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Simunov B, Mrzljak A, Jurekovic Z, Zidovec Lepej S, Bainrauch A, Pavicic Saric J, Hruskar Z, Radmanic L, Vilibic-Cavlek T. Parvovirus B19 status in liver, kidney and pancreas transplant candidates: A single center experience. World J Transplant 2022; 12:378-387. [PMID: 36437842 PMCID: PMC9693899 DOI: 10.5500/wjt.v12.i11.378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 09/05/2022] [Accepted: 09/22/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Parvovirus B19 (B19V) is associated with a wide range of clinical manifestations. The major presentation is erythema infectiosum. However, a persistent infection may cause pure red cell aplasia and chronic anemia in immunocompromized patients. The B19V seroprevalence varies with age and geographical location.
AIM To determine the B19V serological status and DNAemia in kidney, liver, and pancreas transplant candidates.
METHODS Patients who underwent kidney, liver, or simultaneous kidney and pancreas/liver transplantation between January 2021 and May 2022 were included in the study. The serum samples were collected before transplantation. For detection of B19V DNA, a LightMix Kit B19V EC (TIB MOLBIOL, Berlin, Germany) was used. B19V IgM and IgG antibodies were detected using a commercial ELISA test (Euroimmun, Lübeck, Germany).
RESULTS One hundred and thirty-one transplant candidates were included in the study, 71.0% male, with an average age of 53.27 years ± 12.71 years. There were 68.7% liver, 27.5% kidney, 3.0% simultaneous pancreas/kidney transplant (SPKT), and 0.8% simultaneous liver/kidney transplant recipients. No patients had detectable B19V DNA. B19V IgG seroprevalence was 77.1%. No acute or recent infections were detected (IgM antibodies). There was no difference in the mean age of seronegative and seropositive patients (51.8 years ± 12.9 years vs 53.7 years ± 12.7 years, t = -0.603; P = 0.548). Although seropositivity was lower in patients aged less than 30 years (66.6%) compared to the patients aged 30-59 years and > 60 years (80.4% and 78.1%, respectively), this difference was not significant. In addition, there was no difference in seropositivity between male and female transplant candidates, 76.3% and 78.9% (χ2 = 0.104; P = 0.748). The seroprevalence did not differ among organ recipients, with 77.8%, 80.6%, and 50.0% for liver, kidney, and SPKT, respectively, (χ2 = 5.297; P = 0.151). No significant difference was found in the seroprevalence in kidney transplant patients according to dialysis modality. Seroprevalence was 71.1% in hemodialysis patients, and 100% in peritoneal dialysis patients (χ2 = 0.799; P = 0.372).
CONCLUSION The B19V seroprevalence is expectedly high among kidney, liver, and pancreas transplant candidates, but there are still 22.9% of seronegative individuals who remain at risk for primary disease and severe manifestations. Further research should elucidate the necessity of B19V screening in peri-transplant management.
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Affiliation(s)
- Bojana Simunov
- Department of Nephrology, Merkur University Hospital, Zagreb 10000, Croatia
| | - Anna Mrzljak
- Department of Gastroenterology and Hepatology, University Clinical Hospital Zagreb, Zagreb 10000, Croatia
- School of Medicine, University of Zagreb, Zagreb 10000, Croatia
| | - Zeljka Jurekovic
- Department of Nephrology, Merkur University Hospital, Zagreb 10000, Croatia
| | - Snjezana Zidovec Lepej
- Department of Immunological and Molecular Diagnostics, University Hospital for Infectious Diseases “Dr. Fran Mihaljevic”, Zagreb 10000, Croatia
| | - Ana Bainrauch
- Department of Medicine, Merkur University Hospital, Zagreb 10000, Croatia
| | | | - Zeljka Hruskar
- Department of Virology, Croatian Institute of Public Health, Zagreb 10000, Croatia
| | - Leona Radmanic
- Department of Immunological and Molecular Diagnostics, University Hospital for Infectious Diseases “Dr. Fran Mihaljevic”, Zagreb 10000, Croatia
| | - Tatjana Vilibic-Cavlek
- School of Medicine, University of Zagreb, Zagreb 10000, Croatia
- Department of Virology, Croatian Institute of Public Health, Zagreb 10000, Croatia
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Zhong Q, Zeng J, Lin T, Song T. The detection, treatment of parvovirus B19 infection induced anemia in solid organ transplants: a case series and literature review of 194 patients. Transfus Clin Biol 2022; 29:168-174. [PMID: 35007720 DOI: 10.1016/j.tracli.2021.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 12/15/2021] [Accepted: 12/26/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND There are no optimal diagnostic, treatment and post-infection surveillance strategies for parvovirus B19 infection in solid organ transplantation (SOT) recipients. METHODS We conducted a retrospective review of all PVB19 infected cases confirmed by qPCR among SOT recipients at our institution over a 3-year period and reviewed the literature from 1990 to 2021. RESULTS Eight kidney and two heart transplant patients with refractory anemia had PVB19 infection. The viral DNA load in peripheral blood ranged from 2.62 × 102 to 8.31 × 106 copies/mL. Two patients with the lowest PVB19 DNA load only reduced the use of immunosuppressants and anemia was relieved. Eight received intravenous immunoglobulin (IVIG) (ranging from 0.25 to 0.5 g/kg/day). The median time to anemia improvement (hemoglobulin>100g/L) was 16 days (8-70 days) after treatment. One patient had a PVB19 relapse and viral DNA load > 1.00 × 108 copies/mL at diagnosis. A total of 86 studies involving 194 SOTs were screened from the literature, and the most common symptom was anemia and low reticulocyte count. PVB19 DNA was detected in all cases. Of that, 91.4% of cases received IVIG, 53.8% received IVIG and immunosuppression reduction, 6.5% of cases showed reduced immunosuppression without IVIG, and 2.1% did not receive any special treatment. The recurrence rate was 17.5%. CONCLUSION PVB19 infection is a cause of anemia after SOT, and treatment mainly relies on IVIG and/or immunosuppression reduction.
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Affiliation(s)
- Qiang Zhong
- Urology Department, Urology research institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Organ transplantation center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jun Zeng
- Department of Transplantation Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Tao Lin
- Urology Department, Urology research institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Organ transplantation center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - TuRun Song
- Urology Department, Urology research institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Organ transplantation center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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Endonuclease Activity Inhibition of the NS1 Protein of Parvovirus B19 as a Novel Target for Antiviral Drug Development. Antimicrob Agents Chemother 2019; 63:AAC.01879-18. [PMID: 30530599 DOI: 10.1128/aac.01879-18] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 11/30/2018] [Indexed: 12/27/2022] Open
Abstract
Human parvovirus B19 (B19V), a member of the genus Erythroparvovirus of the family Parvoviridae, is a small nonenveloped virus that has a single-stranded DNA (ssDNA) genome of 5.6 kb with two inverted terminal repeats (ITRs). B19V infection often results in severe hematological disorders and fetal death in humans. B19V replication follows a model of rolling hairpin-dependent DNA replication, in which the large nonstructural protein NS1 introduces a site-specific single-strand nick in the viral DNA replication origins, which locate at the ITRs. NS1 executes endonuclease activity through the N-terminal origin-binding domain. Nicking of the viral replication origin is a pivotal step in rolling hairpin-dependent viral DNA replication. Here, we developed a fluorophore-based in vitro nicking assay of the replication origin using the origin-binding domain of NS1 and compared it with the radioactive in vitro nicking assay. We used both assays to screen a set of small-molecule compounds (n = 96) that have potential antinuclease activity. We found that the fluorophore-based in vitro nicking assay demonstrates sensitivity and specificity values as high as those of the radioactive assay. Among the 96 compounds, we identified 8 which have an inhibition of >80% at 10 µM in both the fluorophore-based and radioactive in vitro nicking assays. We further tested 3 compounds that have a flavonoid-like structure and an in vitro 50% inhibitory concentration that fell in the range of 1 to 3 µM. Importantly, they also exhibited inhibition of B19V DNA replication in UT7/Epo-S1 cells and ex vivo-expanded human erythroid progenitor cells.
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Baek CH, Kim H, Yang WS, Han DJ, Park SK. Risk factors and long-term outcomes of parvovirus B19 infection in kidney transplant patients. Transpl Infect Dis 2017; 19. [PMID: 28741797 DOI: 10.1111/tid.12754] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 04/03/2017] [Accepted: 05/08/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Parvovirus B19 is a small, non-enveloped, single-stranded DNA virus with a special affinity for the erythroid progenitor cells of the bone marrow. The first case of parvovirus B19 infection in a kidney transplant recipient (KTR) was reported in 1986. Data on the risk factors and specific clinical characteristics of parvovirus B19 infection remain insufficient. METHODS We screened 602 KTRs for parvovirus B19 infection using parvovirus B19 polymerase chain reaction (PCR) from January 1990 to April 2016, and the clinical characteristics of patients with positive results were compared to those of age- and gender-matched patients with negative PCR results. RESULTS A total of 39 KTRs tested positive for parvovirus B19, and they were compared to 78 age- and gender-matched patients among 563 KTRs who had negative PCR results. In all, 89.7% of positive cases were reported within the first year after kidney transplantation. In multivariate analyses, deceased-donor kidney transplantation (odds ratio [OR] 9.067, 95% confidence interval [CI] 1.668-49.275, P = .011), use of tacrolimus (OR 3.607, 95% CI 1.024-12.706, P = .046), PCR test within 1 year of kidney transplantation (OR 12.456, 95% CI 2.674-58.036, P = .001), and hemoglobin levels (OR 0.559, 95% CI 0.351-0.889, P = .014) showed significant correlations with parvovirus B19 infection. Graft survival did not differ between the two groups during the follow-up period of 111.68 ± 54.54 months (P = .685 by log-rank test). CONCLUSION The identification of factors related to positive parvovirus B19 PCR results may promote the early detection of parvovirus B19 infection. Further studies are needed to elucidate the characteristics of parvovirus B19 infection in kidney transplantation.
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Affiliation(s)
- Chung Hee Baek
- Division of Nephrology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyosang Kim
- Division of Nephrology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Won Seok Yang
- Division of Nephrology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Duck Jong Han
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Su-Kil Park
- Division of Nephrology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Abstract
Parvovirus B19 (B19V) and human bocavirus 1 (HBoV1), members of the large Parvoviridae family, are human pathogens responsible for a variety of diseases. For B19V in particular, host features determine disease manifestations. These viruses are prevalent worldwide and are culturable in vitro, and serological and molecular assays are available but require careful interpretation of results. Additional human parvoviruses, including HBoV2 to -4, human parvovirus 4 (PARV4), and human bufavirus (BuV) are also reviewed. The full spectrum of parvovirus disease in humans has yet to be established. Candidate recombinant B19V vaccines have been developed but may not be commercially feasible. We review relevant features of the molecular and cellular biology of these viruses, and the human immune response that they elicit, which have allowed a deep understanding of pathophysiology.
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Affiliation(s)
- Jianming Qiu
- Department of Microbiology, Molecular Genetics and Immunology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | | | - Neal S Young
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
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Fischer SA. Emerging and Rare Viral Infections in Transplantation. TRANSPLANT INFECTIONS 2016. [PMCID: PMC7122901 DOI: 10.1007/978-3-319-28797-3_49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Immunocompromised patients such as those undergoing solid organ or hematopoietic stem cell transplantation are at substantial risk for infection with numerous pathogens. Infections with cytomegalovirus (CMV), herpes simplex virus (HSV), Epstein–Barr virus (EBV), and human herpesvirus-6 (HHV-6) are well-described complications of transplantation. As viruses previously believed to be quiescent through widespread vaccination (e.g., measles and mumps) reemerge and molecular diagnostic techniques are refined, rare and emerging viral infections are increasingly diagnosed in transplant recipients. This chapter will review the clinical manifestations, diagnosis, and potential antiviral therapies for these viruses in the transplant population.
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Porignaux R, Vuiblet V, Barbe C, Nguyen Y, Lavaud S, Toupance O, Andréoletti L, Rieu P, Lévêque N. Frequent occurrence of parvovirus B19 DNAemia in the first year after kidney transplantation. J Med Virol 2013; 85:1115-21. [DOI: 10.1002/jmv.23557] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2013] [Indexed: 12/11/2022]
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Moal V, Zandotti C, Colson P. Emerging viral diseases in kidney transplant recipients. Rev Med Virol 2012; 23:50-69. [PMID: 23132728 PMCID: PMC7169126 DOI: 10.1002/rmv.1732] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2012] [Revised: 09/13/2012] [Accepted: 09/20/2012] [Indexed: 12/22/2022]
Abstract
Viruses are the most important cause of infections and a major source of mortality in Kidney Transplant Recipients (KTRs). These patients may acquire viral infections through exogenous routes including community exposure, donor organs, and blood products or by endogenous reactivation of latent viruses. Beside major opportunistic infections due to CMV and EBV and viral hepatitis B and C, several viral diseases have recently emerged in KTRs. New medical practices or technologies, implementation of new diagnostic tools, and improved medical information have contributed to the emergence of these viral diseases in this special population. The purpose of this review is to summarize the current knowledge on emerging viral diseases and newly discovered viruses in KTRs over the last two decades. We identified viruses in the field of KT that had shown the greatest increase in numbers of citations in the NCBI PubMed database. BKV was the most cited in the literature and linked to an emerging disease that represents a great clinical concern in KTRs. HHV-8, PVB19, WNV, JCV, H1N1 influenza virus A, HEV, and GB virus were the main other emerging viruses. Excluding HHV8, newly discovered viruses have been infrequently linked to clinical diseases in KTRs. Nonetheless, pathogenicity can emerge long after the discovery of the causative agent, as has been the case for BKV. Overall, antiviral treatments are very limited, and reducing immunosuppressive therapy remains the cornerstone of management.
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Affiliation(s)
- Valérie Moal
- Centre de Néphrologie et Transplantation Rénale, APHM, CHU Conception, Marseille, France.
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Gosset C, Viglietti D, Hue K, Antoine C, Glotz D, Pillebout E. How many times can parvovirus B19-related anemia recur in solid organ transplant recipients? Transpl Infect Dis 2012; 14:E64-70. [DOI: 10.1111/j.1399-3062.2012.00773.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Revised: 03/07/2012] [Accepted: 03/13/2012] [Indexed: 12/22/2022]
Affiliation(s)
- C. Gosset
- Néphrologie-Transplantation; Hôpital Saint-Louis; Université Paris VII; Paris; France
| | - D. Viglietti
- Néphrologie-Transplantation; Hôpital Saint-Louis; Université Paris VII; Paris; France
| | - K. Hue
- Néphrologie; CHU Pointe-à-Pitre; Guadeloupe; France
| | - C. Antoine
- Néphrologie-Transplantation; Hôpital Saint-Louis; Université Paris VII; Paris; France
| | - D. Glotz
- Néphrologie-Transplantation; Hôpital Saint-Louis; Université Paris VII; Paris; France
| | - E. Pillebout
- Néphrologie-Transplantation; Hôpital Saint-Louis; Université Paris VII; Paris; France
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Carraturo A, Catalani V, Ottaviani D, Menichelli P, Rossini M, Terella D, Biondi B. Parvovirus B19 infection and severe anemia in renal transplant recipients. ScientificWorldJournal 2012; 2012:102829. [PMID: 22619569 PMCID: PMC3349305 DOI: 10.1100/2012/102829] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Accepted: 12/22/2011] [Indexed: 12/22/2022] Open
Abstract
Kidney transplant (KT) recipients can develop symptomatic Parvovirus (PV) B19 infections, frequently associated with persistent anemia. The aim of this study was to evaluate the prevalence and clinical significance of PV B19 infection in anemic and non-anemic KT patients. Overall, out of 64 patients monitored for the presence of PV B19 by real-time PCR, 2 (3.12%) had an active PV B19 infection, in absence of other viral coinfections. The 2 cases occurred in nonanemic kidney transplant patients group (2/50, 4%), while none of the anemic transplant patients (0/14) was found to suffer from this infection. Moreover, patients affected by active PV B19 infection showed viral loads not exceeding 1 × 105 genome copies/reaction. In conclusion, in this study, PV B19 infection was not common in renal transplant population and wasn't associated with severe anemia.
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Affiliation(s)
- Antonio Carraturo
- Clinical Pathology Laboratory, Santa Maria Goretti Hospital, AUSL Latina, 04100 Latina, Italy.
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Brodin-Sartorius A, Mekki Y, Bloquel B, Rabant M, Legendre C. [Parvovirus B19 infection after kidney transplantation]. Nephrol Ther 2011; 8:5-12. [PMID: 21757415 DOI: 10.1016/j.nephro.2011.06.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2010] [Revised: 06/06/2011] [Accepted: 06/13/2011] [Indexed: 01/09/2023]
Abstract
Prevalence for human parvovirus B19 infection is estimated to be between 2% and 30% in renal transplant recipients. In post-transplant settings, parvovirus B19 infection may occur either as a primary infection or a reactivation. Parvovirus transmission most commonly occurs through respiratory tract but may also result from graft or blood packs contamination. Co-infections with HHV-6 and CMV viruses are frequent. The hallmark symptom is anemia, more rarely pancytopenia and hemophagocytic syndrome. In respect to renal involvement, parvovirus B19 infection has been associated with graft dysfunction in 10% of cases. Both thrombotic microangiopathies and collapsing glomerulopathies have been reported concomitantly with parvovirus B19 infection but the causal link remains unclear. Other complications are seldomly reported, including hepatitis, encephalitis, and myocarditis. Diagnosis is based on pre and post-transplant serological status. In addition, the management of parvovirus B19 infection in immunocompromised patients requires quantitative assessment of blood viral load by PCR. The treatment relies primarily on reduction of immunosuppression combined with intravenous immunoglobulin infusions. Relapses occur in 30% of cases.
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Affiliation(s)
- Albane Brodin-Sartorius
- Service de transplantation rénale adulte, université Paris-Descartes, hôpital Necker, 149-161, rue de Sèvres, 75015 Paris, France.
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Shen Q, Xu H, Cao Q, Zhou LJ, Xu J, Fang XY, Ge J. Long-term remission of recurrent severe anemia as a result of parvovirus B19 infection in a pediatric renal transplant recipient. Pediatr Transplant 2011; 15:E76-9. [PMID: 20136725 DOI: 10.1111/j.1399-3046.2010.01291.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We studied a case of recurrent PV-B19-associated anemia in a renal transplant child with long-term remission induced by baseline immunosuppression adjusted and intensive IVIG therapy. This was a 15-yr-old boy. Seven wk after transplantation, he experienced acute rejection, which was treated with high-dose steroids, ATG, and plasmapheresis. Ten wk after transplantation (three wk after rejection), his hemoglobin dropped to 54 g/L and serum PV-B19 PCR was positive. After therapy with IVIG and conversion from mycophenolate mofetil to rapamycin, anemia resolved. But the patient had fever on the fourth day of IVIG with mild pulmonary edema and rise in serum creatinine. Two months after the first course of IVIG, anemia recurred and a second course of IVIG (preadministration methylprednisolone) was given, which was followed by the resolution of anemia without side effect and recurrence two months later again. Baseline immunosuppression was adjusted with dual immunosuppression and low doses including prednisolone and tacrolimus. At the same time, monthly course of IVIG was repeated four times. Within the next 23 months, anemia did not recur and renal function remained stable. In conclusion, PV-B19-associated anemia can be recurrent in immunocompromised children and baseline immunosuppression should be carefully adjusted to control PV-B19 infection.
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Affiliation(s)
- Qian Shen
- Department of Nephrology and Rheumatology, Children's Hospital of Fudan University, Shanghai, China
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Park JB, Kim DJ, Woo SY, Choi GS, Chun JM, Jung GO, Kwon CHD, Kim SJ, Joh JW, Lee SK. Clinical implications of quantitative real time-polymerase chain reaction of parvovirus B19 in kidney transplant recipients - a prospective study. Transpl Int 2009; 22:455-62. [DOI: 10.1111/j.1432-2277.2008.00818.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Abstract
PURPOSE OF REVIEW Numerous recent advances have been made in the field of infectious diseases and pediatric solid organ transplant. RECENT FINDINGS Although many studies contain somewhat small cohorts of individuals, when summarized together they contribute significantly to our knowledge about pediatric solid organ transplant, especially regarding risk factors for infection, management of BK virus nephropathy, the use of live viral vaccines, and consideration for rare infections as well as donor-derived infections. SUMMARY In sum, these recent advances in infection in the field of pediatric solid organ transplant will help decrease infection, thus improving morbidity and mortality, as well as transplant outcomes, especially by decreasing direct (graft injury) and indirect (immune upregulation) effects on organ transplantation. This review will focus on recent advances in the field of infectious diseases in pediatric solid organ transplant by highlighting some of the most important and interesting articles in the field within the past few years.
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Emerging Viruses in Transplantation: There Is More to Infection After Transplant Than CMV and EBV. Transplantation 2008; 86:1327-39. [DOI: 10.1097/tp.0b013e31818b6548] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Ardalan MR, Shoja MM, Tubbs RS, Esmaili H, Keyvani H. Postrenal transplant hemophagocytic lymphohistiocytosis and thrombotic microangiopathy associated with parvovirus b19 infection. Am J Transplant 2008; 8:1340-4. [PMID: 18522549 DOI: 10.1111/j.1600-6143.2008.02244.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Persistent anemia is a known consequence of Parvovirus B19 (B19) infection following renal transplantation. However, to date, no description of B19-related hemophagocytic lymphohistiocytosis (HLH) exists in renal transplant recipients. We report a 24-year-old male kidney recipient, who presented with fever, severe anemia and allograft dysfunction two years following transplantation. Hyperferritinemia, hypertriglyceridemia, elevated serum lactate dehydrogenase, pancytopenia and fragmented red blood cells on the peripheral blood were also noted. Bone marrow examination revealed giant pronormoblasts and frequent histiocytes with intracellular hematopoietic elements, consistent with HLH. Renal allograft biopsy revealed closure of the lumen of glomerular capillaries and thickening of the capillary walls compatible with thrombotic microangiopathy. The presence of anti-B19 IgM antibody and viral DNA in the patient's serum (detected by real-time PCR) confirmed an acute B19 infection. Following high-dose intravenous immunoglobulin therapy, the anemia gradually resolved and renal function improved. As far as we know, this is the first report of B19-associated HLH and thrombotic microangiopathy in a renal transplant recipient.
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Affiliation(s)
- M R Ardalan
- Department of Nephrology, Tabriz University of Medical Sciences, Tabriz, Iran
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Hodges VM, Rainey S, Lappin TR, Maxwell AP. Pathophysiology of anemia and erythrocytosis. Crit Rev Oncol Hematol 2007; 64:139-58. [PMID: 17656101 DOI: 10.1016/j.critrevonc.2007.06.006] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2006] [Revised: 03/02/2007] [Accepted: 06/12/2007] [Indexed: 10/23/2022] Open
Abstract
An increasing understanding of the process of erythropoiesis raises some interesting questions about the pathophysiology, diagnosis and treatment of anemia and erythrocytosis. The mechanisms underlying the development of many of the erythrocytoses, previously characterised as idiopathic, have been elucidated leading to an increased understanding of oxygen homeostasis. Characterisation of anemia and erythrocytosis in relation to serum erythropoietin levels can be a useful addition to clinical diagnostic criteria and provide a rationale for treatment with erythropoiesis stimulating agents (ESAs). Recombinant human erythropoietin as well as other ESAs are now widely used to treat anemias associated with a range of conditions, including chronic kidney disease, chronic inflammatory disorders and cancer. There is also heightened awareness of the potential abuse of ESAs to boost athletic performance in competitive sport. The discovery of erythropoietin receptors outside of the erythropoietic compartment may herald future applications for ESAs in the management of neurological and cardiac diseases. The current controversy concerning optimal hemoglobin levels in chronic kidney disease patients treated with ESAs and the potential negative clinical outcomes of ESA treatment in cancer reinforces the need for cautious evaluation of the pleiotropic effects of ESAs in non-erythroid tissues.
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Affiliation(s)
- Vivien M Hodges
- Haematology Research Group, Centre for Cancer Research and Cell Biology, Queen's University, Belfast, United Kingdom.
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Waldman M, Kopp JB. Parvovirus-B19-associated complications in renal transplant recipients. ACTA ACUST UNITED AC 2007; 3:540-50. [PMID: 17895931 DOI: 10.1038/ncpneph0609] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2007] [Accepted: 06/19/2007] [Indexed: 01/08/2023]
Abstract
Parvovirus B19 is a common human pathogen, causing erythema infectiosum in children, hydrops fetalis in pregnant women, and transient aplastic crisis in patients with chronic hemolytic anemia. Immunosuppressed patients can fail to mount an effective immune response to B19, resulting in prolonged or persistent viremia. Renal transplant recipients can develop symptomatic B19 infections as a result of primary infection acquired via the usual respiratory route or via the transplanted organ, or because of reactivation of latent or persistent viral infection. The most common manifestations of B19 infection in immunosuppressed patients are pure red cell aplasia and other cytopenias. Thus, this diagnosis should be considered in transplant recipients with unexplained anemia and reticulocytopenia or pancytopenia. Collapsing glomerulopathy and thrombotic microangiopathy have been reported in association with B19 infection in renal transplant recipients, but a causal relationship has not been definitively established. Prompt diagnosis of B19 infection in the renal transplant recipient requires a high index of suspicion and careful selection of diagnostic tests, which include serologies and polymerase chain reaction. Most patients benefit from intravenous immunoglobulin therapy and/or alteration or reduction of immunosuppressive therapy. Conservative therapy might be sufficient in some cases.
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Affiliation(s)
- Meryl Waldman
- Kidney Disease Section, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Department of Health and Human Services, Bethesda, MD 20814-9692, USA.
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