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Papadatou V, Tologkos S, Deftereou T, Alexiadis T, Pagonopoulou O, Alexiadi CA, Bakatselou P, Oglou STC, Tripsianis G, Mitrakas A, Lambropoulou M. Viral-induced inflammation can lead to adverse pregnancy outcomes. Folia Med (Plovdiv) 2023; 65:744-752. [PMID: 38351756 DOI: 10.3897/folmed.65.e90054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 11/07/2022] [Indexed: 02/16/2024] Open
Abstract
INTRODUCTION Parvoviruses are DNA viruses of small size. There have been a number of reports indicating the possible effects of B19 infections during pregnancy. These effects include spontaneous abortions, stillbirth, fetal damage, and quite often, fetal anemia with hydrops fetalis.
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Berezowsky A, Hochberg A, Regev N, Weisz B, Lipitz S, Yinon Y. Intrauterine Blood Transfusion for Parvo B19-Induced Fetal Anemia: Neuroimaging Findings and Long-Term Neurological Outcomes. Fetal Diagn Ther 2023; 50:206-214. [PMID: 37231949 PMCID: PMC10614255 DOI: 10.1159/000530993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 03/31/2023] [Indexed: 05/27/2023]
Abstract
INTRODUCTION We aimed to evaluate the neuroimaging findings and long-term neurodevelopmental outcomes of fetuses and children following intrauterine blood transfusion (IUT) for parvo B19 infection-induced anemia compared to those with RBC alloimmunization. METHODS We conducted a retrospective cohort study including women who underwent an IUT due to fetal anemia between 2006 and 2019 in a tertiary, university-affiliated medical center. The cohort was divided into two groups: a study group - fetuses affected by congenital parvo B19 infection; and a control group - fetuses affected by RBC alloimmunization. Retrospective data such as antenatal sonographic evaluations, fetal brain MRI results, and short-term fetal and neonatal outcomes were collected. All children underwent a neurodevelopmental evaluation after birth using a Vineland questionnaire. Primary outcome was defined as the presence or absence of neurodevelopmental delay. Secondary outcome was defined as the presence of abnormal fetal neuroimaging findings such as cerebellar hypoplasia, polymicrogyria, intracranial hemorrhage, or severe ventriculomegaly. RESULTS Overall, 71 fetuses requiring at least one IUT were included in the study. Of these, 18 were affected by parvo B19 infection and 53 by RBC alloimmunization with various associated antibodies. Fetuses in the parvo B19 group presented at an earlier gestational age (22.91 ± 3.36 weeks vs. 27.37 ± 4.67 weeks, p = 0.002) and were more affected by hydrops (93.33% vs. 16.98%, p < 0.001). Three fetuses out of the 18 (16.67%) fetuses in the parvo B19 group died in utero following the IUT. Abnormal neuroimaging findings were detected in 4/15 (26.7%) of the parvo B19 survivors versus 2/53 (3.8%) of fetuses affected by RBC alloimmunization (p = 0.005). There was no difference in long-term neurodevelopmental delay rates between the children in the study and control groups, as assessed at the average age of 3.65 and 6.53 years, accordingly. CONCLUSION Fetal anemia due to parvo B19, treated with IUT, might be associated with increased rates of abnormal neurosonographic findings. The correlation between those findings and long-term adverse neurodevelopmental outcomes requires further investigation.
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Affiliation(s)
- Alexandra Berezowsky
- Helen Schneider Hospital for Women, Rabin Medical Center and Tel Aviv University, Petah Tikva, Israel
| | - Alyssa Hochberg
- Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada
| | - Noam Regev
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Petah Tikva, Israel
| | - Boaz Weisz
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Petah Tikva, Israel
| | - Shlomo Lipitz
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Petah Tikva, Israel
| | - Yoav Yinon
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Petah Tikva, Israel
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Lu K, Wang F, Ma B, Cao W, Guo Q, Wang H, Rodriguez R, Wang Z. Teratogenic Toxicity Evaluation of Bladder Cancer-Specific Oncolytic Adenovirus on Mice. Curr Gene Ther 2021; 21:160-166. [PMID: 33334289 DOI: 10.2174/1566523220999201217161258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 11/20/2020] [Accepted: 11/23/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND In our previous studies, we had demonstrated the efficiency and specificity of constructed bladder tissue-specific adenovirus Ad-PSCAE-UPII-E1A-AR (APU-EIA-AR) on bladder cancer. The virus biodistribution and body toxicity in nude mice have also been investigated. However, the safety of the bladder cancer-specific oncolytic adenovirus on fetal mice and F1 mice should be under intense investigation. OBJECTIVE In order to evaluate the teratogenic toxicity of bladder cancer-specific oncolytic adenovirus APU-EIA-AR on mice, in this study, we investigated the fetal mice weight, fetal body length and tail length, fetal skeleton development, as well as the F1 mice weight, growth curve, and major organ pathology. These teratogenic toxicity data of bladder tissue-specific adenovirus Ad-PSCAE- UPII-E1A-AR (AD) would provide safe information prior to embarking on clinical trials. METHODS On the sixth day of being fertilized, the pregnant mice began to be intramuscularly administrated with AD (1×107VP, 1×108VP, 1×109VP) every other day for ten days. The pregnant mice were then divided into two groups. One group was euthanized on the seventeenth day; the fetal mice were taken out, and the bone structure of the infants was observed. The other group was observed until natural childbirth. The Filial Generation (F1) is fed for 30 days; the variations in the growth progress and development were assessed. The mice were then euthanized; The tissues from major organs were harvested and observed under the microscope. RESULTS In the process of teratogenic toxicity test, the Placenta weight, fetal mice weight, body length, and a tail length of mice fetal in adenovirus treated group did not reveal any alteration. Meanwhile, comparing with the PBS group, there is no obvious change in the skeleton of fetal mice treated with adenovirus. During the development process of F1 mice treated with adenovirus, the changes in mice weight show statistical significance. However, in the progress of the growth curve, this difference is not very obvious. Furthermore, the pathological section showed no obvious alteration in major organs. CONCLUSION Our study demonstrated that bladder cancer-specific adenovirus Ad-PSCAE-UPII- E1A-AR appears safe in pregnant mice without any discernable effects on fetal mice and F1 development. Hence, it is relatively safe for tumor gene therapy.
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Affiliation(s)
- Keqing Lu
- Gansu Nephro-Urological Clinical Center, Key Laboratory of Urological Diseases, Gansu Province (Lanzhou University), Institute of Urology, The Second Hospital of Lanzhou University, Lanzhou730000, China
| | - Fang Wang
- Center of Medical Experiments, School of Basic Medical Sciences, Lanzhou University, Gansu Province, Lanzhou730000, China
| | - Baoliang Ma
- Gansu Nephro-Urological Clinical Center, Key Laboratory of Urological Diseases, Gansu Province (Lanzhou University), Institute of Urology, The Second Hospital of Lanzhou University, Lanzhou730000, China
| | - Wenjuan Cao
- Gansu Nephro-Urological Clinical Center, Key Laboratory of Urological Diseases, Gansu Province (Lanzhou University), Institute of Urology, The Second Hospital of Lanzhou University, Lanzhou730000, China
| | - Qi Guo
- Gansu Nephro-Urological Clinical Center, Key Laboratory of Urological Diseases, Gansu Province (Lanzhou University), Institute of Urology, The Second Hospital of Lanzhou University, Lanzhou730000, China
| | - Hanzhang Wang
- Department of Urology, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229-3900, United States
| | - Ronald Rodriguez
- Department of Urology, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229-3900, United States
| | - Zhiping Wang
- Gansu Nephro-Urological Clinical Center, Key Laboratory of Urological Diseases, Gansu Province (Lanzhou University), Institute of Urology, The Second Hospital of Lanzhou University, Lanzhou730000, China
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Narang K, Cheek EH, Enninga EAL, Theiler RN. Placental Immune Responses to Viruses: Molecular and Histo-Pathologic Perspectives. Int J Mol Sci 2021; 22:2921. [PMID: 33805739 PMCID: PMC7998619 DOI: 10.3390/ijms22062921] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/09/2021] [Accepted: 03/09/2021] [Indexed: 12/12/2022] Open
Abstract
As most recently demonstrated by the SARS-CoV-2 pandemic, congenital and perinatal infections are of significant concern to the pregnant population as compared to the general population. These outcomes can range from no apparent impact all the way to spontaneous abortion or fetal infection with long term developmental consequences. While some pathogens have developed mechanisms to cross the placenta and directly infect the fetus, other pathogens lead to an upregulation in maternal or placental inflammation that can indirectly cause harm. The placenta is a temporary, yet critical organ that serves multiple important functions during gestation including facilitation of fetal nutrition, oxygenation, and prevention of fetal infection in utero. Here, we review trophoblast cell immunology and the molecular mechanisms utilized to protect the fetus from infection. Lastly, we discuss consequences in the placenta when these protections fail and the histopathologic result following infection.
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Affiliation(s)
- Kavita Narang
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA;
| | - Elizabeth H. Cheek
- Department of Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA;
| | - Elizabeth Ann L. Enninga
- Departments of Immunology, Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA;
| | - Regan N. Theiler
- Division of Obstetrics, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA
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Attwood LO, Holmes NE, Hui L. Identification and management of congenital parvovirus B19 infection. Prenat Diagn 2020; 40:1722-1731. [PMID: 32860469 DOI: 10.1002/pd.5819] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/24/2020] [Accepted: 08/25/2020] [Indexed: 12/12/2022]
Abstract
Parvovirus B19 (B19V) infection is well known for its mild, self-limiting clinical presentations in children, such as erythema infectiosum. Approximately 40% of women of childbearing age are susceptible to B19V infection. While maternal B19V infection usually has a good prognosis, B19V can cause severe fetal anaemia and pregnancy loss due to its ability to suppress erythroid progenitor cells. Non-invasive ultrasound monitoring for fetal anaemia is usually performed if maternal seroconversion occurs in the first 20 weeks of gestation, with amniocentesis for fetal infection reserved for those who first present with fetal anaemia or hydrops of unknown cause. Intrauterine transfusion is the standard treatment for severe fetal anaemia and is associated with a significant improvement in survival. However, survivors of hydrops fetalis may have a higher rate of long-term neurodevelopmental complications compared with non-hydropic survivors. This review aims to synthesise published data on the diagnosis, surveillance and outcomes of congenital parvovirus infection to assist clinicians in diagnosing and managing this important condition.
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Affiliation(s)
- Lucy O Attwood
- Department of Infectious Diseases, Austin Health, Melbourne, Victoria, Australia
| | - Natasha E Holmes
- Department of Infectious Diseases, Austin Health, Melbourne, Victoria, Australia.,Department of Perinatal Medicine, Mercy Hospital for Women, Melbourne, Victoria, Australia.,Department of Medicine and Radiology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Lisa Hui
- Department of Perinatal Medicine, Mercy Hospital for Women, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Victoria, Australia.,Reproductive Epidemiology group, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Obstetrics and Gynaecology, Northern Health, Melbourne, Victoria, Australia
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Xiong YQ, Tan J, Liu YM, He Q, Li L, Zou K, Sun X. The risk of maternal parvovirus B19 infection during pregnancy on fetal loss and fetal hydrops: A systematic review and meta-analysis. J Clin Virol 2019; 114:12-20. [PMID: 30897374 DOI: 10.1016/j.jcv.2019.03.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 02/11/2019] [Accepted: 03/07/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Human parvovirus B19 (B19) is widespread infection in humans, yet the impact on adverse pregnancy outcomes is controversial. OBJECTIVE to evaluate the impact of B19 infection during pregnancy on adverse pregnancy outcome, and investigated the incidence of fetal loss and fetal hydrops after maternal B19 infection during pregnancy. STUDY DESIGN A systematic literature search was performed using Embase, Medline, PubMed, Web of science, and the Cochrane Library database for relevant publications up to 10th August 2018. Cohort studies and case-control studies were included in analyses. RESULTS In total, 36 eligible studies were included. Of these, 18 studies reported the risk of maternal B19 infection during pregnancy on fetal loss and 20 studies reported the incidence of fetal loss or fetal hydrops after maternal B19 infection. Collectively, the results indicated that maternal B19 infection increased the risk of fetal loss, spontaneous abortion, and stillbirth with ORs of 2.68 (95% CI: 2.02-3.55), 2.42 (95% CI: 1.76-3.33), and 3.53 (95% CI: 1.91-6.54), respectively, when compared with uninfected pregnant women. In addition, the incidence of fetal loss and fetal hydrops in B19 infected pregnant women was 7.6% (95% CI: 5.5-9.5) and 9.3% (95% CI: 5.6-13.0), respectively. CONCLUSIONS maternal parvovirus B19 infection during pregnancy increased the risk of fetal loss, spontaneous abortion, and stillbirth. A high incidence of fetal loss and fetal hydrops was observed in pregnant women with parvovirus B19 infection.
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Affiliation(s)
- Yi-Quan Xiong
- Chinese Evidence-based Medicine Centre and CREAT Group, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Jing Tan
- Chinese Evidence-based Medicine Centre and CREAT Group, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Yan-Mei Liu
- Chinese Evidence-based Medicine Centre and CREAT Group, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Qiao He
- Chinese Evidence-based Medicine Centre and CREAT Group, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Ling Li
- Chinese Evidence-based Medicine Centre and CREAT Group, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Kang Zou
- Chinese Evidence-based Medicine Centre and CREAT Group, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Xin Sun
- Chinese Evidence-based Medicine Centre and CREAT Group, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
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Ornoy A, Ergaz Z. Parvovirus B19 infection during pregnancy and risks to the fetus. Birth Defects Res 2018; 109:311-323. [PMID: 28398685 DOI: 10.1002/bdra.23588] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 08/02/2016] [Accepted: 09/14/2016] [Indexed: 01/30/2023]
Abstract
Parvovirus B19 infects 1 to 5% of pregnant women, generally with normal pregnancy outcomes. During epidemics, the rate of infection is higher. Major congenital anomalies among offspring of infected mothers are rare, as the virus does not appear to be a significant teratogen. However, parvovirus B19 infection may cause significant fetal damage, and in rare cases, brain anomalies and neurodevelopmental insults, especially if infection occurs in the first 20 weeks of pregnancy. Parvovirus B19 is also an important cause of fetal loss, especially in the second half of pregnancy when spontaneous fetal loss from other causes is relatively rare. Parvovirus B19 infection may affect many fetal organs and can cause severe anemia, following fetal erythroid progenitor cells infection and apoptosis, especially in fetuses, that have shortened half-life of erythrocytes. Severe anemia may cause high output cardiac failure and nonimmune hydrops fetalis. In addition, parvovirus B19 may directly infect myocardial cells and produce myocarditis that further aggravates the cardiac failure. Intrauterine fetal transfusion is commonly used for the treatment of severe fetal anemia with survival rates of 75 to 90% and significant reduction of fetal morbidity. Only 66 cases were evaluated neurodevelopmentally, of which 10 (16%) had slight or severe neurodevelopmental problems. Because parvovirus B19 infection can cause severe fetal morbidity and mortality, it should be part of the routine work-up of pregnant women who have been exposed to the virus or of pregnancies with suspected fetal hydrops. Assessment for maternal infection during pregnancy is especially important during epidemics, when sero-conversion rates are high. Birth Defects Research 109:311-323, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Asher Ornoy
- Laboratory of Teratology, Department of Medical Neurobiology, Hebrew University Hadassah Medical School, Jerusalem, Israel
| | - Zivanit Ergaz
- Laboratory of Teratology, Department of Medical Neurobiology, Hebrew University Hadassah Medical School, Jerusalem, Israel.,Department of Neonatology, Hadassah University Hospital Mount Scopus, Jerusalem, Israel
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Congenital cytomegalovirus, parvovirus and enterovirus infection in Mozambican newborns at birth: A cross-sectional survey. PLoS One 2018. [PMID: 29538464 PMCID: PMC5851632 DOI: 10.1371/journal.pone.0194186] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Congenital cytomegalovirus (cCMV) infection is the most prevalent congenital infection acquired worldwide, with higher incidence in developing countries and among HIV-exposed children. Less is known regarding vertical transmission of parvovirus B19 (B19V) and enterovirus (EV). We aimed to assess the prevalence of CMV, B19V and EV vertical transmission and compare results of screening of congenital CMV obtained from two different specimens in a semirural Mozambican maternity. Methods A cross sectional study was conducted among pregnant mothers attending Manhiça District Hospital upon delivery. Information on maternal risk factors was ascertained. Dried umbilical cord (DUC) samples were collected in filter paper for CMV, B19V and EV detection by real-time polymerase chain reaction (RT-PCR), and nasopharyngeal aspirates (NPA) to test for CMV by RT-PCR. Maternal blood samples and placental biopsy samples were also obtained to investigate CMV maternal serology, HIV status and immunopathology. Results From September 2014 to January 2015, 118 mothers/newborn pairs were recruited. Prevalence of maternal HIV infection was 31.4% (37/118). CMV RT-PCR was positive in 3/115 (2.6%) of DUC samples and in 3/96 (6.3%) of NPA samples obtained from neonates. The concordance of the RT-PCR assay through DUC with their correspondent NPA sample was moderate (Kappa = 0.42 and p<0.001. No differences on cCMV prevalence were found among HIV-exposed and unexposed. All (100%) mothers were seropositive for CMV IgG. RT-PCR of EV and B19V in DUC were both negative in all screened cases. No histological specific findings were found in placental tissues. No risk factors associated to vertical transmission of these viral infections were found. Conclusions This study indicates the significant occurrence of vertical transmission of CMV in southern Mozambique. Larger studies are needed to evaluate the true burden, clinical relevance and consequences of congenital infections with such pathogens in resource-constrained settings.
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Bonvicini F, Bua G, Gallinella G. Parvovirus B19 infection in pregnancy-awareness and opportunities. Curr Opin Virol 2017; 27:8-14. [PMID: 29096233 DOI: 10.1016/j.coviro.2017.10.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 09/26/2017] [Accepted: 10/11/2017] [Indexed: 12/31/2022]
Abstract
Parvovirus B19 (B19V) is a human pathogenic virus associated with a wide range of clinical conditions. In pregnancy, B19V poses a potential hazard to the fetus as crossing the placental barrier and infecting erythroid progenitor cells in bone marrow and liver, it blocks fetal erythropoiesis leading to profound anemia, hydrops and/or fetal death. The virus is not regarded as a teratogen, however more scientific awareness is emerging on mechanisms and consequences of intrauterine infection and possible sequelae in the neonatal development. Reliable diagnostic procedures and fetal management strategies, including intrauterine transfusion, are established. In spite of being a recognized fetotropic agent possibly leading to fetal loss, testing for B19V is not routinely included in preconception or antenatal screenings, possibly delaying the management of B19V-complicated pregnancies. Continuous advances in B19V research will provide for better diagnostic methods and algorithms, as well as for the development of effective prophylactic interventions and novel therapeutic options.
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Affiliation(s)
- Francesca Bonvicini
- Department of Pharmacy and Biotechnology, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy.
| | - Gloria Bua
- Department of Pharmacy and Biotechnology, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy
| | - Giorgio Gallinella
- Department of Pharmacy and Biotechnology, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy; S.Orsola-Malpighi Hospital - Microbiology, Via Massarenti 9, 40138 Bologna, Italy
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Li JJ, Henwood T, Van Hal S, Charlton A. Parvovirus infection: an immunohistochemical study using fetal and placental tissue. Pediatr Dev Pathol 2015; 18:30-9. [PMID: 25361230 DOI: 10.2350/14-05-1495-oa.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Parvovirus B19 infection causes 5% to 15% of cases of nonimmune hydrops fetalis. The aim of our study was to evaluate the use of immunohistochemistry in diagnosing parvovirus infection in fetal and placental tissue during routine fetal and perinatal autopsies. Histology slides of 20 cases of confirmed parvovirus infection were reviewed, and immunohistochemistry was applied to selected blocks of fetal and placental tissue. Immunohistochemistry was positive in all 20 cases, and histologic viral inclusions were seen in 19 cases. Immunohistochemical staining was closely correlated with histology and was more sensitive than histology in detecting virally infected cells, especially in autolyzed tissue. All cases also had confirmatory evidence of parvovirus infection by polymerase chain reaction of fetal liver and positive maternal serology, where it was available. We conclude that parvovirus immunohistochemistry is a reliable method for diagnosing parvovirus infection, especially in autolyzed tissue where histologic assessment may be suboptimal.
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Affiliation(s)
- Jing Jing Li
- 1 Department of Anatomical Pathology, Children's Hospital, Westmead, NSW, Australia
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Syridou G, Skevaki C, Kafetzis DA. Intrauterine infection with parvovirus B19 and CMV: implications in early and late gestation fetal demise. Expert Rev Anti Infect Ther 2014; 3:651-61. [PMID: 16107203 DOI: 10.1586/14787210.3.4.651] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In utero viral infections have been associated with an adverse pregnancy outcome and may have a causative role in the unexplained fetal death file. Parvovirus B19 and cytomegalovirus are among the most common pathogens implicated in fetal loss cases. Parvovirus B19 has been reported to account for cases of spontaneous abortions, intrauterine fetal death and nonimmune hydrops fetalis, whereas cytomegalovirus accounts for nonimmune hydrops fetalis, intrauterine growth retardation and congenital anomalies. This review aims to summarize the current literature in an attempt to underline the need for routine screening, close follow-up and prevention. A better understanding of the pathogenetic mechanisms of viral infections during the crucial time of organogenesis, along with early detection, may contribute to the reduction in stillbirth rate.
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Affiliation(s)
- Garyfallia Syridou
- Second Department of Pediatrics, P and A Kiriakou Children's Hospital, University of Athens, Thevon & Livadias Str, GR-11527, Athens, Greece.
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Marnerides A, Sirotkina M, Papadogiannakis N. Unusual concurrence of heterotopic glial nodule of the scalp and congenital herpes simplex virus type-2 infection. Congenit Anom (Kyoto) 2013; 53:134-6. [PMID: 23998268 DOI: 10.1111/j.1741-4520.2012.00385.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Accepted: 07/13/2012] [Indexed: 11/27/2022]
Abstract
Heterotopic glial nodules are rare congenital cutaneous lesions; only 13 cases of scalp localized lesions of this kind are reported in the English medical literature. Herpes simplex virus is a rare cause of neonatal morbidity and mortality and is a rare cause of intrauterine infection. We report the first case of concurrent presence of a heterotopic glial nodule of the scalp and neonatal, in utero-acquired, fatal herpes simplex virus type-2 infection.
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Affiliation(s)
- Andreas Marnerides
- Section of Perinatal Pathology, Department of Pathology, Karolinska University Hospital and Karolinska Institute, Huddinge, Stockholm, Sweden.
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Williams EJ, Embleton ND, Clark JE, Bythell M, Ward Platt MP, Berrington JE. Viral infections: contributions to late fetal death, stillbirth, and infant death. J Pediatr 2013; 163:424-8. [PMID: 23507026 DOI: 10.1016/j.jpeds.2013.02.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 12/14/2012] [Accepted: 02/04/2013] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To determine the role of viral infections in causing fetal and infant death. STUDY DESIGN We assessed a well-validated population database of fetal (≥20 weeks gestation) and infant death for infective deaths and deaths from viruses over a 21-year period (1988-2008). We analyzed by specific viral cause, timing (late fetal loss [20-23 weeks], stillbirth [≥24 weeks], neonatal death [0-27 days], and post-neonatal infant death [28-364 days]) and across time. RESULTS Of the 989 total infective deaths, 108 were attributable to viral causes (6.5% of late fetal losses, 14.5% of stillbirths, 6.5% of neonatal deaths, and 19.4% of postneonatal infant deaths). Global loss (combined fetal and infant losses per 100,000 registerable births) was 139.6 (95% CI, 130.9-148.3) for any infective cause and 15.2 (95% CI, 12.3-18.1) for viral infections. More than one-third (37%) of viral-attributed deaths were before live birth, from parvovirus (63%) or cytomegalovirus (33%). Parvovirus accounted for 26% (28 of 108) of all viral deaths. Cytomegalovirus was associated with a global loss rate of 3.1 (95% CI, 1.8-4.4) and an infant mortality rate of 1.3 (95% CI, 0.4-2.1) per 100,000 live births; 91% of cases were congenital infections. Herpes simplex virus caused death only after live births (infant mortality rate, 1.4; 95% CI, 0.5-2.3). No changes in rates were seen over time. CONCLUSION We have identified a substantial contribution of viral infections to global fetal and infant losses. More than one-third of these losses occurred before live births. Considering our methodology, our estimates represent the minimum contribution of viral illness. Strategies to reduce this burden are needed.
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Affiliation(s)
- Eleri J Williams
- Newcastle Neonatal Service, Royal Victoria Infirmary, Newcastle Upon Tyne Hospitals National Health Service Foundation Trust, Newcastle-Upon-Tyne, United Kingdom
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Abstract
Parvovirus B19 is a widespread human pathogenic virus, member of the Erythrovirus genus in the Parvoviridae family. Infection can be associated with an ample range of pathologies and clinical manifestations, whose characteristics and outcomes depend on the interplay between the pathogenetic potential of the virus, its adaptation to different cellular environments, and the physiological and immune status of the infected individuals. The scope of this review is the advances in knowledge on the biological characteristics of the virus and of virus-host relationships; in particular, the interactions of the virus with different cellular environments in terms of tropism and ability to achieve a productive replicative cycle, or, on the contrary, to establish persistence; the consequences of infection in terms of interference with the cell physiology; the process of recognition of the virus by the innate or adaptive immune system, hence the role of the immune system in controlling the infection or in the development of clinical manifestations. Linked to these issues is the continuous effort to develop better diagnostic algorithms and methods and the need for development of prophylactic and therapeutic options for B19V infections.
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Affiliation(s)
- Giorgio Gallinella
- Department of Pharmacy and Biotechnology, University of Bologna, and Microbiology, S.Orsola-Malpighi Hospital, Via Massarenti 9, 40138 Bologna, Italy
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Puccetti C, Contoli M, Bonvicini F, Cervi F, Simonazzi G, Gallinella G, Murano P, Farina A, Guerra B, Zerbini M, Rizzo N. Parvovirus B19 in pregnancy: possible consequences of vertical transmission. Prenat Diagn 2012; 32:897-902. [PMID: 22777688 DOI: 10.1002/pd.3930] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Revised: 05/10/2012] [Accepted: 05/26/2012] [Indexed: 01/15/2023]
Abstract
OBJECTIVE The aim was to determine the outcome of pregnancies complicated by maternal Parvovirus B19 (B19) infection. METHOD Among 175 pregnant women referred to our clinic because of suspicion of a B19 infection, 63 with confirmed laboratory diagnosis of acute/recent B19 infection were followed up by ultrasound and Doppler measurement of the middle cerebral artery peak systolic velocity. RESULTS The vertical transmission rate was 31.7% (20/63). Of the 20 infected, 8 had hydrops, 1 had signs suggestive of meconium peritonitis and 1 had an isolated hydrothorax. Three fetuses presenting with hydrops were treated with intrauterine blood transfusion. Two of them died while the last showed resolution of anemia. Among the five untreated hydropic fetuses, one presented with mild signs that resolved spontaneously, two died at 16 and 17 weeks of gestation and two had also cardiomegaly and the parents opted for elective termination of pregnancy. All the anemic fetuses had middle cerebral artery peak systolic velocity values more than 1.8 multiples of the median. No stillbirth occurred. CONCLUSIONS The outcome of uncomplicated cases with B19 infection is good. In the presence of hydrops prognosis was very poor. It seems therefore logical to attempt to pick up this ominous signs early.
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Affiliation(s)
- C Puccetti
- Department of Obstetrics and Gynecology, Division of Prenatal Medicine, University of Bologna, Bologna, Italy.
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Plentz A, Modrow S. Diagnosis, management and possibilities to prevent parvovirus B19 infection in pregnancy. Future Virol 2011. [DOI: 10.2217/fvl.11.120] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Human parvovirus B19 (B19V) infection in pregnancy can cause severe fetal anemia and nonimmune hydrops fetalis, which may be associated with spontaneous abortion and fetal death. Approximately 30–40% of women of child-bearing age are not immune to B19V infection. The risk to fetal life is particularly high if maternal infection occurs during the first 20 weeks of gestation. In this article we intend to give an overview on the molecular biology, epidemiology and management of B19V infection during pregnancy. These data will be combined with an assessment of the clinical situation of the infected fetus and the possibilities for avoiding and/or preventing B19V infection in pregnant women. Currently B19V infection is the causative agent of one of the most frequently occurring infectious complications in pregnancy that endangers fetal life, and so the necessity to develop a preventive vaccine is discussed.
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Affiliation(s)
- Annelie Plentz
- Institut für Medizinische Mikrobiologie und Hygiene, Universität Regensburg, Franz-Josef-Strauß Allee 11, 93053 Regensburg, Germany
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de Jong EP, Walther FJ, Kroes ACM, Oepkes D. Parvovirus B19 infection in pregnancy: new insights and management. Prenat Diagn 2011; 31:419-25. [PMID: 21351281 DOI: 10.1002/pd.2714] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Revised: 12/23/2010] [Accepted: 01/09/2011] [Indexed: 11/07/2022]
Abstract
In this article, we review the virology, pathology, epidemiology and clinical spectrum of intrauterine human parvovirus B19 (B19V) infection, including intrauterine fetal death, non-immune hydrops fetalis, thrombocytopenia and neurological manifestations such as pediatric stroke and perivascular calcifications. In addition, we discuss the new insights into the neurodevelopmental outcome of intrauterine B19V infection. Current diagnosis and management of B19V infection is summarized, including a diagnostic and follow-up flowchart for practical clinical use.
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Affiliation(s)
- E P de Jong
- Department of Pediatrics, HAGA Hospital, Juliana's Childrens Hospital, The Hague, The Netherlands.
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19
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Lamont RF, Sobel J, Vaisbuch E, Kusanovic JP, Mazaki-Tovi S, Kim SK, Uldbjerg N, Romero R. Parvovirus B19 infection in human pregnancy. BJOG 2011; 118:175-86. [PMID: 21040396 PMCID: PMC3059196 DOI: 10.1111/j.1471-0528.2010.02749.x] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Human parvovirus B19 infection is widespread. Approximately 30-50% of pregnant women are nonimmune, and vertical transmission is common following maternal infection in pregnancy. Fetal infection may be associated with a normal outcome, but fetal death may also occur without ultrasound evidence of infectious sequelae. B19 infection should be considered in any case of nonimmune hydrops. Diagnosis is mainly through serology and polymerase chain reaction. Surveillance requires sequential ultrasound and Doppler screening for signs of fetal anaemia, heart failure and hydrops. Immunoglobulins, antiviral and vaccination are not yet available, but intrauterine transfusion in selected cases can be life saving.
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Affiliation(s)
- Ronald F. Lamont
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland and Detroit, Michigan, USA
- Wayne State University School of Medicine, Department of Obstetrics and Gynecology, Detroit, Michigan, USA
| | - Jack Sobel
- Wayne State University School of Medicine, Department of Infectious Diseases, Detroit, Michigan, USA
| | - Edi Vaisbuch
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland and Detroit, Michigan, USA
- Wayne State University School of Medicine, Department of Obstetrics and Gynecology, Detroit, Michigan, USA
| | - Juan Pedro Kusanovic
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland and Detroit, Michigan, USA
- Wayne State University School of Medicine, Department of Obstetrics and Gynecology, Detroit, Michigan, USA
| | - Shali Mazaki-Tovi
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland and Detroit, Michigan, USA
- Wayne State University School of Medicine, Department of Obstetrics and Gynecology, Detroit, Michigan, USA
| | - Sun Kwon Kim
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland and Detroit, Michigan, USA
| | - Niels Uldbjerg
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland and Detroit, Michigan, USA
| | - Roberto Romero
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland and Detroit, Michigan, USA
- Wayne State University School of Medicine, Department of Obstetrics and Gynecology, Detroit, Michigan, USA
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, Michigan, USA
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Enders M, Klingel K, Weidner A, Baisch C, Kandolf R, Schalasta G, Enders G. Risk of fetal hydrops and non-hydropic late intrauterine fetal death after gestational parvovirus B19 infection. J Clin Virol 2010; 49:163-8. [PMID: 20729141 DOI: 10.1016/j.jcv.2010.07.014] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2010] [Revised: 07/20/2010] [Accepted: 07/27/2010] [Indexed: 01/30/2023]
Abstract
BACKGROUND Risk assessment of parvovirus B19 (B19)-associated fetal complications following gestational B19 infection remains controversial. OBJECTIVES To determine the risk of fetal hydrops or non-hydropic late intrauterine fetal death following acute maternal B19 infection at defined gestational weeks. STUDY DESIGN Observational cohort study of pregnant women with serologic evidence of acute B19 infection. If available, fetal or neonatal tissue samples from cases complicated by fetal loss or hydrops were investigated for the presence of B19 DNA by polymerase chain reaction (PCR) and/or in situ hybridization (ISH). RESULTS Of 236 women with known pregnancy outcome, 228 had a live birth and 8 a fetal loss. The observed rate of fetal hydrops for all pregnant women was 4.2% (10/236) (95% confidence interval [CI], 2.1-7.7) and 10.6% (10/94) (95% CI, 5.2-18.7) for those infected between 9 and 20 weeks gestation. Tissue samples from 8 hydrops cases were investigated by PCR or ISH and all were B19 DNA positive. Fetal death occurring during or after gestational week 22 was only observed in one case which was associated with B19-derived fetal hydrops. CONCLUSIONS Our findings demonstrate that although adverse fetal outcome is a rare complication of gestational B19 infection, a relevant risk of fetal hydrops exists particularly for women infected between 9 and 20 weeks' gestation. Cases of B19-derived non-hydropic late intrauterine fetal death were not observed in the present study.
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Affiliation(s)
- Martin Enders
- Laboratory Prof G. Enders and Partners & Institute of Virology, Infectious Diseases and Epidemiology e.V., Rosenbergstrasse 85, D-70193 Stuttgart, Germany.
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Abstract
Human parvovirus B19 (B19) is common in society. Among adults, more than 50% have contracted the infection and immunity is believed to last lifelong. Infection occurs in a few percent of pregnancies, and albeit rare it can then cause fetal anemia, non-immune fetal hydrops and fetal death. Among cases with fetal demise, B19 is found in significant numbers, especially in the second and third trimesters of pregnancy. There is no specific treatment or prophylaxis available against B19 infection, but counseling of non-immune mothers and active monitoring of confirmed maternal infections with intervention to correct fetal anemia is likely to decrease mortality. Passive immunization also has potential to resolve fetal complications, but needs further study.
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Affiliation(s)
- Thomas Tolfvenstam
- Department of Medicine, Solna, Unit of Infectious Diseases, Center for Molecular Medicine, Karolinska Institutet, Karolinska University Hospital, B2:00, SE-17176 Stockholm, Sweden.
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Bonvicini F, Manaresi E, Gallinella G, Gentilomi GA, Musiani M, Zerbini M. Diagnosis of fetal parvovirus B19 infection: value of virological assays in fetal specimens. BJOG 2009; 116:813-7. [PMID: 19432570 DOI: 10.1111/j.1471-0528.2009.02109.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The purpose of our work was to examine the most reliable laboratory diagnosis of fetal parvovirus B19 infection in hydropic fetuses by evaluating the most appropriate clinical sample and laboratory test. DESIGN B19 DNA detection in fetal samples and serological signs of B19 infection in the respective mothers. Samples collected between January 2000 and July 2008. SETTING Microbiology, University of Bologna, Bologna, Italy. SAMPLES One hundred thirty-five fetal samples (58 fetal cord blood and 77 amniotic fluid samples) and 109 serum samples collected from 109 pregnant women. METHODS Validated and certified in situ hybridisation assay (ISH) and polymerase chain reaction-enzyme-linked immunosorbent assay (PCR-ELISA) were performed on fetal samples to detect B19 DNA. B19-specific antibodies were investigated in maternal serum samples by a commercial enzyme immunoassay. MAIN OUTCOME MEASURES Parvovirus B19 DNA detection in fetal specimens was analysed in relation to maternal serological signs of infection. RESULTS Parvovirus B19 DNA was detected in 22.41% of fetal cord blood and 36.36% of amniotic fluid samples. A statistically significant difference was found between DNA detection by ISH (23.70%) and PCR-ELISA (14.81%) (P= 0.004). Only 11.76% of fetuses with virological diagnosis of B19 infection were from women with serological signs of acute/recent B19 infection. CONCLUSIONS Diagnosis of fetal parvovirus B19 infection cannot always rely on maternal serological investigations but rather on the virological analysis of fetal samples. Both fetal cord blood and amniotic fluid samples are suitable for diagnosis, but the detection of B19 DNA in the cells of amniotic fluid samples by ISH proved to be the most reliable diagnostic system.
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Affiliation(s)
- F Bonvicini
- Department of Haematology and Oncological Sciences L. e A. Seragnoli-Microbiology Section, University of Bologna, Bologna, Italy
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Landolsi H, Yacoubi M, Bouslama L, Lahmar A, Trabelsi A, Hmissa S, Aouni M, Korbi S. Detection of the human Parvovirus B19 in nonimmune hydrops fetalis using immunohistochemistry and nested-PCR in formalin-fixed and paraffin-embedded placenta and fetal tissues. ACTA ACUST UNITED AC 2009; 57:e1-7. [DOI: 10.1016/j.patbio.2007.11.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2007] [Accepted: 11/07/2007] [Indexed: 11/25/2022]
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Riipinen A, Väisänen E, Nuutila M, Sallmen M, Karikoski R, Lindbohm ML, Hedman K, Taskinen H, Söderlund-Venermo M. Parvovirus b19 infection in fetal deaths. Clin Infect Dis 2008; 47:1519-25. [PMID: 18991512 DOI: 10.1086/593190] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Parvovirus B19 infection during pregnancy can lead to nonimmune fetal hydrops, miscarriage, and intrauterine fetal death (IUFD). Some studies have suggested that parvovirus B19 infection may surprisingly often result in nonhydropic fetal death during the third trimester, in the absence of maternal serological evidence of acute infection. This study was conducted to investigate the prevalence of parvovirus B19 DNA among fetuses from miscarriages and IUFDs. METHODS We retrospectively studied 535 unborn fetuses, including 120 fetuses from miscarriages and 169 from IUFDs. The control fetuses were 246 fetuses from induced abortions. All fetuses were autopsied from July 1992 through December 1995 and from January 2003 through December 2005 in Helsinki, Finland. The period included a major epidemic of parvovirus B19 infection in 1993. Formalin-fixed, paraffin-embedded fetal tissues were studied with use of a highly sensitive and specific PCR that was capable of detecting all 3 parvovirus B19 genotypes and by histologic examination. In addition, maternal parvovirus B19 serological status was determined. RESULTS Parvovirus B19 DNA was detected in 5 fetuses with gestational ages of 14, 22, 23, 30, and 39 weeks; these included fetuses from 4 (2.4%) of the 169 IUFDs and 1 (0.8%) of the 120 miscarriages. During the epidemic year 1993, the prevalence of parvovirus B19 DNA-positive fetal deaths was 6 times the prevalence during nonepidemic years. All 5 mothers of the parvovirus B19 DNA-positive fetuses had serological signs of acute parvovirus B19 infection close to the time of fetal death. The only nonhydropic fetus was full-term. CONCLUSIONS Our findings indicate that the prevalence of parvovirus B19 infection among fetuses from IUFDs is low. In particular, our findings did not verify the claimed high prevalence of third-trimester nonhydropic IUFDs associated with parvovirus B19.
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Affiliation(s)
- Anita Riipinen
- Centre of Expertise for Health and Work Ability, Finnish Institute of Occupational Health, Helsinki, Finland.
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Syridou G, Spanakis N, Konstantinidou A, Piperaki ET, Kafetzis D, Patsouris E, Antsaklis A, Tsakris A. Detection of cytomegalovirus, parvovirus B19 and herpes simplex viruses in cases of intrauterine fetal death: Association with pathological findings. J Med Virol 2008; 80:1776-82. [DOI: 10.1002/jmv.21293] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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de Haan TR, Beersma MFC, Oepkes D, de Jong EP, Kroes ACM, Walther FJ. Parvovirus B19 infection in pregnancy: maternal and fetal viral load measurements related to clinical parameters. Prenat Diagn 2007; 27:46-50. [PMID: 17154332 DOI: 10.1002/pd.1619] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To correlate quantitative maternal and fetal parvovirus B19 (B19V) viral loads and antibody levels at intrauterine transfusion (IUT) as a predictor of fetal morbidity. METHODS Prospectively collected clinical data and quantitative B19V viral load and specific IgM and IgG values in fetal and maternal blood samples taken during IUT. RESULTS Maternal IgM and IgG levels exceeded fetal antibody levels. Fetal viral load measurements correlated positively with maternal viral loads and exceeded maternal viral load 10(5)-fold (p < 0.0001). Maternal B19V IgM and fetal B19V viral load showed a positive correlation (r = 0.840, p = 0.007). No relation was found between fetal viral load and severity of fetal anemia derived from Doppler flow measurements in the middle cerebral artery. CONCLUSIONS Maternal and fetal B19V viral load values are highly interrelated, suggesting continuous maternal and fetal viral replication or a fetal source of maternal viremia. Maternal B19V IgM values may predict the severity of fetal infection, but the severity of B19V induced fetal anemia cannot be predicted using fetal or maternal viral loads. Fetal ultrasound remains the gold standard for identifying fetal anemia in B19V infection.
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Affiliation(s)
- Timo R de Haan
- Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
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27
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Konstantinidou AE, Syridou G, Spanakis N, Tsakris A, Agrogiannis G, Patsouris E. Association of hypospadias and cardiac defect in a Parvovirus B19-infected stillborn: A causality relation? J Infect 2007; 54:e41-5. [PMID: 16712940 DOI: 10.1016/j.jinf.2006.03.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2005] [Revised: 03/22/2006] [Accepted: 03/24/2006] [Indexed: 11/24/2022]
Abstract
Parvovirus B19 intrauterine infection is a known cause of hydrops fetalis and fetal death. It is also associated with congenital malformations, although the teratogenic potential seems to be low. Postmortem examination of a male stillborn of 29 gestational weeks revealed mild subcutaneous edema, malformed micropenis, perineoscrotal hypospadias and atrial septal defect, along with fetal erythroblastosis and villitis. Polymerase chain reaction detected Parvovirus B19 DNA genome in tissues from the fetus and the placenta, confirming the hypothesis of an intrauterine infection.
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Affiliation(s)
- A E Konstantinidou
- Department of Pathology, Medical School, National Kapodistrian University of Athens, 28, Narkisson Street, 152 33 Halandri, Athens, Greece.
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Nagel HTC, de Haan TR, Vandenbussche FPHA, Oepkes D, Walther FJ. Long-Term Outcome After Fetal Transfusion for Hydrops Associated With Parvovirus B19 Infection. Obstet Gynecol 2007; 109:42-7. [PMID: 17197586 DOI: 10.1097/01.aog.0000249611.67873.94] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate neurodevelopmental status of children treated with intrauterine red blood cell and platelet transfusion for fetal hydrops caused by parvovirus B19. METHODS Maternal and neonatal records of all intrauterine transfusions for congenital parvovirus B19 infection in our center between 1997 and 2005 were reviewed. Congenital B19 virus infection was confirmed by the presence of parvovirus B19-specific immunoglobulin M or parvovirus B19 DNA in fetal blood samples. All children underwent a general pediatric and neurological examination. Primary outcome measure was neurodevelopmental status (developmental index by Bayley Scales of Infant Development or Snijders-Oomen test). Secondary outcome measure was general health status of surviving children. RESULTS A total of 25 intrauterine transfusions were performed in 24 hydropic fetuses. Median fetal hemoglobin concentration, platelet count, and blood pH before intrauterine transfusions were 4.5 g/dL (range 2.4-11.4 g/dL), 79x10(9)/L (range 37-238x10(9)/L) and 7.36 (range 7.31-7.51), respectively. Sixteen survivors aged 6 months to 8 years were included in the follow-up study. Eleven children (68%) were normal, and 5 children (32%) demonstrated a delayed psychomotor development with an suboptimal neurological examination (mild delay n=3, severe delay n=2). Neurodevelopmental status did not correlate with pre-intrauterine transfusion hemoglobin, platelet, or blood pH values. Growth and general health status were normal in all. Two children had minor congenital defects. CONCLUSION Neurodevelopmental status was abnormal in 5 of 16 survivors and was not related to the severity of fetal anemia and acidemia. We hypothesize that fetal parvovirus B19 infection may induce central nervous system damage. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Hélène T C Nagel
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
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Abstract
Parvovirus B19 is a significant human pathogen that causes a wide spectrum of clinical complications ranging from mild, self-limiting erythema infectiosum in immunocompetent children to lethal cytopenias in immunocompromised patients and intrauterine foetal death in primary infected pregnant women. The infection may also be persistent and can mimic or trigger autoimmune inflammatory disorders. Another important clinical aspect to consider is the risk of infection through B19-contaminated blood products. Recent advances in diagnosis and pathogenesis, new insights in the cellular immune response and newly discovered genotypes of human parvoviruses form a platform for the development of modern therapeutic and prophylactic alternatives.
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Affiliation(s)
- K Broliden
- Department of Medicine, Solna, Unit of Infectious Diseases, Center for Molecular Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
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de Haan TR, Beersma MFC, Claas ECJ, Oepkes D, Kroes ACM, Walther FJ. Parvovirus B19 infection in pregnancy studied by maternal viral load and immune responses. Fetal Diagn Ther 2006; 22:55-62. [PMID: 17003557 DOI: 10.1159/000095845] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2006] [Accepted: 04/03/2006] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Facilitate risk assessment of vital complications in fetuses of pregnancies affected by acute parvovirus B19 (B19V) infection. DESIGN Study of the natural course of maternal B19V infection in four cases, from early pregnancy on. SETTING University Medical Center in the Netherlands. POPULATION Pregnant mothers attending obstetric services. METHODS Serial measurements of the maternal and fetal or neonatal viral load and antibody responses. MAIN OUTCOME MEASURES Maternal and fetal/neonatal serum B19V viral DNA load and specific IgM and IgG antibodies in maternal serum. RESULTS Peak viral load levels occurred within 1 week after maternal infection and peak IgM levels were observed 1 week after the peak viral load levels. Approximation of IgG and IgM ratios usually took place 4 weeks after infection. Vertical transmission occurred 1-3 weeks after maternal infection, suggesting that fetal infection occurs during the maternal peak viral load. CONCLUSIONS Maternal B19V DNA load levels and IgM responses are useful to estimate the risk of parvovirus B19-associated fetal complications. The maternal peak viral load directly precedes the onset of fetal infection and may be used to indicate the stage of intrauterine B19V infection.
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Affiliation(s)
- Timo R de Haan
- Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
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31
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de Jong EP, de Haan TR, Kroes ACM, Beersma MFC, Oepkes D, Walther FJ. Parvovirus B19 infection in pregnancy. J Clin Virol 2006; 36:1-7. [PMID: 16488187 DOI: 10.1016/j.jcv.2006.01.004] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2005] [Revised: 12/30/2005] [Accepted: 01/10/2006] [Indexed: 10/25/2022]
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.
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Affiliation(s)
- Eveline P de Jong
- Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
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Abstract
Parvovirus B19 is a common infection in children occurring in winter and spring months that can affect pregnant women and their unborn fetuses. Adverse fetal sequelae may include red blood cell aplasia due to bone marrow suppression, anemia, myocarditis, nonimmune hydrops, and fetal death. Fortunately, several noninvasive testing schemes are available to assess the fetus, and invasive testing is reserved for fetuses with marked anemia.
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Affiliation(s)
- Mildred M Ramirez
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Texas Health Science Center at Houston, Houston, TX 77030, USA.
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Affiliation(s)
- Gabriela Gebrin Cezar
- Department of Animal Sciences, University of Wisconsin-Madison, Madison, Wisconsin 06340, USA.
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34
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Snapshots for May 2004. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2004. [DOI: 10.1097/01.idc.0000129845.04014.76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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35
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Current awareness in prenatal diagnosis. Prenat Diagn 2003; 23:179-85. [PMID: 12622104 DOI: 10.1002/pd.526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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