What is a parvovirus?

Parvovirus B19 is an exanthematous cytotoxic virus that manifests as an infectious erythema resembling the rubella infection. It is called ‘fifth disease’ because it is the 5^th most common childhood infection, causing fever, rash and transient acute arthritis. However, it is less serious than the others: measles, rubella, scarlet fever. The disease is transmitted mainly via respiratory droplets. It is quite contagious, usually harmless in the general population, but poses a threat to pregnancy because it causes anemia, heart failure, and sometimes intrauterine death due to the destruction of erythroblasts.

Symptoms

In most cases, parvovirus does not cause severe symptoms and the disease is mild in children and adults. About 2 out of 10 people who become infected with the virus will by asymptomatic.

The Parvovirus symptoms are:

Fever
Headache
Cough
Sore throat
Rashes
Joint pain

‘red cheek’

The most common rash associated with parvovirus B19 infection is a red rash on the face. The rash usually appears a few days after the previously listed initial symptoms. It is more common in children than in adults. If you have a parvovirus B19 infection, you may develop a second rash a few days later on your chest, back, buttocks, or arms and legs. The rash can be itchy, especially on the soles of the feet, its intensity varies, and usually subsides in 7 to 10 days, but can persist for several weeks, according to the official CDC website, which contains detailed information about the virus.

Joint pain or swelling

If you have a parvovirus B19 infection, you may also develop pain and swelling in your joints. This is called polyarthropathy syndrome. It is more common in adults than children and occurs more often in women. Some adults with parvovirus B19 infection may have only joint pain, usually in the hands, feet, or knees, and no other symptoms. Joint pain usually lasts 1-3 weeks, but can last for months or longer. It usually goes away without causing long-term problems.

Complications

Parvovirus B19 infection is usually mild in otherwise healthy children and adults. However, for some people, it can cause serious health complications that affect the nerves, joints, or blood system. It has been shown to cause severe anemia in patients with certain blood disorders or with a weakened immune system.

You may be at increased risk of parvovirus B19 infection in one or more of the following situations:

Pregnancy
Blood disorders, such as sickle cell anemia and thalassemia

Weakened immune system, which can be caused by conditions such as:
Leukemia or other forms of cancer
Organ transplantation
HIV infection

Prevention and treatment

There is no vaccine that can prevent parvovirus B19 infection. You can protect yourself and others from parvovirus B19 by taking daily preventive measures, such as:

Wash your hands often with soap and water
Cover your mouth and nose when you cough or sneeze
Avoid touching your eyes, nose and mouth
Avoid close contact with people who are sick

*Stay home when you are sick

Frequency of occurrence

Appears mainly in Winter and Spring. Affects children aged 5-14 years. The infection is contagious in children for a few days before the onset of symptoms and until the symptoms disappear. When the rash appears, the infection is no longer contagious. The presence of the parvovirus B19 rash is not a reason for children to stay home from daycare or school. Acute infection occurs in 3-4% of pregnant women while 35-53% of pregnant women are immune.

It occurs with more severe symptoms, even death in children with chronic hemolytic anemias such as sickle cell anemia, thalassemias, globular anemia, etc.

Association with chromosomal abnormalities and genetic syndromes:

Ultrasound findings may reveal various abnormalities such as:

Increased cervical thickening and skin swelling
Cardiomegaly, pericardial effusion
Ascites
Hydramnium
Placental thickening
Hydrops (Hydrops fetalis)

Brain abnormalities were observed in 26% of transfused fetuses on MRI. Neurodevelopmental impairment may therefore occur among survivors, despite appropriate prenatal management, including intrauterine transfusion.

Fetal infection can result in intrauterine death in 5% of newly infected mothers.

Vaccination

To date, there is no available vaccine, therefore routine serological testing of B19 antibodies is recommended for pregnant women or women planning a future pregnancy, as well as for people suffering from hemolytic anemias.

How will I know if I’ve had, or currently have, a parvovirus B19 infection?

In addition to the previously mentioned symptoms, which can often be confused with the symptoms of other viruses, there is also a diagnostic test which can be performed to establish either the presence of the virus in the body at the time of the examination, or whether there has been a recent or past infection.

Detection of the presence of the virus at the time of examination is done via PCR. A highly sensitive test on the patient’s blood. No preparation is needed, but a blood draw is required, and the test is performed on the patient’s plasma.

Real Time PCR for detection of parvovirus B19 DNA: €60

In cases where someone thiks they have had a B19 parvovirus infection, they can confirm it by detecting antibodies in their blood serum. There are two types of antibodies: IgM, for recent infection, for a time period including the onset of symptoms, up to less than one month post-symptoms, and IgG, for a period of more than two weeks after the onset of symptoms (Figure 1) .

Detection of IgM antibodies: €30

Detection of IgG antibodies: €30

parvovirus