Human parvovirus B19 infection in a renal transplant recipient: a case report

BMC Research Notes

Karina Braga Gomes¹  Luci Maria Sant’ Ana Dusse¹  Ana Paula Fernandes¹  Maria das Graças Carvalho¹  Sandra Simone Vilaça²  Michelle Teodoro Alves¹ 

[1] Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil;Hospital Felício Rocho, Belo Horizonte, MG, Brazil

关键词: Antibodies;    Renal transplant;    Anemia;    Parvovirus B19;   

Others  :  1144927
DOI  :  10.1186/1756-0500-6-28

 received in 2012-07-17, accepted in 2013-01-18,  发布年份 2013

【 摘 要 】

Background

Parvovirus B19 presents tropism for human erythroid progenitor cells, causing chronic anemia in organ transplant recipients, due to their suppressed humoral and cellular responses. Diagnosis may be achieved through serological tests for detection of anti-B19 antibodies. However, renal transplant recipients are not routinely tested for parvovirus B19 infection, since there is scanty data or consensus on screening for B19 infection, as well as for treatment or preventive management of transplanted patients.

Case presentation

Herein we report a kidney transplant recipient, who was unresponsive to treatment of severe anemia, and presented hypocellular hematopoietic marrow, megaloblastosis and hypoplasia of erythroid lineage with larger cells with clear nuclei chromatin and eosinophilic nuclear inclusions. This patient was seropositive for Epstein-Barr and Cytomegalovirus infections and negative for anti-parvovirus B19 IgM and IgG antibodies, although symptoms were suggestive of parvoviruses infection. A qualitative polymerase chain reaction testing for B19 in serum sample revealed positive results for B19 virus DNA.

Conclusion

This case report suggests that the diagnostic process for parvovirus B19 in renal transplant recipients should include a polymerase chain reaction assay to detect B19-DNA, since specific serological tests may be unreliable given their impaired humoral responses. These results also indicate the importance of considering parvovirus B19 infection in the differential diagnosis of persistent anemia in transplanted patients.

【 授权许可】

   
2013 Alves et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Brown KE, Young NS, Liu JM: Molecular, cellular and clinical aspects of parvovirus B19 infection. Crit Rev Oncol Hematol 1994, 16:1-31.
• [2]Heegaard ED, Brown KE: Human Parvovirus B19. Clin Microbiol Rev 2002, 15(3):485-505.
• [3]Brown KE, Young NS: Parvoviruses and bone marrow failure. Stem Cells 1996, 14:151-163.
• [4]Brown KE, Anderson SM, Young NS: Erythrocyte P antigen: cellular receptor for B19 parvovirus. Science 1993, 262:114-117.
• [5]Parsyan A, Candotti D: Human erythrovirus B19 and blood transfusion – an updtate. Transfus Med 2007, 17:263-278.
• [6]Young NS, Brown KE: Parvovirus B19. N Engl J Med 2004, 350:586.
• [7]Broliden K, Tolfvenstam T, Norbeck O: Clinical aspects of parvovirus B19 infection. J Intern Med 2006, 260:285-304.
• [8]Koduri PR: Novel cytomorphology of the giant proerythroblasts of Parvovirus B19 infection. Am J Hematol 1998, 58:95-99.
• [9]Patou G, Pillay D, Myint S, Pattinson J: Characterization of a nested polymerase chain reaction assay for detection of Parvovirus B19. J Clin Microbiol 1993, 31(3):540-546.
• [10]Barsoum NR, Bunnapradist S, Mougdil A, Toyoda M, Vo A, Jordan SC: Treatment of Parvovirus B-19 (PV B-19) infection allows for successful kidney transplantation without disease recurrence. Am J Transplant 2002, 2:425-428.
• [11]Egbuna O, Zand MS, Arbini A, Menegus M, Taylor J: A cluster of Parvovirus B19 infections in renal transplant recipients: a prospective case series and review of the literature. Am J Transplant 2006, 6:225-231.
• [12]Geetha D, Zachary JB, Baldado HM, Kronz JD, Kraus ES: Pure red cell aplasia caused by Parvovirus B19 infection in solid organ transplant recipients: a case report and review of literature. Clinical Tranplantation 2000, 14:586-591.
• [13]Cavallo R, Merlino C, Re D, Bollero C, Bergallo M, Lembo D, Musso T, Leonardi G, Segoloni GP, Ponzi NA: B19 virus infection in renal transplant recipients. Virology 2003, 26:361-368.
• [14]Ki CS, Kim IS, Kim JW, Lee N, Kim SH, Lee KW, Kim SJ, Joh JW, Huh WS, Oh HY: Incidence and clinical significance of human parvovirus B19 infection in kidney transplant recipients. Clin Transplant 2005, 19:751-755.
• [15]Waldman M, Kopp JB: Parvovirus-B19-associated complications in renal transplant recipients. Nature 2007, 3(10):540-550.
• [16]Doyle S, Kerr S, O'Keeffe G, O'Carroll D, Daly P, Kilty C: Detection of parvovirus B19 IgM by antibody capture enzyme immunoassay: receiver operating characteristic analysis. J Virol Methods 2000, 90:143-152.
• [17]Butchko AR, Jordan JA: Comparison of three commercially available serological assays used to detect human Parvovirus B19-specific immunoglobulin M (IgM) and IgG antibodies in sera of pregnant women. J Clin Microbiol 2004, 42:3191-3195.
• [18]Cassinotti P, Burtonboy G, Fopp M, Siegl G: Evidence for persistence of Human parvovirus B19 DNA in bone marrow. J Med Virol 1997, 53:229-232.
• [19]Peterlana D, Puccetti A, Carrocher R, Lunardi C: Serologic and molecular detection of human Parvovirus B19 infection. Clin Chim Acta 2006, 372:14-23.
• [20]Kurukulasuriya A, Hamed AA, Al-Muslahi M, Ibrahim A: Acquired pure red cell aplasia caused by parvovirus B19 infection following a renal transplant. SQU Med J 2011, 11:280-283.