Erythema infectious / Hidrops Fetalis

Infection with human B19 parvovirus

  

Identification

Infection with human B19 parvovirus produces:

• Erythema infectious is a mild viral disease, usually afebrile (without fever), with erythematous rash in the skin (redness of the skin), which occurs either sporadically or in epidemics, in children. It’s also known as the Fifth childhood disease. In the context of infectious erythema:
  • The virus has tropism for erythrocytes (red cells), which are lysed. .are tropism pentru eritrocite (celulele rosii), pe care le lizeaza.  May cause thrombocytopenia and neutropenia.
  • A characteristic sign is the striking erythema of the cheeks with the appearance of the spanked face which can be seen especially after exposure to sunlight or heat (e.g. in the bathroom).
  • Disease appears in both children and adults.
  • In adults, the eruption is often absent, but joint damage occurs. Especially are affected the small joints of the hands.
  • Complications are unusual but in people with anemia or immunosuppression, the transient aplastic crisis may occur. The infection can complicate and can evolve clinically with myocarditis, encephalitis and glomerulonephritis. (1)

• Hidrops Fetalis, generalized edema of the fetus. Appears in the fetus if the pregnant is infected with human parvovirus B19. The hallmark of the disease is the abnormal accumulation of fluid in the body cavities (pleural, pericardial, peritoneal) and soft tissues with a wall thickness greater than 5 mm. In addition, hydrops fetalis is associated with polyhydramnios and a thickened placenta (> 6 cm) in 30-75% of patients. Many affected fetuses also have hepatosplenomegaly. (7) 

The infection of the pregnant woman

• In the first half of pregnancy leads to the transmission of the intrauterine virus. The fetus is affected, fetal anemia occurs with fetal hidrops (severe edema that occurs in intrauterine life, with accumulation of fluid in all cavities of the organism) and fetal death in the uterus in 10% of the infections.
• In the second and third trimesters of pregnancy, the risk is minimal.
• In Our country this infection is little documented. Hidrops fetalis can lead to spontaneous abortion (10% in the first trimester) or less frequently at premature childbirth. (1,7)
  

Diagnostic

• In order to detect the infection, preconception tests can be done, but these tests are not done routinely.
• Diagnosis is usually based on clinical and epidemiological criteria.
• Confirmation of infection with human parvovirus B19 is done by laboratory diagnosis, by detection of specific Parvovirus B19 antibodies, IgM type, or by titer increasing of specific antibody anti B19 Parvovirus type IgG.
• Laboratory diagnosis can detect viral DNA by molecular diagnosis (PCR), the test is positive for the infected person from the first month of infection and remains positive for long periods. (1)

Nota bene. In this document, the laboratory diagnosis was not extensively treated for infection with human B19 parvovirus, but were pointed some elements regarding pregnancy and newborn. For the complete diagnosis of this infection, those who are interested will contact the infectious doctors.

Agent Infectious

Human B19 Parvovirus, is a DNA virus, from the Parvoviridae family. (1)

 

Incidence and prevalence

• It is a global condition, more frequently in winter and spring in temperate climates, with a periodicity of 3-7 years.
• Studies are not on large groups of patients.
• A retrospective study published in 2008 in Pennsylvania, the United States, showed that at 25 pregnant women with parvovirus B19 infection, 3 fetuses developed hydrops fetalis, and 4 died intrauterine, totaling a risk of maternal-fetal damage of 28% (2).
• In Japan, the analysis of 100 pregnant women with B19 Parvovirus showed that in 7% of them appeared an unfavorable evolution of pregnancy with hydrops fetalis and fetal death. (3)
• The prevalence of contact with B19 Parvovirus was evaluated in pregnant women and newborns in several countries by determining IgG antibodies, and showed that it could reach more than 50%. In the U.S., in the general population, the prevalence of contact with B19 Parvovirus evaluated by the determination of IgG antibodies is 80%.(4, 5)

 

Source

The man is the only source of transmission.

 

Method of transmission

The transmission pathways are mainly: (6)

• Airborne by contact with infected respiratory secretions,
• Parenteral by blood transfusions and blood products
• Maternal-foetal, more speciffically transplacental.

The virus is very resistant to inactivation by spilling methods, including heating at 80 º C for 72 hours.

• Joint use of cutlery or plates.

 

Risk groups

People with blood group P antigen, which is even the erythrocyte receptor for parvovirus B19

At major risk because they can develop complications are:

• People with anemia,
• People with immunodeficiency,
• Pregnant women,

Because they can develop complications.

Incubation period

Incubation is between 4-20 days.

 

Contagious Period

Patients are contagious during incubation and throughout the duration of the symptomatology.

Prophylaxis

• General: Avoiding contact with the infected persons.
• The pregnant woman or the one who wishes to become mother:

-must avoid exposure or contact with people having B19 human parvovirus infection (e.g. school, sanitary institutions, or even at home if they have children).

-it is necessary to avoid joint use of eating tools

-is recommended the frequent hands washing

• The effectiveness of intravenous immunoglobulin has not been studied. (1)

Vaccination

There’s still no vaccine available.

The birth to the woman infected with B19 parvovirus

There are no special recommendations.

Breastfeeding

There are no special recommendations.

Treatment

Intravenous immunoglobulin has been successfully used in the treatment of chronic anemia in people with persistent infection, but relapses may occur.

BIBLIOGRAPHY

 

1. Heymann D.L. Manual de management al bolilor transmisibile. 2012
2. Beigi RH, Wiesenfeld HC, Landers DV, Simhan HN. High rate of severe fetal outcomes associated with maternal parvovirus B19 infection in pregnancy. Infectious diseases in obstetrics and gynecology. 2008
3. Chisaka H, Ito K, Niikura H, et al. Clinical manifestations and outcomes of parvovirus B19 infection during pregnancy in Japan. The Tohoku journal of experimental medicine. 2006;209(4):277-83
4. Ziyaeyan M, Rasouli M, Alborzi A. The seroprevalence of parvovirus B19 infection among to-be-married girls, pregnant women, and their neonates in Shiraz, Iran. Jpn J Infect Dis. 2005;58(2):95-7
5. Maksheed MA, Pacsa AS, Essa SS, Ahmed MA, Monem RA, Surkouh M. The prevalence of antibody to human parvovirus B19 in pregnant women in Kuwait. Acta Tropica. 1999;73(3):225-9
6. ***. CDC Pregnancy and Fifth Disease 2017. Retrieved from:  https://www.cdc.gov/parvovirusB19/pregnancy.html
7. ***. Medscape. Hydrops fetalis 2015. Retrieved from: http://emedicine.medscape.com/article/403962-overview