Parvovirus B19 infection after transplantation

A review of 98 cases

Albert J. Eid, Robert A. Brown, Robin Patel, Raymund R Razonable

Research output: Contribution to journalArticle

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Abstract

Background. Infections with parvovirus B19 (PVB19) can cause significant morbidity in transplant recipients. Methods. To characterize the epidemiology and clinical spectrum of posttransplant PVB19 infection, we reviewed all cases at our institution during a 16-year period, summarized the data from 91 cases published in the medical literature, and performed longitudinal molecular surveillance for PVB19 DNAemia among 47 solid organ and hematopoietic stem cell transplant recipients. Results. The median time to onset of PVB19 disease was 7 weeks after transplantation. Anemia, leukopenia, and thrombocytopenia were present in 98.8%, 37.5%, and 21.0% of patients, respectively. Hepatitis, myocarditis, and pneumonitis were also reported in association with PVB19 disease. Allograft tissue loss or dysfunction was observed at the time of PVB19 disease in 10% of cases. At the onset of disease, PVB19 IgM serological test results were negative in 29% of cases. Almost all patients (96%) with anti-PVB19 IgM had a positive PVB19 polymerase chain reaction assay result. Intravenous immunoglobulin was the most commonly used treatment modality. Three of 98 patients died of myocarditis and cardiogenic shock associated with PVB19 disease. Molecular surveillance throughout the first year after transplantation did not reveal PVB19 DNAemia in 47 anemic solid organ and hematopoietic stem cell transplant patients. Conclusions. PVB19 is a rare but clinically significant infection that manifests as refractory anemia during the posttransplantation period. The use of polymerase chain reaction for diagnosis is particularly helpful in immunosuppressed transplant patients who may fail to mount antibodies against PVB19 during active infection.

Original languageEnglish (US)
Pages (from-to)40-48
Number of pages9
JournalClinical Infectious Diseases
Volume43
Issue number1
DOIs
StatePublished - Jul 1 2006

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Parvoviridae Infections
Parvovirus
Transplantation
Myocarditis
Hematopoietic Stem Cells
Transplants
Immunoglobulin M
Refractory Anemia
Polymerase Chain Reaction
Cardiogenic Shock
Intravenous Immunoglobulins
Leukopenia
Serologic Tests
Infection
Thrombocytopenia
Hepatitis
Allografts
Anemia
Pneumonia
Epidemiology

ASJC Scopus subject areas

  • Immunology

Cite this

Parvovirus B19 infection after transplantation : A review of 98 cases. / Eid, Albert J.; Brown, Robert A.; Patel, Robin; Razonable, Raymund R.

In: Clinical Infectious Diseases, Vol. 43, No. 1, 01.07.2006, p. 40-48.

Research output: Contribution to journalArticle

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abstract = "Background. Infections with parvovirus B19 (PVB19) can cause significant morbidity in transplant recipients. Methods. To characterize the epidemiology and clinical spectrum of posttransplant PVB19 infection, we reviewed all cases at our institution during a 16-year period, summarized the data from 91 cases published in the medical literature, and performed longitudinal molecular surveillance for PVB19 DNAemia among 47 solid organ and hematopoietic stem cell transplant recipients. Results. The median time to onset of PVB19 disease was 7 weeks after transplantation. Anemia, leukopenia, and thrombocytopenia were present in 98.8{\%}, 37.5{\%}, and 21.0{\%} of patients, respectively. Hepatitis, myocarditis, and pneumonitis were also reported in association with PVB19 disease. Allograft tissue loss or dysfunction was observed at the time of PVB19 disease in 10{\%} of cases. At the onset of disease, PVB19 IgM serological test results were negative in 29{\%} of cases. Almost all patients (96{\%}) with anti-PVB19 IgM had a positive PVB19 polymerase chain reaction assay result. Intravenous immunoglobulin was the most commonly used treatment modality. Three of 98 patients died of myocarditis and cardiogenic shock associated with PVB19 disease. Molecular surveillance throughout the first year after transplantation did not reveal PVB19 DNAemia in 47 anemic solid organ and hematopoietic stem cell transplant patients. Conclusions. PVB19 is a rare but clinically significant infection that manifests as refractory anemia during the posttransplantation period. The use of polymerase chain reaction for diagnosis is particularly helpful in immunosuppressed transplant patients who may fail to mount antibodies against PVB19 during active infection.",
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