Parvovirus B19

 Q: 32 years old female is admitted to ICU with aplastic crisis with a recent history of intrauterine fetal demise. Subsequent workup leads to the diagnosis of Parvovirus B19. All of the following are considered among the five major syndromes of Parvovirus B19 EXCEPT?

A) Fifth disease (in children) 

B) Myocarditis 

C) Transient aplastic crisis 

D) Fetal infection 

E) Pure red blood cell aplasia 

Answer: B

Parvovirus B19 continues to be an important discussion in medicine as 50 percent of child-bearing age women worldwide lack measurable IgG to parvovirus B19. 

There are five established syndromes associated with parvovirus B19, which are

1. Fifth disease/erythema infectiosum in children 
2. Transient aplastic crisis, occurs usually in patients  with chronic hemolytic disorders 
3. Fetal infection manifesting as non-immune hydrops fetalis, intrauterine fetal death, miscarriage, or cardiomyopathy 
4. Pure red blood cell aplasia in immunocompromised hosts 
5. Arthropathy 

 Myocarditis manifesting as dilated cardiomyopathy or left heart failure has been reported but not established as a definite syndrome.

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References:

1. Rodis JF, Quinn DL, Gary GW Jr, et al. Management and outcomes of pregnancies complicated by human B19 parvovirus infection: a prospective study. Am J Obstet Gynecol 1990; 163:1168. 

2. Gratacós E, Torres PJ, Vidal J, et al. The incidence of human parvovirus B19 infection during pregnancy and its impact on perinatal outcome. J Infect Dis 1995; 171:1360.

3. Stewart GC, Lopez-Molina J, Gottumukkala RV, et al. Myocardial parvovirus B19 persistence: lack of association with clinicopathologic phenotype in adults with heart failure. Circ Heart Fail 2011; 4:71. 

4. Kühl U, Rohde M, Lassner D, et al. miRNA as activity markers in Parvo B19 associated heart disease. Herz 2012; 37:637.

5. Heegaard ED, Brown KE. Human parvovirus B19. Clin Microbiol Rev. 2002;15(3):485-505. doi:10.1128/CMR.15.3.485-505.2002

6. Servey JT, Reamy BV, Hodge J. Clinical presentations of parvovirus B19 infection. Am Fam Physician. 2007 Feb 1;75(3):373-6. PMID: 17304869.