Review
Parvovirus B19 infection in pregnancy

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Abstract

Parvovirus B19 is a small single-stranded DNA virus and a potent inhibitor of erythropoiesis, due to its cytotoxicity to erythroid progenitor cells. Infection with parvovirus B19 during pregnancy can cause several serious complications in the fetus, such as fetal anemia, neurological anomalies, hydrops fetalis, and fetal death. Early diagnosis and treatment of intrauterine parvovirus B19 infection is essential in preventing these fetal complications. Testing maternal serum for IgM antibodies against parvovirus B19 and DNA detection by PCR can confirm maternal infection. If maternal infection has occurred, ultrasound investigation of the fetus and measurement of the peak systolic flow velocity of the middle cerebral artery are sensitive non-invasive procedures to diagnose fetal anemia and hydrops. Intrauterine transfusion is currently the only effective treatment to alleviate fetal anemia, but if the fetus is (near) term, induction of delivery should be considered. Most maternal infections with parvovirus B19 occur through contact with infected children at home. Individual counseling of susceptible pregnant women will reduce unnecessary fetal deaths.

Section snippets

B19 virus: virology

Human parvovirus B19 (B19V) is a small single-stranded DNA virus (Cossart et al., 1975). It is the only member of the Parvoviridae family, genus Erythrovirus, known to be pathogenous to humans (Lukashov and Goudsmit, 2001). Its genome of about 2500 base pairs encodes for three major proteins. Two structural proteins (VP1 and VP2) make up the viral capsid. The viral capsid consists for 95% of VP2; the remaining 5% is made up of VP1. VP1 differs from VP2 only in the N-terminal region with the

Pathogenesis of B19V in pregnancy

B19V is a potent inhibitor of hematopoiesis because it lytically infects erythroid precursor cells. The cellular receptor for B19V is globoside or P-antigen. It is found on erythrocyte progenitor cells (erythroblasts and megakaryocytes), but also on erythrocytes, synovium, placental tissue, fetal myocardium, and endothelial cells (Chisaka et al., 2003, Young and Brown, 2004). Viral replication of B19V is restricted to erythroid progenitor cells. Expression of globoside on the cell surface is

Epidemiology of B19V

Infection with parvovirus B19 is common worldwide. The yearly peak incidence of infection occurs during spring and epidemics occur every 4 years (Bosman et al., 2002). The prevalence of IgG antibodies directed against B19V in the population ranges from 2 to 15% in children 1–5 years old, 15–60% in children 6–19 years old, 30–60% in adults and more than 85% in the geriatric population (Heegaard and Brown, 2002).

About 35–45% of women of childbearing age do not possess protective IgG antibodies

Clinical manifestations of B19V in pregnancy

Fetal infection with B19V is associated with intrauterine fetal death (IUFD), non-immune hydrops fetalis (NIHF) and neurological manifestations. Fetal infection can also be asymptomatic (Koch et al., 1998).

Serological tests

Serologic examination of maternal blood is the first and most useful diagnostic test that should be performed as soon as possible once B19V infection is suspected during pregnancy (see algorithm). B19 IgG or IgM antibody detection now is most often performed by enzyme immuno assays, which tend to replace the immunofluorescent technique (Beersma et al., 2005, Doyle et al., 2000). B19V specific IgM antibodies become detectable in maternal serum within 7–10 days after infection, sharply peak at

Intrauterine transfusion (IUT)

Management of B19V infection with IUT can correct fetal anemia and may reduce the mortality of B19V infection significantly (Fig. 3). Timely IUT of fetuses with severe hydrops reduces the risk of fetal death (Enders et al., 2004, Fairley et al., 1995, Rodis et al., 1998, Schild et al., 1999). In most cases, one transfusion is sufficient for fetal recovery. Following successful transfusion, it may take weeks for all hydropic signs to disappear. A few cases of spontaneous resolution of hydrops

Management of intrauterine B19V infection

Pregnant women who have been exposed to B19V, or those developing symptoms compatible with B19V infection, should be assessed for susceptibility or the presence of infection, by determining their B19V IgG and IgM status (Fig. 4). If the woman is immune to B19V (IgG positive, IgM negative) she can be reassured that recent exposure will not result in adverse consequences in her pregnancy. If there is no immunity to the virus and no seroconversion has taken place after 1–2 weeks, the woman is not

Prognosis

Children who survived a successful IUT for B19V-induced fetal anemia and hydrops fetalis have a good neurodevelopmental prognosis (Dembinski et al., 2002).

Risk factors

A prospective evaluation of 618 pregnant women exposed to B19V in an endemic period was performed by Harger et al. (1998). In this study the single statistically significant risk factor that was found for B19V infections in pregnant women was exposure to B19V by their own children. Other studies have found an increased risk for B19V

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