Human Parvovirus B19 is a small unenveloped virus containing single stranded DNA and is responsible for several clinical syndromes.
Normal transmission is presumably by the respiratory route via droplet aerosol. Most children have encountered the virus by their teenage years but those who escape infection as children are susceptible as adults. Parvovirus can be transmitted across the placenta posing a potential threat to the fetus.
The attack rate for severe fetal disease (hydrops) is approximately 5% following infection during the first 18 weeks. Infection occurring beyond 18 weeks have been associated with anemia. B 19 virus has been detected in cardiac tissue causing myocarditis, and can also cause fetal hepatitis with severe liver disease. This is a condition managed by a perinatologist
Measure serum IgG and IgM levels. IgM levels appear by day 3 of an acute infection and begin to fall by 2 to 3 months after infection. IgG appears a few days after IgM and may persist for years.
Viral antigens may be directly detected in tissues by radioimmunoassay, ELISA, immunofluorescence, in situ nucleic acid hybridization, or PCR.
Treatment is generally supportive.
There are case reports of successful use of Intravenous gamma globulin (IVIG) in patients with severe hematologic disorders. IVIG prophylaxis may be considered in immunocompromised patients exposed to B19 infection, however, IVIG is not currently recommended for prophylaxis in pregnancy.
Measurement of serum IgG and IgM levels may be useful to determine those at risk or acutely infected after B19 exposure. These tests should generally limited to pregnant women clearly at increased risk for acute B19 exposure during the first 18 weeks of gestation.
Consultation with an infectious disease physcian is reccommended.
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Sandra K. Burchett. Manual of neonatal care. John P. Cloherty (4th Ed). Philadelphia: Lippincott-Raven, 1998.
Samuel P.Gotoff. Textbook of pediatrics. Behrman (16th Ed) Philadelphia: W. B. Saunders Company