-ß-1b treatment is a well-tolerated and safe treatment option, leading to effective virus clearance or reduction of the virus load in patients with chronic viral cardiomyopathy. Favourable clinical effects assess quality of life, NYHA functional class, and patient global assessment. ClinicalTrials.gov identifier: NCT001185250.
Asunto(s)
Infecciones por Adenoviridae/tratamiento farmacológico , Antivirales/uso terapéutico , Cardiomiopatías/tratamiento farmacológico , Infecciones por Enterovirus/tratamiento farmacológico , Eritema Infeccioso/tratamiento farmacológico , Interferon beta-1b/uso terapéutico , Infecciones por Adenoviridae/diagnóstico , Infecciones por Adenoviridae/fisiopatología , Infecciones por Adenoviridae/virología , Adulto , Anciano , Antivirales/efectos adversos , Biopsia , Cardiomiopatías/diagnóstico , Cardiomiopatías/fisiopatología , Cardiomiopatías/virología , Enfermedad Crónica , Método Doble Ciego , Infecciones por Enterovirus/diagnóstico , Infecciones por Enterovirus/fisiopatología , Infecciones por Enterovirus/virología , Eritema Infeccioso/diagnóstico , Eritema Infeccioso/fisiopatología , Eritema Infeccioso/virología , Europa (Continente) , Femenino , Humanos , Interferon beta-1b/efectos adversos , Masculino , Persona de Mediana Edad , Calidad de Vida , Recuperación de la Función , Factores de Tiempo , Resultado del Tratamiento , Carga ViralRESUMEN
No disponible
Asunto(s)
Humanos , Masculino , Anciano de 80 o más Años , Parvovirus B19 Humano , Parvovirus B19 Humano/inmunología , Parvovirus B19 Humano/aislamiento & purificación , Eritema Infeccioso/complicaciones , Eritema Infeccioso/tratamiento farmacológico , Fiebre/complicaciones , Fiebre/etiología , Inmunoglobulina M/análisis , Inmunoglobulina M , Fiebre/tratamiento farmacológico , Leucopenia/complicaciones , Leucopenia/epidemiologíaRESUMEN
We describe 2 cases of 6-year-old twin girls presenting with acute carpal tunnel syndrome (CTS) associated with human parvovirus B19 (HPV-B19) infection, as evidenced by serological data and detection of HPV-B19 DNA in blood with use of polymerase chain reaction (PCR). To our knowledge, this is the first time that HPV-B19 infection has been suggested as the causal agent of simultaneous acute bilateral CTS in twins, thus presenting the possibility that similar immunologic responses can be observed in twins during viral infections.
Asunto(s)
Síndrome del Túnel Carpiano/diagnóstico , Síndrome del Túnel Carpiano/tratamiento farmacológico , Eritema Infeccioso/tratamiento farmacológico , Parvovirus B19 Humano , Enfermedad Aguda , Antiinflamatorios no Esteroideos/uso terapéutico , Síndrome del Túnel Carpiano/virología , Niño , Femenino , Humanos , Naproxeno/uso terapéutico , Reacción en Cadena de la Polimerasa , Gemelos , Complejo Vitamínico B/uso terapéuticoRESUMEN
TORCH infections classically comprise toxoplasmosis, Treponema pallidum, rubella, cytomegalovirus, herpesvirus, hepatitis viruses, human immunodeficiency virus, and other infections, such as varicella, parvovirus B19, and enteroviruses. The epidemiology of these infections varies; in low-income and middle-income countries, TORCH infections are major contributors to prenatal, perinatal, and postnatal morbidity and mortality. Evidence of infection may be seen at birth, in infancy, or years later. For many of these pathogens, treatment or prevention strategies are available. Early recognition, including prenatal screening, is key. This article covers toxoplasmosis, parvovirus B19, syphilis, rubella, hepatitis B virus, hepatitis C virus, and human immunodeficiency virus.
Asunto(s)
Eritema Infeccioso/diagnóstico , Infecciones por VIH/diagnóstico , Hepatitis B/diagnóstico , Hepatitis C/diagnóstico , Complicaciones Infecciosas del Embarazo/diagnóstico , Síndrome de Rubéola Congénita/diagnóstico , Sífilis Congénita/diagnóstico , Toxoplasmosis Congénita/diagnóstico , Antibacterianos/uso terapéutico , Antiprotozoarios/uso terapéutico , Antivirales/uso terapéutico , Eritema Infeccioso/tratamiento farmacológico , Femenino , Infecciones por VIH/congénito , Infecciones por VIH/tratamiento farmacológico , Hepatitis B/tratamiento farmacológico , Hepatitis C/tratamiento farmacológico , Humanos , Recién Nacido , Embarazo , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Diagnóstico Prenatal , Síndrome de Rubéola Congénita/tratamiento farmacológico , Sífilis Congénita/tratamiento farmacológico , Toxoplasmosis Congénita/tratamiento farmacológicoAsunto(s)
Antivirales/uso terapéutico , Eritema Infeccioso/diagnóstico , Eritema Infeccioso/tratamiento farmacológico , Molusco Contagioso/diagnóstico , Molusco Contagioso/tratamiento farmacológico , Verrugas/diagnóstico , Verrugas/tratamiento farmacológico , Adolescente , Niño , Preescolar , Dermatitis/diagnóstico , Dermatitis/tratamiento farmacológico , Diagnóstico Diferencial , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Guías de Práctica Clínica como AsuntoRESUMEN
Persistent parvovirus B19 (PVB) infection has been reported sporadically in immunocompromised patients including hematopoietic stem cell and solid organ transplant recipients. However, the pathogenesis of persistent infection has yet to be fully elucidated. We report here a patient with multiple myeloma developing red cell aplasia during the hematopoietic recovery after allogeneic hematopoietic stem cell transplantation (HSCT) caused by PVB. The patient had already had PVB viremia before transplantation and remained asymptomatic. The route of PVB transmission was considered to be direct contact with the patient's family member with primary PVB infection 1 month before transplantation. Treatment with intravenous immunoglobulin resulted in prompt resolution of anemia. These findings suggest that monitoring of PVB DNA is recommended for patients undergoing HSCT and having contact with individuals with documented PVB infection, even if they are asymptomatic.
Asunto(s)
Eritema Infeccioso/complicaciones , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Parvovirus B19 Humano , Aplasia Pura de Células Rojas/virología , Adulto , Eritema Infeccioso/tratamiento farmacológico , Eritema Infeccioso/transmisión , Humanos , Inmunoglobulinas Intravenosas/uso terapéutico , Factores Inmunológicos/uso terapéutico , Masculino , Mieloma Múltiple/terapiaAsunto(s)
Artralgia/etiología , Eritema Infeccioso/diagnóstico , Fiebre de Origen Desconocido/etiología , Hiperestesia/etiología , Parvovirus B19 Humano , Niño , Preescolar , Diagnóstico Diferencial , Eritema Infeccioso/tratamiento farmacológico , Humanos , Inmunización Pasiva , Masculino , Uso Fuera de lo Indicado , RecurrenciaRESUMEN
No disponible
No disponible
Asunto(s)
Humanos , Femenino , Adulto Joven , Eritema Infeccioso/complicaciones , Eritema Infeccioso/diagnóstico , Eritema Infeccioso/tratamiento farmacológico , Enfermedades Cutáneas Papuloescamosas/etiología , SíndromeAsunto(s)
Colitis/etiología , Eritema Infeccioso/complicaciones , Exantema/etiología , Enfermedad Injerto contra Huésped/etiología , Linfoma de Células del Manto/complicaciones , Parvovirus B19 Humano , Enfermedad Aguda , Adulto , Antígenos Virales/inmunología , Colitis/tratamiento farmacológico , Colitis/inmunología , Reacciones Cruzadas/inmunología , Eritema Infeccioso/tratamiento farmacológico , Eritema Infeccioso/inmunología , Exantema/tratamiento farmacológico , Exantema/inmunología , Enfermedad Injerto contra Huésped/tratamiento farmacológico , Enfermedad Injerto contra Huésped/inmunología , Humanos , Linfoma de Células del Manto/inmunología , Linfoma de Células del Manto/terapia , Masculino , Parvovirus B19 Humano/inmunología , Trasplante de Células Madre de Sangre Periférica , Linfocitos T/inmunología , Acondicionamiento Pretrasplante , Trasplante AutólogoRESUMEN
A 7-year-old girl presented with acute vulval erythema and pustules, associated with a petechial eruption in her flexures and over her feet. There was a mild prodromal illness and the patient was afebrile. There were minimal symptoms associated with the rash. Skin and throat swabs were negative and blood examination showed mild neutrophilia and lymphopaenia. Parvovirus B19 IgM was detected on serology and cutaneous features resolved within 4 days. This is a further case of parvovirus B19 infection presenting as a 'bathing trunk' exanthem that has unique dermatologic features, including the presence of pustules and distant petechiae.
Asunto(s)
Eritema Infeccioso/diagnóstico , Parvovirus B19 Humano/aislamiento & purificación , Enfermedades de la Vulva/diagnóstico , Enfermedad Aguda , Administración Cutánea , Niño , Diagnóstico Diferencial , Eritema Infeccioso/sangre , Eritema Infeccioso/tratamiento farmacológico , Eritema Infeccioso/patología , Femenino , Ácido Fusídico/administración & dosificación , Humanos , Inmunoglobulina M/sangre , Inmunoglobulina M/inmunología , Parvovirus B19 Humano/inmunología , Índice de Severidad de la Enfermedad , Enfermedades de la Vulva/sangre , Enfermedades de la Vulva/tratamiento farmacológico , Enfermedades de la Vulva/patologíaAsunto(s)
Artralgia/etiología , Eritema Infeccioso/diagnóstico , Exantema/etiología , Dermatosis Facial/etiología , Fiebre/etiología , Parvovirus B19 Humano , Adulto , Antiinflamatorios no Esteroideos/uso terapéutico , Anticuerpos Antivirales/sangre , Artralgia/inmunología , Niño , Diagnóstico Diferencial , Eritema Infeccioso/tratamiento farmacológico , Exantema/inmunología , Dermatosis Facial/inmunología , Femenino , Humanos , Masculino , Parvovirus B19 Humano/inmunología , Embarazo , PronósticoRESUMEN
A 6-year-old girl developed shock and multiple organ dysfunction including acute respiratory distress syndrome in association with parvovirus B19 infection. The diagnosis was based on positive antibodies and the detection of parvovirus 19 DNA in serum, bronchial secretions and skin biopsy. It seems likely, but it was not proved, that the parvovirus infection caused acute respiratory distress syndrome.