Parvovirus B19 is a single-stranded DNA virus that primarily infects humans and is associated with several clinical conditions, including fifth disease, aplastic crisis, and papular-purpuric 'gloves-and-socks' syndrome. Transmission occurs through respiratory secretions, vertical transmission, and exposure to infected blood, with symptoms typically manifesting 4-14 days post-infection. While infectious morbidity is generally low, severe complications such as hydrops fetalis can occur, especially if a nonimmune woman contracts the virus during early pregnancy.

1. Prof. Dr. Saad S Al Ani
Senior Pediatric Consultant
Head of Pediatric Department
Khorfakkan Hospital
Sharjah ,UAE
saadsalani@yahoo.com
*Parvovirus
B19 Infection

2. *Parvovirus B19
*Parvovirus B19 (B19V) is a
single-stranded DNA virus of the
family Parvoviridae and genus
Erythrovirus
08/10/2018Parvovirus 3B19 infection Prof. Dr. Saad S AlAni 2

3. 08/10/2018Parvovirus 3B19 infection Prof. Dr. Saad S AlAni 3
*Parvovirus B19
Institute for Molecular Virology

4. *Parvovirus B19 (Cont.)
1. Classic fifth disease
2. Aplastic crisis
3. Papular-Purpuric “Gloves-and-
Socks" Syndrome (PPGSS)
are caused almost exclusively by
parvovirus B19
08/10/2018Parvovirus 3B19 infection Prof. Dr. Saad S AlAni 4

5. *Parvovirus B19 (Cont.)
*This virus infects only humans.
* Transmission occurs via :
 Vertical transmission (birth)
 Large droplet respiratory secretions
 Transfusion of blood products
 Percutaneous exposure to blood
08/10/2018Parvovirus 3B19 infection Prof. Dr. Saad S AlAni 5

6. *Pathophysiology
*The incubation period from
infection to initial, nonspecific
symptoms ranges from 4-14
days
*The rash and joint symptoms
usually occur 2-3 weeks after
initial infection
08/10/2018Parvovirus 3B19 infection Prof. Dr. Saad S AlAni 6
American Academy of Pediatrics Committee on Infectious Diseases. Parvovirus B19. Kimberlin
DW, Brady M, Jackson SA, Long SS, eds. 2015 Red Book: Report of the Committee on Infectious
Diseases. 30th ed. Elk Grove Village, IL: American Academy of Peiatrics; 2015. 593-596.

7. *Pathophysiology (Cont.)
*Patients are most contagious in
the few days preceding rash
* Patients with aplastic anemia
are considered contagious before
the onset of symptoms and for at
least 1 week
08/10/2018Parvovirus 3B19 infection Prof. Dr. Saad S AlAni 7
Brown KE. Parvovirus B19. Bennet JE, Dolin R, Blaser M. Mandell, Douglas and Bennett's Principals
and Practice of Infectious Diseases. 8th ed. Philadelphia, PA: Churchill Livingstone Elsevier; 2015.
Vol 2: 1840-1847.

8. *Pathophysiology(Cont.)
* Parvovirus B19 has a unique
tropism for human erythroid
progenitor cells
* The virus requires the P blood
antigen receptor (also known as
globoside) to enter the cell.
08/10/2018Parvovirus 3B19 infection Prof. Dr. Saad S AlAni 8

9. *Pathophysiology(Cont.)
* The virus is cytotoxic to host cells.
*The cytotoxic effect to host cells
coupled with the tropism for
rapidly dividing erythrocyte
precursors leads to the suppression
of erythrogenesis seen during
infection
08/10/2018Parvovirus 3B19 infection Prof. Dr. Saad S AlAni 9
Burns K, Parish CR. Parvoviridae. Knipe DM, Howley PM, eds. Fields
Virology. 5th ed. Philadelphia, PA: Lippincott Williams & Wilkins;
2007. Vol 2: 65.

10. *Parvovirus invade RBC precursors
Pinterest
08/10/2018Parvovirus 3B19 infection Prof. Dr. Saad S AlAni 10

11. *Pathophysiology(Cont.)
*No reticulocytes (immature
erythrocytes) are available to replace
aging or damaged erythrocytes
* Occasionally, the virus infects
leukocytes (especially neutrophils).
Parvovirus B19 does not infect
megakaryocytes
08/10/2018Parvovirus 3B19 infection Prof. Dr. Saad S AlAni 11
Schneider, E. Human Parvoviruses. Long SS, Pickering LK, Prober CG, eds. Principles and Practice of
Pediatric Infectious Diseases. 4th ed. Philadelphia, PA: Churchill Livingstone Elsevier; 2012. 1087-1091.

12. 08/10/2018Parvovirus 3B19 infection Prof. Dr. Saad S AlAni 12
*Parvovirus B19 is the only infectious
cause of transient aplastic crisis (TAC)
known and has been shown to be the
cause of aplastic crisis in over 80% of
patients with sickle cell disease
*Pathophysiology(Cont.)
Young NS, Brown KE. Parvovirus B19. N Engl J Med. 2004 Feb 5. 350(6):586-97.

13. *Epidemiology
* Parvovirus B19 infection is
extremely common
* Seropositivity rates :
 5-10% among young
children (aged 2-5 years),
 50% by age 15 years
 60% by age 30 years.
08/10/2018Parvovirus 3B19 infection Prof. Dr. Saad S AlAni 13

14. *Epidemiology(Cont.)
* Clinical cases:
 Sporadic
or
 Occur in outbreaks in the
late winter through early
spring.
08/10/2018Parvovirus 3B19 infection Prof. Dr. Saad S AlAni 14

15. *Epidemiology(Cont.)
*Attack rates during school
outbreaks may be as high as
60%
*Secondary spread through
nonimmune household contacts
is common
08/10/2018Parvovirus 3B19 infection Prof. Dr. Saad S AlAni 15
Brown KE. Parvovirus B19. Bennet JE, Dolin R, Blaser M. Mandell, Douglas and Bennett's Principals and Practice of
Infectious Diseases. 8th ed. Philadelphia, PA: Churchill Livingstone Elsevier; 2015. Vol 2: 1840-1847.

16. *Epidemiology(Cont.)
*A cyclic increase in the
number of infections is also
observed, peaking every 3-4
years
08/10/2018Parvovirus 3B19 infection Prof. Dr. Saad S AlAni 16
Brown KE. Parvovirus B19. Bennet JE, Dolin R, Blaser M. Mandell, Douglas and Bennett's Principals and Practice of
Infectious Diseases. 8th ed. Philadelphia, PA: Churchill Livingstone Elsevier; 2015. Vol 2: 1840-1847.

17. *Weekly No. of reported erythema
infectiosum cases per sentinel in Japan
www.niid.go.jp
08/10/2018Parvovirus 3B19 infection Prof. Dr. Saad S AlAni 17

18. 08/10/2018Parvovirus 3B19 infection Prof. Dr. Saad S AlAni 18
*Mortality/Morbidity
*Parvovirus B19 infection in
otherwise healthy children and
adults has an extremely low
mortality rate
Schneider, E. Human Parvoviruses. Long SS, Pickering LK, Prober CG, eds. Principles and Practice of
Pediatric Infectious Diseases. 4th ed. Philadelphia, PA: Churchill Livingstone Elsevier; 2012. 1087-1091.

19. 08/10/2018Parvovirus 3B19 infection Prof. Dr. Saad S AlAni 19
*Morbidity (Cont.)
*Erythema infectiosum (Fifth disease)
*Polyarthropathy syndrome is mostly
seen in adult women with acute
infection
*Transient Aplastic Crises (TAC)(In
patients with hemoglobinopathies or
hemolytic anemias)

20. 08/10/2018Parvovirus 3B19 infection Prof. Dr. Saad S AlAni 20
*Morbidity (Cont.)
*Chronic anemia as a result of
chronic parvovirus B19 infection
(in immunocompromised)
*Immune thrombocytopenic
purpura (ITP), Henoch-Schönlein
purpura (HSP), and the
hemophagocytic syndrome
American Academy of Pediatrics Committee on Infectious Diseases. Parvovirus B19. Kimberlin DW, Brady M, Jackson SA, Long
SS, eds. 2015 Red Book: Report of the Committee on Infectious Diseases. 30th ed. Elk Grove Village, IL: American Academy of
Peiatrics; 2015. 593-596.

21. 08/10/2018Parvovirus 3B19 infection Prof. Dr. Saad S AlAni 21
*Morbidity (Cont.)
*Hydrops fetalis, (the most serious
complication of parvovirus B19
infection), (may occur when a
nonimmune woman is infected,
usually in the first 20 weeks of
pregnancy.)

22. 08/10/2018Parvovirus 3B19 infection Prof. Dr. Saad S AlAni 22
*Parvovirus B19 is not associated
with a congenital malformation

23. 08/10/2018Parvovirus 3B19 infection Prof. Dr. Saad S AlAni 23
*Parvovirus B19 has been spread by
blood products, such as:
Intravenous immunoglobulin (IVIG)
Nonrecombinant clotting factors
Platelets
Packed RBCs(to a lesser extent)

24. 08/10/2018Parvovirus 3B19 infection Prof. Dr. Saad S AlAni 24
*Hydrops fetalis
*Parvovirus B19 infection is the most
common cause of nonimmune
hydrops fetalis and can result in
fetal death in 2-6% of cases
*The most critical gestational age
appears to be 13-16 weeks'
gestation

25. 08/10/2018Parvovirus 3B19 infection Prof. Dr. Saad S AlAni 25
*Hydrops fetalis (Cont.)
*hydrops had a mortality rate of less
than 10% if the fetus can be
supported by transfusion
*Intrauterine growth retardation,
myocarditis, and pleural and
pericardial effusions may also occur
Infections. Cunningham FG, Leveno KL, Bloom SL, Hauth JC, Gilstrap III LC, Wenstrom KD, eds. Williams
Obstetrics. 22nd Ed. USA: McGraw-Hill; 2001. chap 58.

26. 08/10/2018Parvovirus 3B19 infection Prof. Dr. Saad S AlAni 26
*Clinical Presentation
*Common symptoms of parvovirus B19 (B19V)
infection include a mild nonspecific prodromal
illness that may consist of:
 fever (15-30% of patients)
 malaise
 headache
 myalgia
 nausea, and rhinorrhea;
typically beginning 5-7 days after initial infection.
Brown KE. Parvovirus B19. Bennet JE, Dolin R, Blaser M. Mandell, Douglas and Bennett's Principals and Practice of Infectious
Diseases. 8th ed. Philadelphia, PA: Churchill Livingstone Elsevier; 2015. Vol 2: 1840-1847.

27. 08/10/2018Parvovirus 3B19 infection Prof. Dr. Saad S AlAni 27
*Clinical Presentation (Cont.)
*Approximately 1 week later, a bright red
macular exanthem appears on the cheeks
and is often associated with circumoral
pallor
*A diffuse maculopapular rash can appear 1-
4 days later and fades to a lacy erythematous
rash, which may be pruritic and may spread
gradually toward the distal extremities
American Academy of Pediatrics Committee on Infectious Diseases. Parvovirus B19. Kimberlin DW, Brady M, Jackson SA,
Long SS, eds. 2015 Red Book: Report of the Committee on Infectious Diseases. 30th ed. Elk Grove Village, IL: American
Academy of Peiatrics; 2015. 593-596.

28. 08/10/2018Parvovirus 3B19 infection Prof. Dr. Saad S AlAni 28
*Clinical Presentation (Cont.)
*The clinical symptoms widely vary,
and the classic "slapped cheek" rash
is much more common in young
children
*Many individuals may experience
asymptomatic or unrecognized
infection

29. 08/10/2018Parvovirus 3B19 infection Prof. Dr. Saad S AlAni 29
*The classic "slapped cheek" rash
WebMD

30. 08/10/2018Parvovirus 3B19 infection Prof. Dr. Saad S AlAni 30
*Clinical Presentation (Cont.)
*Less than 10% of children experience
arthropathy; ( in those who do, the
knees are most commonly involved)
(Transient small joint arthropathy may
be the main clinical presentation of
parvovirus B19 in adults
American Academy of Pediatrics Committee on Infectious Diseases. Parvovirus B19. Kimberlin DW, Brady M, Jackson SA,
Long SS, eds. 2015 Red Book: Report of the Committee on Infectious Diseases. 30th ed. Elk Grove Village, IL: American
Academy of Peiatrics; 2015. 593-596.

31. 08/10/2018Parvovirus 3B19 infection Prof. Dr. Saad S AlAni 31
*Arthropathy
https://emedicine.medscape.com

32. 08/10/2018Parvovirus 3B19 infection Prof. Dr. Saad S AlAni 32
*Clinical Presentation (Cont.)
*Patients with severe anemia due to
transient aplastic crisis (TAC) may
present with :
Pallor
Fatigue
Signs of an aplastic crisis.
Brown KE. Parvovirus B19. Bennet JE, Dolin R, Blaser M. Mandell, Douglas and Bennett's Principals and Practice of Infectious
Diseases. 8th ed. Philadelphia, PA: Churchill Livingstone Elsevier; 2015. Vol 2: 1840-1847.

33. 08/10/2018Parvovirus 3B19 infection Prof. Dr. Saad S AlAni 33
*Clinical Presentation (Cont.)
*Underlying hemoglobinopathies should
be sought in these patients.
*Patients with thrombocytopenia may
exhibit bruising
Brown KE. Parvovirus B19. Bennet JE, Dolin R, Blaser M. Mandell, Douglas and Bennett's Principals and Practice of Infectious
Diseases. 8th ed. Philadelphia, PA: Churchill Livingstone Elsevier; 2015. Vol 2: 1840-1847.

34. 08/10/2018Parvovirus 3B19 infection Prof. Dr. Saad S AlAni 34
*Clinical Presentation (Cont.)
*Rarely, parvovirus B19 infection
manifests as:
Myocarditis
Vasculitis
Glomerulonephritis
Encephalitis.

35. 08/10/2018Parvovirus 3B19 infection Prof. Dr. Saad S AlAni 35
*Clinical Presentation (Cont.)
*B19V infection has been reported in
association with:
 Idiopathic thrombocytopenia purpura
 Henoch-Schönlein purpura,
 Pseudo appendicitis

36. 08/10/2018Parvovirus 3B19 infection Prof. Dr. Saad S AlAni 36
*Physical examination
*Children are often febrile, but their
appearance is nontoxic and the
prodrome is nonspecific.
*Patients with aplastic crisis have pallor
and tachycardia secondary to anemia.
N.B. Children with aplastic crisis
usually do not have a rash.

37. 08/10/2018Parvovirus 3B19 infection Prof. Dr. Saad S AlAni 37
*Physical examination(Cont.)
* Benign flow murmurs are common in
anemic children with tachycardia
*The small joints of the hands, feet,
elbows, and knees may exhibit signs of
arthritis

38. 08/10/2018Parvovirus 3B19 infection Prof. Dr. Saad S AlAni 38
*Most patients with parvovirus B19
(B19V) infection do not require
laboratory studies because symptoms
are mild and the illness resolves over
5-7 days.
*Routine imaging is not necessary.

39. 08/10/2018Parvovirus 3B19 infection Prof. Dr. Saad S AlAni 39
*Laboratory Studies
1. Enzyme-linked immunoassay (ELISA)
2. Radioimmunoassay
3. Immunofluorescence
Can be used to determine parvovirus serology
(anti–parvovirus B19 immunoglobulin M [IgM]
and immunoglobulin G [IgG] antibodies)
Bredl S, Plentz A, Wenzel JJ, Pfister H, Möst J, Modrow S. False-negative serology in
patients with acute parvovirus B19 infection. J Clin Virol. 2011 Jun. 51(2):115-20.

40. 08/10/2018Parvovirus 3B19 infection Prof. Dr. Saad S AlAni 40
*Laboratory Studies(Cont.)
*PCR testing for parvovirus B19 is
routinely available with increased
sensitivity level.
*This test, a more useful clinical tool to
diagnose chronic infection, detects viral
DNA present in the blood or other
tissues/fluids
Adler SP, Koch WC. Human Parvovirus Infections. Remington JS, Klein JO,
Wilson CB, Baker CJ. Infectious Diseases of the Fetus and Newborn Infant.
6th ed. Philadelphia, PA: Saunders Elsevier; 2006. 868-892.

41. 08/10/2018Parvovirus 3B19 infection Prof. Dr. Saad S AlAni 41
*Treatment & Management
* Acetaminophen or ibuprofen is effective
for treating fever in patients with
parvovirus B19 (B19V) infection
* Intravenous immunoglobulin (IVIG) has
been used with good results for patients
suffering pure red cell aplasia (PRCA)
Brown KE. Parvovirus B19. Bennet JE, Dolin R, Blaser M. Mandell, Douglas and
Bennett's Principals and Practice of Infectious Diseases. 8th ed. Philadelphia, PA:
Churchill Livingstone Elsevier; 2015. Vol 2: 1840-1847.

42. 08/10/2018Parvovirus 3B19 infection Prof. Dr. Saad S AlAni 42
*Treatment & Management(Cont.)
* Patients in aplastic crisis require
packed RBC transfusions
* More than 80% of patients with sickle
cell disease in transient aplastic crisis
(TAC) have required transfusion
*IVIG is not recommended for TAC
American Academy of Pediatrics Committee on Infectious Diseases. Parvovirus B19.
Kimberlin DW, Brady M, Jackson SA, Long SS, eds. 2015 Red Book: Report of the
Committee on Infectious Diseases. 30th ed. Elk Grove Village, IL: American Academy
of Peiatrics; 2015. 593-596.

43. 08/10/2018Parvovirus 3B19 infection Prof. Dr. Saad S AlAni 43
*Treatment & Management(Cont.)
* In some individuals with human
immunodeficiency virus (HIV) infection,
highly active antiretroviral therapy
restores immune function, enabling
resolution of chronic parvovirus B19
infection
Broliden K, Tolfvenstam T, Norbeck O. Clinical aspects of parvovirus B19
infection. Jrnl Internal Med. 2006. 260:285-304.

44. 08/10/2018Parvovirus 3B19 infection Prof. Dr. Saad S AlAni 44
*Precautions &Prognosis
*Patients with classic erythema
infectiosum are no longer contagious
after the rash has appeared
American Academy of Pediatrics Committee on Infectious Diseases. Parvovirus B19.
Kimberlin DW, Brady M, Jackson SA, Long SS, eds. 2015 Red Book: Report of the
Committee on Infectious Diseases. 30th ed. Elk Grove Village, IL: American Academy
of Peiatrics; 2015. 593-596.

45. 08/10/2018Parvovirus 3B19 infection Prof. Dr. Saad S AlAni 45
*Precautions &Prognosis (Cont.)
*Patients with:
Aplastic crisis
Papular-purpuric "gloves and socks" syndrome
(PPGSS)
Immunosuppression
Chronic parvovirus B19 infection with anemia
Should be isolated with droplet and standard
precautions due to ongoing viremia.
American Academy of Pediatrics Committee on Infectious Diseases. Parvovirus B19. Kimberlin DW, Brady M, Jackson SA,
Long SS, eds. 2015 Red Book: Report of the Committee on Infectious Diseases. 30th ed. Elk Grove Village, IL: American
Academy of Peiatrics; 2015. 593-596.

46. 08/10/2018Parvovirus 3B19 infection Prof. Dr. Saad S AlAni 46
*Precautions &Prognosis(Cont.)
*Maintain precaution for patients with
TAC for:
 7 days or
 until the reticulocyte count rebounds
to at least 2%,
*Those with chronic infection should be
isolated for the duration of their stay
American Academy of Pediatrics Committee on Infectious Diseases. Parvovirus B19. Kimberlin DW, Brady M, Jackson SA, Long
SS, eds. 2015 Red Book: Report of the Committee on Infectious Diseases. 30th ed. Elk Grove Village, IL: American Academy of
Peiatrics; 2015. 593-596.

47. 08/10/2018Parvovirus 3B19 infection Prof. Dr. Saad S AlAni 47
*Precautions &Prognosis(Cont.)
*Pregnant staff should be alerted to
the potential risks of parvovirus
B19 infection when caring for
these patients
American Academy of Pediatrics Committee on Infectious Diseases. Parvovirus B19. Kimberlin DW, Brady M, Jackson SA,
Long SS, eds. 2015 Red Book: Report of the Committee on Infectious Diseases. 30th ed. Elk Grove Village, IL: American
Academy of Peiatrics; 2015. 593-596.

48. *References
* American Academy of Pediatrics Committee on Infectious Diseases. Parvovirus B19.
Kimberlin DW, Brady M, Jackson SA, Long SS, eds. 2015 Red Book: Report of the Committee
on Infectious Diseases. 30th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2015.
593-596
* Brown KE. Parvovirus B19. Bennet JE, Dolin R, Blaser M. Mandell, Douglas and Bennett's
Principals and Practice of Infectious Diseases. 8th ed. Philadelphia, PA: Churchill Livingstone
Elsevier; 2015. Vol 2: 1840-1847
* Burns K, Parish CR. Parvoviridae. Knipe DM, Howley PM, eds. Fields Virology. 5th ed.
Philadelphia, PA: Lippincott Williams & Wilkins; 2007. Vol 2: 65
* Schneider, E. Human Parvoviruses. Long SS, Pickering LK, Prober CG, eds. Principles and
Practice of Pediatric Infectious Diseases. 4th ed. Philadelphia, PA: Churchill Livingstone
Elsevier; 2012. 1087-1091
* Young NS, Brown KE. Parvovirus B19. N Engl J Med. 2004 Feb 5. 350(6):586-97.
* Infections. Cunningham FG, Leveno KL, Bloom SL, Hauth JC, Gilstrap III LC, Wenstrom KD,
eds. Williams Obstetrics. 22nd Ed. USA: McGraw-Hill; 2001. chap 58
* Adler SP, Koch WC. Human Parvovirus Infections. Remington JS, Klein JO, Wilson CB, Baker
CJ. Infectious Diseases of the Fetus and Newborn Infant. 6th ed. Philadelphia, PA: Saunders
Elsevier; 2006. 868-892.
08/10/2018Parvovirus 3B19 infection Prof. Dr. Saad S AlAni 48

49. 08/10/2018Parvovirus 3B19 infection Prof. Dr. Saad S AlAni 49
*Thank you