Keiji Haseyama

Human parvovirus B19 infection associated with acute hepatitis

BACKGROUND Human parvovirus (HPV) B19 infection produces a range of clinical manifestations including erythema infectiosum in children. Here we describe seven children who had acute hepatitis with HPV B19 infection. METHODS Hepatic dysfunction was noted in three children referred to our hospital during the course of erythema infectiosum caused by HPV B19 infection diagnosed by ELISA and PCR. The role of HPV B19 in the pathogenesis of hepatic involvement was investigated retrospectively by PCR assay of stored serum samples from 773 patients admitted to our hospital. FINDINGS 15 patients admitted to our hospital from January, 1991, to June, 1992, were HPV B19 DNA positive, of whom four had acute hepatitis of unknown origin. These four patients were aged between 7 months and 5 years. Of the seven patients, infection with hepatitis A, B, or C viruses or Epstein-Barr virus was ruled out in six by virological examinations. INTERPRETATION Epidemiological evidence suggests that HPV B19 can be the cause of acute hepatitis.

Incidence of human parvovirus B19 DNA detection in blood donors.

Summary. 1000 serum samples from blood donors were tested for human parvovirus B19 (B19) DNA by a nested PCR assay: six samples were positive for B19 DNA. The frequency was 1/167 (0‐6%), considerably higher than previous surveys (0‐004‐0‐03%). Five of the six samples were also positive for anti‐B19 IgM, indicating an acute phase of infection. It is recommended to screen for B19 DNA in blood products to prevent transfusion mediated viral infection for those susceptible such as immunocompromised patients and pregnant women.

Analysis of genetic diversity in the VP1 unique region gene of human parvovirus B19 using the mismatch detection method and direct nucleotide sequencing

To assess the prevalent genetic types of human parvovirus B19 strains derived from various sources and their relation to particular clinical symptoms, the genetic diversity in the VP1 unique region, which is important for the neutralizing response to human parvovirus B19, was examined by the mismatch detection method using the Non‐isotopic RNase Cleavage Assay™ (NIRCA™) and direct nucleotide sequencing. Twenty three samples obtained between 1986 and 1997 were examined. Three electrophoresis patterns were observed with NIRCA™. The nucleotide sequence showed that there were 14 nucleotide changes and 4 amino acid substitions in comparison with Au strains employed as a standard strain. The nucleotide variability of all samples ranged from 0.3 to 2.7% and the amino acid variability ranged from 1.0 to 3.0%. They were classified into three types according to NIRCA™. Types 1 and 3 had similar sequences, but the type 2 sequence was quite different. Although there were some nucleotide variations in the same NIRCA™ type, these were silent. However, there was no relationship between the clinical features and NIRCA™ types or between clinical features and the nucleotide sequence. All samples obtained before 1987 were NIRCA™ type 2. On the other hand, 19 of 20 samples obtained after 1989 were NIRCA™ type 1. The other sample obtained in 1992 was type 3. The results suggest that the B19 strain of type 2 disappeared by 1988 and changed to other B19 strains such as type 1 and type 3 after 1988, indicating a correlation between genome type and prevalence. NIRCA™ is a convenient method for screening mutations due to its simplicity and quickness. J. Med. Virol. 56:205–209, 1998.

Pancytopenia with hemophagocytosis secondary to parvovirus B19 infection in a family with hereditary spherocytosis.

infectiosum in children, sometimes red cell aplastic crisis with hemolytic anemia, chronic bone marrow failure in immunocompromised hosts, hydrops fetalis after intrauterine infection1 and acute hepatitis in normal children.2 In particular, it causes a hypoproliferative crisis (aplastic crisis) in conditions with reduced red blood cell life span.1 Hematopoietic cells infected with parvovirus B19 are specific, having a P protein (globoside) as a receptor for parvovirus B19.3 Most parvovirus-infected patients can show transient falls in neutrophils and platelet counts, which may further increase the risk of infection in patients with conditions of reduced redblood cell life span, such as hereditary spherocytosis (HS). Virus-associated hemophagocytic syndrome (VAHS) is a non-malignant histiocytosis characterized by pancytopenia, marrow hypoplasia, disseminated intravascular coagulation (DIC) and lymphadenopathy as per Henter’s diagnosis guidelines. Viruses, including human parvovirus B19, can cause VAHS. We report on two patients (a girl and her mother) with occult HS in whom pancytopenia and hemophagocytosis in their bone marrow are associated with human parvovirus B19 infection.

Pneumomediastinum, subcutaneous emphysema, and pulmonary fibrosis in a patient with idiopathic pneumonia syndrome after bone marrow transplantation.

An adolescent female underwent bone marrow transplantation for relapsed leukemia and developed acute and chronic graft-versus-host disease and idiopathic pneumonia syndrome. Her lung disease responded to large doses of methylprednisolone but evolved to pulmonary fibrosis and pneumomediastinum and subcutaneous emphysema in the convalescent period. Pulmonary function tests revealed a restrictive pattern. Pneumomediastinum and subcutaneous emphysema are complications not only of obstructive but also of restrictive lung disease and vary with respect to time of onset.