The clinical presentations associated with parvovirus B19 infection vary greatly, ranging from benign to life threatening. The clinical presentation is influenced by the infected individual's age and hematologic and immunologic status.
Patients with parvovirus B19 infection are most contagious during the phase of active viral replication and viral shedding. Viremia occurs approximately 5 to 10 days after exposure and usually lasts approximately 5 days, with viral load peaking on the first few days of infection. During this phase, patients can be asymptomatic or present with non-specific flu-like illness, and patients with underlying hematologic abnormalities can suffer severe anemia.
The possibility of parvovirus B19 infection should be suspected in patients who present with symptoms consistent with the associated clinical syndromes, including erythema infectiosum, acute arthralgias, transient aplastic crises, and chronic reticulocytopenic anemia in the setting of immunosuppression. The diagnostic approach depends on the host and the clinical presentation.
Microbiology - Virology
Erythema infectiosum - PCR
Erythrovirus B19 - PCR
Human parvovirus B19 - PCR
Blood: 5mL in plain (red top) tube. Minimum sample volume for testing of serum is 0.5mL of serum, so at least 1mL of blood is required.
Other: Minimum of 1.0 mL in sterile container, Amniotic fluid, CSF, fetal blood, joint aspirates, biopsies etc
Chilled (2 - 8 degrees Celsius)
Place specimen in PCR bag.
Acute parvovirus B19 infection causes erythema infectiosum or fifth disease (slapped cheek).
Parvovirus DNA detection is suitable in the following situations:
1. Human parvovirus B19 antibodies are not detectable in some immunocompromised patients with chronic and persistent infection.
2. Diagnosis of infection for prenatal diagnosis of non-immune fetal hydrops.
3. During aplastic crisis parvovirus IgM antibodies may not be present until some days after crisis onset. DNA testing may be useful.
Serology is recommended in immunocompetent individuals, including pregnant women, patients with erythema infectiosum or transient aplastic crisis.
PCR performed on serum is useful for the recognition of chronic parvovirus (aplastic anaemia) B19 infection in immunocompromised individuals.
PCR performed on amniotic fluid or fetal blood can be useful for the diagnosis of inter uterine infection. Detection of parvovirus B19 in these specimens is presumptive evidence of fetal infection, but does not provide information about the consequences of the infection.
Parvovirus B19 DNA can also be detected in the peripheral blood of almost all patients with fifth disease.
Parvovirus B19 can be detected by PCR in serum, urine, CSF, pleural fluid, respiratory secretions, peripheral mononuclear cells, bone marrow cells, tissue, synovial fluid, joint aspirates and amniotic fluid.
Parvovirus DNA detection by PCR.
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