RESUMO
BACKGROUND: Parvovirus B19 infections are associated with different clinical manifestations that vary from symptom-less to severe. The main clinical manifestations are erythema infectiosum or fifth disease, transient aplastic crisis in individuals with hemoglobinopathies, chronic anemia in the immunocompromised, acute polyarthralgia syndrome in adults, hydrops fetalis, spontaneous abortion and stillbirth. Although the classical features of B19 and rubella infections are distinct, uncommon presentations can lead to misdiagnosis. OBJECTIVE: The goal of this study was to assess the occurrence of parvovirus B19 (B19) infection in patients with clinical signs of toxoplasmosis or rubella, both of which were not confirmed by laboratorial techniques. STUDY DESIGN: Serum samples from 214 patients were collected between January 1996 and December 1997 in the state of Rio de Janeiro, Brazil, B19 specific IgG and IgM were detected by using commercial enzyme-linked immunosorbent assays (ELISA), and viral nucleic acid was detected employing a nested polymerase chain reaction (PCR) protocol. RESULTS: Combining the results obtained by IgM ELISA and PCR, 14.5% of the samples were positive in one or both tests, with a concordance of 92.5% between the two techniques. CONCLUSIONS: Specimens collected in 16 out of 22 municipalities were positive in at least one out of the three tests employed, indicating that parvovirus B19 circulates in several regions of the state of Rio de Janeiro.
Assuntos
Infecções por Parvoviridae/virologia , Parvovirus B19 Humano/isolamento & purificação , Aborto Espontâneo/virologia , Adolescente , Adulto , Anticorpos Antivirais/sangue , Brasil , Criança , Pré-Escolar , DNA Viral/análise , Ensaio de Imunoadsorção Enzimática , Exantema Súbito/virologia , Feminino , Humanos , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Lactente , Masculino , Pessoa de Meia-Idade , Infecções por Parvoviridae/fisiopatologia , Parvovirus B19 Humano/genética , Parvovirus B19 Humano/imunologia , Reação em Cadeia da Polimerase , GravidezRESUMO
Human parvovirus B19 infection can cause erythema infectiosum (EI) and several other clinical presentations. Central nervous system (CNS) involvement is rare, and only a few reports of encephalitis and aseptic meningitis have been published. Here, we describe 2 cases of B19 infection in a family presenting different clinical features. A 30 year old female with a 7-day history of headache, malaise, myalgias, joint pains, and rash was seen. Physical examination revealed a maculopapular rash on the patient's body, and arthritis of the hands. She completely recovered in 1 week. Two days before, her 6 year old son had been admitted to a clinic with a 1-day history of fever, headache, abdominal pain and vomiting. On admission, he was alert, and physical examination revealed neck stiffness, Kerning and Brudzinski signs, and a petechial rash on his trunk and extremities. Cerebrospinal fluid analysis was normal. He completely recovered in 5 days. Acute and convalescent sera of both patients were positive for specific IgM antibody to B19. Human parvovirus B19 should be considered in the differential diagnosis of aseptic meningitis, particularly during outbreaks of erythema infectiosum. The disease may mimic meningococcemia and bacterial meningitis.
Assuntos
Exantema/virologia , Transtornos da Cefaleia/virologia , Infecções por Parvoviridae/diagnóstico , Parvovirus B19 Humano/isolamento & purificação , Adulto , Criança , Diagnóstico Diferencial , Eritema Infeccioso/diagnóstico , Feminino , Humanos , Imunoglobulina M/análise , Masculino , Meningite Asséptica/diagnóstico , Infecções por Parvoviridae/fisiopatologiaRESUMO
Life-threatening infections with Streptococcus pneumoniae and parvovirus occurred in two patients with hemoglobin S-beta-thalassemia. We recommend that acute febrile illnesses in the presence of any hemoglobinopathy be considered potentially life threatening, and managed accordingly.