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Parvovirus
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Parvovirus B19 is mainly transmitted by respiratory droplets. The incubation period for erythema infectiosum is 13–18 days, and infectivity is greatest 7–10 days before the onset of symptoms. The major target cells for parvovirus B19 are erythroid progenitors bearing the main cellular parvovirus B19 receptor P blood group antigen globoside on their surface (Figure 51.1). The virus is believed to cause arrest of maturation of red blood cell (RBC) precursors at the late normoblast stage and causes a decrease in the number of platelets. The virus causes infection and lysis of erythroid progenitor cells by apoptosis, leading to hemolysis and transient aplastic crisis. Subsequent fetal anemia is thought to be responsible for the development of skin edema and effusions. Hepatitis, placentitis, and myocarditis leading to heart failure may contribute to the development of fetal hydrops [2, 4, 5]. Parvovirus B19 has been demonstrated to carry an apoptosis-inducing factor and to induce cell-cycle arrest. Cells in the S-phase of DNA mitosis are particularly vulnerable to parvo-virus B19, and the fetus is at risk because of the vast number of cells in active mitosis, shorter half-life of RBCs, and an immature immune system.
Other viral infections
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
As with many viral infections, infection with human parvovirus B19 may be asymptomatic or carry symptoms of only a mild flu-like illness. The rash is more common in children than in adults but adults are more likely to develop arthritic complaints. The rash is characterized as a lacy rash especially on the face providing the “slapped cheek” appearance. A variable rash on the extremities may follow with a morbilliform, confluent, circinate, or annular appearance. This usually does not involve the trunk, palms, or soles and may be pruritic. The rash usually disappears within 1 to 2 weeks but may recur especially with stress, exercise, sunlight, or bathing (34,35).
Diagnostic Approach to Fulminant Hepatitis in the Critical Care Unit
Published in Cheston B. Cunha, Burke A. Cunha, Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
Parvovirus B19 is a DNA virus belonging to the Parvoviridae family. Parvovirus B19 occurs commonly in children and manifests as erythema infectiosum or aplastic anemia. In adults, arthropathy or hydrop fetalis during pregnancy can occur [45]. Parvovirus B19 has been associated with ALF in solid-organ transplantation and hematopoietic stem cell transplantation. Clinical manifestation is atypical and can include fever, rash, arthralgia, anemia and organ-invasive disease such as hepatitis and myocarditis. Liver function abnormalities resemble that of other viral hepatitides [46]. Diagnosis can be made via serology (IgM and IgG) and serum PCR for parvovirus B19, although serology is unreliable in the context of immunosuppression, as patients may mount a delayed immune response. Direct viral detection in blood or, in the case of hepatitis, liver biopsy specimen should be performed if both serology and PCR are negative but suspicion remains high. Treatment of parvovirus B19 is with intravenous immunoglobulins [45,46].
Hemophagocytic lymphohistiocytosis associated with parvovirus B19-induced aplastic crisis in a hereditary spherocytosis patient: A case report and literature review
Published in Pediatric Hematology and Oncology, 2022
Ki Tae Kim, Kyung Taek Hong, Bo Kyung Kim, Hong Yul An, Jung Yoon Choi, Yoon Hwan Chang, Hyoung Jin Kang
In this case, HLH was suspected based on various laboratory findings and the presence of hemophagocytes in the bone marrow. However, there were spherocytes in the peripheral blood smear, which showed the possibility of HS. Extremely elevated parvovirus B19 viral loads and bone marrow examination confirmed a diagnosis of aplastic crisis accompanied by HLH. Although many patients with parvovirus B19-associated HLH recovered with no specific therapy, as reported in the literature, immediate chemoimmunotherapy, with a regimen including etoposide, dexamethasone, and cyclosporine, was initiated to the patient in the present case because her condition rapidly deteriorated. Fortunately, the patient’s health improved rapidly after treatment initiation. Initially, we had planned to administer etoposide for up to 8 weeks according to the HLH-2004 protocol. However, bone marrow suppression lasted for a long time; therefore, the patient received only 5-week induction therapy. As the patient’s serum parvovirus B19 viral loads continued to increase, the patient received cyclosporine A for an additional 6 months for the prevention of HLH recurrence. Given the good prognosis in HLH caused by parvovirus B19, it is possible to consider reducing the intensity or duration of HLH treatment depending on the patient’s degree of bone marrow suppression. For patients suspected of parvovirus B19-associated HLH, it would also be possible to carefully observe the clinical progression without treatment if the initial clinical condition is not bad.
Experimental Evaluation of a New Tissue Factor-Based Topical Hemostat (TT-173) for Treatment of Hepatic Bleeding
Published in Journal of Investigative Surgery, 2020
Alberto Centeno, Santiago Rojas, Belén Arias, Ignasi Miquel, Pilar Sánchez, Claudia Ureta, Esther Rincón, Ramón López, Jesús Murat
In the scenario of partial liver resection, TT-173 could present several advantages in comparison with other hemostatic products. There is no doubt that hemostatic patches such as Tachosil are very useful to improve bleeding control, but they are also expensive. Moreover, they immediately adhere to the parenchyma making any change in its position virtually impossible. Fibrin sealants present the same limitations and probably are less convenient than hemostatic patches for this specific surgery. From the safety point of view, both agents contain fibrinogen derived from human blood and in consequence are associated with a theoretical risk of pathogen transmission. This may be more relevant for those viruses especially resistant to inactivation procedures such as the human parvovirus B19. In the past, several cases of parvovirus infection due to the use of fibrin sealants have been reported [35,36]. However current manufacture procedures have minimized this risk [17]. In any case human blood is an expensive and limited resource and requires specialized procedures for its obtention and processing with enough safety guarantees.
Considering the spleen in sickle cell disease
Published in Expert Review of Hematology, 2019
Sara El Hoss, Valentine Brousse
ASS is one of the earliest life-threatening complications seen in patients with SCD. Such a complication has been reported in a 5-week old and 4-month old [45,46]. The median age range for this complication is between 6 months and 5 years, with a median age of 1.4 years in a French cohort study [43]. Over two-thirds of infants (67%) experience more than one ASS episode, with a higher risk, when ASS occurs before the age of 2. Precipitating factors are largely unknown although an infectious triggering event is often associated. Studies have reported an association between the occurrence of a parvovirus B19 infection and ASS and highlighted the need to monitor patients with an active parvovirus B19 infection for ASS episodes [47]. More recently in a longitudinal cohort of 57 SCA infants enrolled at 6 months, eight (17%) suffered from at least one ASS episode at a median age of 13.4 months, five of the patients experienced a reoccurrence during the study period [44].