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Aghaei M, Sarabi MA. A are cause of post-renal transplant anemia by parvovirus-B19: Case report. Transpl Immunol 2024; 87:102118. [PMID: 39241810 DOI: 10.1016/j.trim.2024.102118] [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: 05/06/2024] [Revised: 08/25/2024] [Accepted: 09/01/2024] [Indexed: 09/09/2024]
Abstract
One of the issues during the post-transplant phase is anemia. The increased risk of graft rejection makes evaluating transplant recipients difficult. Parvovirus-B19 (PV-B19) should be considered one of the differential diagnosis of post-transplant anemia (PTA) in renal transplantation recipients. In this article, we report a 32 year old man who was admitted to the hospital with anemia. During the assessment, infection with PV-B19 was confirmed as the cause of the anemia. He received intravenous immunoglobin (IVIG) as the treatment.
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Affiliation(s)
- Mona Aghaei
- School of Medicine, Islamic Azad University, Tehran Medical Branch, Tehran, Iran.
| | - Mohammad Amir Sarabi
- School of Medicine, Islamic Azad University, Tehran Medical Branch, Tehran, Iran
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2
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Sabanci M, Taşdemir M, Öksüz B, Altuner Torun Y, Sütçü M, Özkaya O. Managing recurrent parvovirus B19-associated anemia after a pediatric kidney transplant. Pediatr Nephrol 2024; 39:2923-2925. [PMID: 38775967 PMCID: PMC11349799 DOI: 10.1007/s00467-024-06378-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/14/2024] [Accepted: 04/03/2024] [Indexed: 08/28/2024]
Abstract
A 13-year-old girl who had a kidney transplant four weeks prior presented with a 10-day history of fatigue, paleness, and headache. On physical examination, tachycardia and paleness were noted. Laboratory testing was notable for severe anemia and mild leukopenia and thrombocytopenia. Polymerase chain reaction (PCR) test for Epstein-Barr virus (EBV) and cytomegalovirus (CMV) were negative and for parvovirus B19 (PVB19) was positive. Despite lower immunosuppression and administration of intravenous immunoglobulin (IVIG) it persisted for 15 months, and frequent red blood cell transfusions were needed. PVB19 is a less common but significant complication. The patient's clinical course demonstrates the importance of this complication and the challenges in its management. A notable void exists in the literature regarding standardized treatment protocols for PVB19-induced recurrent anemia after kidney transplant. This case indicates the need for further research and consensus to guide effective clinical interventions in similar cases.
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Affiliation(s)
| | - Mehmet Taşdemir
- Division of Pediatric Nephrology, Department of Pediatrics, İstinye University School of Medicine, Azerbaycan Caddesi, No: 4/A, Sarıyer, Istanbul, Türkiye.
| | - Burcu Öksüz
- Molecular Infection Laboratory, Genetic Diseases Diagnosis Center, İstinye University, Istanbul, Turkey
| | - Yasemin Altuner Torun
- Division of Pediatric Hematology, Department of Pediatrics, İstinye University School of Medicine, Istanbul, Turkey
| | - Murat Sütçü
- Division of Pediatric Infectious Disease, Department of Pediatrics, İstinye University School of Medicine, Istanbul, Turkey
| | - Ozan Özkaya
- Division of Pediatric Nephrology, Department of Pediatrics, İstinye University School of Medicine, Azerbaycan Caddesi, No: 4/A, Sarıyer, Istanbul, Türkiye
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Hernández-Velasco P, Sevillano ÁM, González-García C, López-Medrano F, Morales E, Andrés A. Thrombotic microangiopathy after parvovirus B19 infection treatment in a kidney transplant recipient. An uncommon presentation. Nefrologia 2024; 44:750-752. [PMID: 39472183 DOI: 10.1016/j.nefroe.2024.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/16/2024] [Accepted: 01/21/2024] [Indexed: 11/17/2024] Open
Affiliation(s)
| | - Ángel M Sevillano
- Servicio de Nefrología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | - Enrique Morales
- Servicio de Nefrología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Amado Andrés
- Servicio de Nefrología, Hospital Universitario 12 de Octubre, Madrid, Spain
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Kampouri E, Little JS, Crocchiolo R, Hill JA. Human herpesvirus-6, HHV-8 and parvovirus B19 after allogeneic hematopoietic cell transplant: the lesser-known viral complications. Curr Opin Infect Dis 2024; 37:245-253. [PMID: 38726832 DOI: 10.1097/qco.0000000000001020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
PURPOSE OF REVIEW Viral infections continue to burden allogeneic hematopoietic cell transplant (HCT) recipients. We review the epidemiology, diagnosis, and management of human herpesvirus (HHV)-6, HHV-8 and parvovirus B19 following HCT. RECENT FINDINGS Advances in HCT practices significantly improved outcomes but impact viral epidemiology: post-transplant cyclophosphamide for graft-versus-host disease prevention increases HHV-6 reactivation risk while the impact of letermovir for CMV prophylaxis - and resulting decrease in broad-spectrum antivirals - is more complex. Beyond the well established HHV-6 encephalitis, recent evidence implicates HHV-6 in pneumonitis. Novel less toxic therapeutic approaches (brincidofovir, virus-specific T-cells) may enable preventive strategies in the future. HHV-8 is the causal agent of Kaposi's sarcoma, which is only sporadically reported after HCT, but other manifestations are possible and not well elucidated. Parvovirus B19 can cause severe disease post-HCT, frequently manifesting with anemia, but can also be easily overlooked due to lack of routine screening and ambiguity of manifestations. SUMMARY Studies should establish the contemporary epidemiology of HHV-6, and other more insidious viruses, such as HHV-8 and parvovirus B19 following HCT and should encompass novel cellular therapies. Standardized and readily available diagnostic methods are key to elucidate epidemiology and optimize preventive and therapeutic strategies to mitigate the burden of infection.
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Affiliation(s)
- Eleftheria Kampouri
- Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jessica S Little
- Dana-Farber Cancer Institute
- Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Roberto Crocchiolo
- Servizio di Immunoematologia e Medicina Trasfusionale, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Joshua A Hill
- Vaccine and Infectious Disease Division
- Clinical Research Division, Fred Hutchinson Cancer Center
- Department of Medicine, University of Washington, Seattle, Washington, USA
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Wen Q, Guo Z, Zhang XH, Xu LP, Wang Y, Yan CH, Chen H, Chen YH, Han W, Wang FR, Sun YQ, Huang XJ, Mo XD. COVID-19 was associated with the complications after allogeneic hematopoietic stem cell transplantation. Sci Rep 2024; 14:11778. [PMID: 38782966 PMCID: PMC11116404 DOI: 10.1038/s41598-024-62731-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 05/21/2024] [Indexed: 05/25/2024] Open
Abstract
We aimed to identify the severity and duration of COVID-19 infection on complications after allo-HSCT. Enrolled 179 hospitalized patients with COVID-19 were categorized into long-term infection (> 18 days, n = 90) or short-term infection group (≤ 18 days, n = 89) according to the median duration of COVID-19. The severity of COVID-19 was categorized as asymptomatic infection, mild, moderate, severe, and critical illness according to guidelines of National Institutes of Health. Particularly, severe illness and critical illness were classified as serious infection. Asymptomatic infection, mild illness and moderate illness were classified as non-serious infection. The 150-day probabilities of poor graft function (PGF), cytomegalovirus (CMV) pneumonia and non-relapse mortality (NRM) were significantly higher in long-term infection group. The 150-day probabilities of CMV pneumonia and NRM after COVID-19 were higher in serious infection group. The 150-day probabilities of overall survival (OS) was significantly lower in long-term and serious infection group. In multivariable analysis, the severity of COVID-19 was associated with NRM and OS, and the duration of COVID-19 was associated with PGF. In summary, our data reported that the severity and duration of COVID-19 were associated with several complications and contribute to poor outcomes after allo-HSCT.
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Affiliation(s)
- Qi Wen
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, National Clinical Research Center for Hematologic Disease, Peking University People's Hospital, Peking University Institute of Hematology, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Ze Guo
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, National Clinical Research Center for Hematologic Disease, Peking University People's Hospital, Peking University Institute of Hematology, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Xiao-Hui Zhang
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, National Clinical Research Center for Hematologic Disease, Peking University People's Hospital, Peking University Institute of Hematology, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Lan-Ping Xu
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, National Clinical Research Center for Hematologic Disease, Peking University People's Hospital, Peking University Institute of Hematology, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Yu Wang
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, National Clinical Research Center for Hematologic Disease, Peking University People's Hospital, Peking University Institute of Hematology, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Chen-Hua Yan
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, National Clinical Research Center for Hematologic Disease, Peking University People's Hospital, Peking University Institute of Hematology, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Huan Chen
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, National Clinical Research Center for Hematologic Disease, Peking University People's Hospital, Peking University Institute of Hematology, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Yu-Hong Chen
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, National Clinical Research Center for Hematologic Disease, Peking University People's Hospital, Peking University Institute of Hematology, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Wei Han
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, National Clinical Research Center for Hematologic Disease, Peking University People's Hospital, Peking University Institute of Hematology, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Feng-Rong Wang
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, National Clinical Research Center for Hematologic Disease, Peking University People's Hospital, Peking University Institute of Hematology, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Yu-Qian Sun
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, National Clinical Research Center for Hematologic Disease, Peking University People's Hospital, Peking University Institute of Hematology, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Xiao-Jun Huang
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, National Clinical Research Center for Hematologic Disease, Peking University People's Hospital, Peking University Institute of Hematology, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
- Research Unit of Key Technique for Diagnosis and Treatments of Hematologic Malignancies, Chinese Academy of Medical Sciences, Beijing, 2019RU029, China
| | - Xiao-Dong Mo
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, National Clinical Research Center for Hematologic Disease, Peking University People's Hospital, Peking University Institute of Hematology, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China.
- Research Unit of Key Technique for Diagnosis and Treatments of Hematologic Malignancies, Chinese Academy of Medical Sciences, Beijing, 2019RU029, China.
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Jia R, Cao L, Lu L, Zhong H, Xu M, Liu P, Zhu X, Su L, Xu J. Distinct clinical features of transplanted children with Parvovirus B19 infection. Virol J 2024; 21:108. [PMID: 38730285 PMCID: PMC11088171 DOI: 10.1186/s12985-024-02380-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 05/02/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND The immature and suppressed immune response makes transplanted children a special susceptible group to Parvovirus B19 (PVB19). However, the clinical features of transplanted children with PVB19 infection haven't been comprehensively described. METHODS We searched the medical records of all the transplant recipients who attended the Children's Hospital of Fudan University from 1 Oct 2020 to 31 May 2023, and reviewed the medical literature for PVB19 infection cases among transplanted children. RESULTS A total of 10 cases of PVB19 infection were identified in 201 transplanted children at our hospital, and the medical records of each of these cases were shown. Also, we retrieved 40 cases of PVB19 infection among transplanted children from the literature, thus summarizing a total of 50 unique cases of PVB19 infection. The median time to the first positive PVB19 DNA detection was 14 weeks post-transplantation. PVB19 IgM and IgG were detected in merely 26% and 24% of the children, respectively. The incidence of graft loss/dysfunction was as high as 36%. Hematopoietic stem cell transplant (HSCT) recipients showed higher PVB19 load, lower HGB level, greater platelet damage, lower PVB19 IgM/IgG positive rates, and more graft dysfunction than solid-organ transplant (SOT) recipients, indicating a more incompetent immune system. CONCLUSIONS Compared with the published data of transplanted adults, transplanted children displayed distinct clinical features upon PVB19 infection, including lower PVB19 IgM/IgG positive rates, more graft dysfunction, and broader damage on hematopoietic cell lines, which was even more prominent in HSCT recipients, thus should be of greater concern.
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Affiliation(s)
- Ran Jia
- Department of Clinical Laboratory, Children's Hospital of Fudan University & National Children's Medical Center, Shanghai, 201102, China
| | - Lingfeng Cao
- Department of Clinical Laboratory, Children's Hospital of Fudan University & National Children's Medical Center, Shanghai, 201102, China
| | - Lijuan Lu
- Department of Clinical Laboratory, Children's Hospital of Fudan University & National Children's Medical Center, Shanghai, 201102, China
| | - Huaqing Zhong
- Department of Pediatric Institute, Children's Hospital of Fudan University & National Children's Medical Center, Shanghai, China
| | - Menghua Xu
- Department of Clinical Laboratory, Children's Hospital of Fudan University & National Children's Medical Center, Shanghai, 201102, China
| | - Pengcheng Liu
- Department of Clinical Laboratory, Children's Hospital of Fudan University & National Children's Medical Center, Shanghai, 201102, China
| | - Xunhua Zhu
- Department of Clinical Laboratory, Children's Hospital of Fudan University & National Children's Medical Center, Shanghai, 201102, China
| | - Liyun Su
- Department of Clinical Laboratory, Children's Hospital of Fudan University & National Children's Medical Center, Shanghai, 201102, China
| | - Jin Xu
- Department of Clinical Laboratory, Children's Hospital of Fudan University & National Children's Medical Center, Shanghai, 201102, China.
- Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai, China.
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Steininger P, Korn K, Hackstein H, Strasser EF. Validation of a Parvovirus B19 NAT Assay for Screening of Umbilical Cord Blood for Allogenic Hematopoietic Stem Cell Donation. Transfus Med Hemother 2024; 51:48-51. [PMID: 38314242 PMCID: PMC10836944 DOI: 10.1159/000532073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/17/2023] [Indexed: 02/06/2024] Open
Abstract
Introduction Parvovirus B19 transmitted by umbilical cord blood (UCB) products may cause severe disease in allogenic hematopoietic stem cell transplant recipients. Thus, commercially available nucleic acid test (NAT) assays for highly sensitive detection of parvovirus B19 DNA validated for the specimen cord blood plasma (CBP) are required to avoid parvovirus B19 transmission by umbilical hematopoietic stem cell preparations. Methods The multiplex cobas DPX NAT assay was validated for detection of parvovirus B19 DNA in CBP derived from citrate anticoagulated UCB units which have been processed by the Rubinstein method. In total, 363 retained CBP samples pretested negative for parvovirus B19 DNA were prepared for analyzing sensitivity, specificity, and interference of that NAT assay. The 3rd WHO International Standard for parvovirus B19 DNA was used for determining the 95% limit of detection (LOD95) by probit analysis. Results The validation of the parvovirus B19 NAT assay for CBP demonstrated high sensitivity, specificity, intra- and inter-assay precision. Dilution series and replicate analyses showed a high linearity of the assay with a coefficient of determination above 0.99 and revealed a LOD95 of 17 International Units (IU)/mL (95% confidence interval, 14-44 IU/mL) for parvovirus B19 DNA in CBP samples. Conclusion The validation of a commercially available parvovirus B19 NAT assay for the specimen CBP demonstrated a high assay performance fulfilling German guidelines and international regulations.
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Affiliation(s)
- Philipp Steininger
- Institute of Clinical and Molecular Virology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Klaus Korn
- Institute of Clinical and Molecular Virology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Holger Hackstein
- Department of Transfusion Medicine and Haemostaseology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Erwin F Strasser
- Division of Transfusion Medicine, Cell Therapeutics and Haemostaseology, University Hospital, LMU Munich, Munich, Germany
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Vuković V, Patić A, Ristić M, Kovačević G, Hrnjaković Cvjetković I, Petrović V. Seroepidemiology of Human Parvovirus B19 Infection among the Population of Vojvodina, Serbia, over a 16-Year Period (2008-2023). Viruses 2024; 16:180. [PMID: 38399956 PMCID: PMC10893261 DOI: 10.3390/v16020180] [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: 01/06/2024] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 02/25/2024] Open
Abstract
This study aimed to estimate the serological status and dynamic changes in the prevalence of Parvovirus B19 (PVB19) antibodies within the general population residing in the northern part of the Republic of Serbia (Province of Vojvodina) during a 16-year period. Serum samples were analyzed for Human PVB19-specific IgM and IgG antibodies using enzyme-linked immunosorbent assay (ELISA). Throughout the study period, the overall seroprevalence was 49.51%. Approximately 10% of patients exhibited a serologic profile positive for PVB19 IgM antibodies. Notably, seroprevalence varied significantly, ranging from 9.12% in the pediatric cohort (ages 1-4 years) to 65.50% in the adult demographic (40-59 years old). Seroprevalence was higher (51.88%) among women compared to men (42.50%). Immunologically naive pregnant women in the age groups 26-36 and 36-45 years had 45% (OR = 0.55, 95% CI: 0.31-1.00) and 52% (OR = 0.48; 95% CI: 0.24-0.94) lower odds of having negative IgM and IgG compared to those in age group 16-25 years old. Improved knowledge of the epidemiology of PVB19 may assist clinicians in the differential diagnosis of PVB19 clinical manifestations. The PVB19 detection is particularly important for monitoring individuals in risk groups such as women of reproductive age, medical staff, patients with hematological disorders, and those with immunodeficiency.
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Affiliation(s)
- Vladimir Vuković
- Institute of Public Health of Vojvodina, 21000 Novi Sad, Serbia; (A.P.); (M.R.); (G.K.); (I.H.C.); (V.P.)
- Department of Epidemiology, Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia
| | - Aleksandra Patić
- Institute of Public Health of Vojvodina, 21000 Novi Sad, Serbia; (A.P.); (M.R.); (G.K.); (I.H.C.); (V.P.)
- Department of Microbiology with Parasitology and Immunology, Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia
| | - Mioljub Ristić
- Institute of Public Health of Vojvodina, 21000 Novi Sad, Serbia; (A.P.); (M.R.); (G.K.); (I.H.C.); (V.P.)
- Department of Epidemiology, Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia
| | - Gordana Kovačević
- Institute of Public Health of Vojvodina, 21000 Novi Sad, Serbia; (A.P.); (M.R.); (G.K.); (I.H.C.); (V.P.)
| | - Ivana Hrnjaković Cvjetković
- Institute of Public Health of Vojvodina, 21000 Novi Sad, Serbia; (A.P.); (M.R.); (G.K.); (I.H.C.); (V.P.)
- Department of Microbiology with Parasitology and Immunology, Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia
| | - Vladimir Petrović
- Institute of Public Health of Vojvodina, 21000 Novi Sad, Serbia; (A.P.); (M.R.); (G.K.); (I.H.C.); (V.P.)
- Department of Epidemiology, Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia
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Hou YB, Chang S, Chen S, Zhang WJ. Intravenous immunoglobulin in kidney transplantation: Mechanisms of action, clinical applications, adverse effects, and hyperimmune globulin. Clin Immunol 2023; 256:109782. [PMID: 37742791 DOI: 10.1016/j.clim.2023.109782] [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: 07/24/2023] [Revised: 09/11/2023] [Accepted: 09/20/2023] [Indexed: 09/26/2023]
Abstract
Intravenous immunoglobulin (IVIG) has been developed for over 40 years. The mechanisms of action of IVIG are complex and diverse, and there may be multiple mechanisms that combine to influence it. IVIG has been used in kidney transplantation for desensitization, treatment of antibody-mediated rejection, and ABO-incompatible transplantation. and treatment or prevention of some infectious diseases. Hyperimmune globulins such as cytomegalovirus hyperimmune globulin (CMV-IG) and hepatitis B hyperimmune globulin (HBIG) have also been used to protect against cytomegalovirus and hepatitis B virus, respectively. However, IVIG is also associated with some rare but serious adverse effects and some application risks, and clinicians need to weigh the pros and cons and develop individualized treatment programs to benefit more patients. This review will provide an overview of the multiple mechanisms of action, clinical applications, adverse effects, and prophylactic measures of IVIG, and hyperimmune globulin will also be introduced in it.
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Affiliation(s)
- Yi-Bo Hou
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology; Key Laboratory of Organ Transplantation, Ministry of Education; NHC Key Laboratory of Organ Transplantation; Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan 430030, China
| | - Sheng Chang
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology; Key Laboratory of Organ Transplantation, Ministry of Education; NHC Key Laboratory of Organ Transplantation; Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan 430030, China
| | - Song Chen
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology; Key Laboratory of Organ Transplantation, Ministry of Education; NHC Key Laboratory of Organ Transplantation; Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan 430030, China
| | - Wei-Jie Zhang
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology; Key Laboratory of Organ Transplantation, Ministry of Education; NHC Key Laboratory of Organ Transplantation; Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan 430030, China.
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Singh V, Dogra PM, Singh P, Singh SK, Ghosh I, Sreenivasa S, Singhal G, Arya R. Parvovirus B19 infection after kidney transplantation: A single centre experience. Med J Armed Forces India 2023; 79:665-671. [PMID: 37981933 PMCID: PMC10654353 DOI: 10.1016/j.mjafi.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 08/06/2023] [Indexed: 11/21/2023] Open
Abstract
Background Parvovirus B19 is an uncommon cause of anaemia in kidney transplant recipients (KTRs). The study aims to determine the incidence, clinical presentation, laboratory findings and outcome of parvovirus B19-related anaemia in KTR. Method We conducted a 12-year retrospective, single-centre study describing the clinical profile of KTRs with parvovirus B19-related anaemia. Result Amongst the 714 patients who underwent kidney transplantation between January 2011 and January 2023, (cumulative follow-up: 1287 patient-years), six females and one male, developed parvovirus B19-related anaemia. The incidence proportion (risk) is 0.98% with an incidence rate of 5.43 cases per 1000 patient-year. The median duration from transplant to development of anaemia was 6 weeks (range: 4-40 weeks). The mean fall in haemoglobin was 2.88 ± 1.55 gm/dl; concomitant leukopenia and thrombocytopenia were observed in 57.1 and 28.6% of patients. Three patients responded to a reduction in immunosuppression, the four non-responders required the administration of low-dose intravenous immunoglobulin. The mean duration from initiation of therapy to a sustained rise in haemoglobin was 7.71 ± 2.62 weeks. None of the patients had a relapse of the infection. Conclusions Parvovirus B19 infection is an uncommon cause of post-transplant refractory anaemia. The key to successfully managing such patients includes a high index of suspicion, early diagnosis and reduction of immunosuppression with or without administration of intravenous immunoglobulin.
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Affiliation(s)
- Vishal Singh
- Professor & Head (Nephrology), Army Hospital (R&R), Delhi Cantt, India
| | - Pavitra Manu Dogra
- Senior Advisor (Medicine) & Nephrologist, Army Hospital (R&R), Delhi Cantt, India
| | - Pulkit Singh
- Department of Medicine, MS Ramaiah Medical College, Bangalore, India
| | | | - Indranil Ghosh
- Senior Advisor (Medicine) & Nephrologist, Army Hospital (R&R), Delhi Cantt, India
| | - S. Sreenivasa
- Senior Advisor (Medicine) & Nephrologist, Army Hospital (R&R), Delhi Cantt, India
| | - Gaurav Singhal
- Resident (Nephrology), Army Hospital (R&R), Delhi Cantt, India
| | - Rohan Arya
- Resident (Nephrology), Army Hospital (R&R), Delhi Cantt, India
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Tambi P, Dave R, Kute V, Patel HV, Shah S, Yadav R. Parvovirus in Kidney Transplant Recipients: A Single-Center Experience. EXP CLIN TRANSPLANT 2023; 21:868-871. [PMID: 38140930 DOI: 10.6002/ect.2023.0127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Abstract
OBJECTIVES Parvovirus testing is not done in routine clinical practice; thus, it is possible that reported parvovirus cases are just the tip of the iceberg of total prevalence. We present a single-center retrospective analysis of 22 events of parvovirus B19 anemia in 20 renal transplant recipients, among which 2 patients had recurrence. MATERIALS AND METHODS For this descriptive analytical study, parvovirus B19 disease was defined as parvovirus infection (detection by real-time polymerase chain reaction) in the presence of anemia with clinical symptoms or bone marrow biopsy findings consistent with the diagnosis. Study duration was 18 months, from June 2021 through December 2022, and patients were enrolled from a single center. RESULTS All patients detected with the virus had received induction with thymocyte globulin and were on standard triple drug immunosuppression. Mean age was 32 ± 12 years with median time to diagnosis of 2 months after transplant. Anemia was observed in all patients with mean hemoglobin level at presentation of 6.02 ± 1.28 g/dL. Creatinine at presentation was 1.49 mg/dL (interquartile range, 0.92-2.69 mg/dL). The most common presentation was asymptomatic patient with evaluation for anemia. During therapy, the highest median creatinine level was 2.0 mg/dL (interquartile range, 1.38-3.2 mg/dL), which was significantly higher than that at presentation (P < .018). After therapy, median creatinine level was 1.3 mg/dL, which was not significantly higher than the baseline level, demonstrating a mostly transient graft dysfunction. CONCLUSIONS Parvovirus B19 is a relatively underreported disease in renal transplant recipients, with patients presenting with anemia and the disease causing transient graft dysfunction. Parvovirus B19 infection responds well to a decrease in immunosuppression and intravenous immunoglobulin therapy.
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Affiliation(s)
- Priyash Tambi
- From the Department of Nephrology and Transplantation, Institute of Kidney Disease and Research Center, Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, Gujarat, India
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12
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Sammut R, Feghoul L, Xhaard A, Dhedin N, Robin M, Michonneau D, Loschi M, Legoff J, de Peffault de Latour R, de Sicre de Fontbrune F. Clinical and immune features of human parvovirus B19 infection in allogeneic stem cell transplantation recipients: A retrospective monocentric study. Transpl Infect Dis 2023; 25:e14118. [PMID: 37594199 DOI: 10.1111/tid.14118] [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: 03/08/2023] [Revised: 07/08/2023] [Accepted: 08/01/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND Human parvovirus B19 (B19V) infection is associated with pure red cell aplasia (PRCA) in immunocompromised patients; however, the spectrum of manifestations associated with B19V in allogeneic hematopoietic stem cell transplantation recipients (alloHSCT) has rarely been reported. METHODS In this study, we aimed to report clinical and immune features of B19V infection after alloHSCT. We retrospectively collected and analyzed clinical and microbiological data of all transplanted patients with B19V DNAmia or tissue infection detected by polymerase chain reaction (PCR) in our center from 2010 to 2021. RESULTS We report 35 cases of B19V infections in 33 patients. Median time from transplant to B19V first PCR positivity was 6.9 months (interquartile range (IQR) [1.6-18.9]). No preferential immune profile, type of transplantation or conditioning was identified. Hematological impairment was the most frequent sign, followed by rash and fever. Unconventional clinical forms were also detected, such as acute myelitis and myositis. For some cases, the direct relationship between symptoms and B19V infection was difficult to prove but was suggested by targeted tissue PCR positivity. When hematological impairment was not at the forefront, reticulocytopenia helped to diagnose B19V infections. Treatment was mainly based on high dose intravenous immunoglobulin. CONCLUSION Although hematological impairment was the most frequent sign, B19V can affect multiple targets and lead to atypical manifestations. Because of its heterogeneous clinical presentation, B19V infection is likely under-diagnosed. Diagnosis of unusual B19V organ involvement needs combination of arguments which can include targeted tissue PCR.
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Affiliation(s)
- Rinzine Sammut
- Service d'Hématologie Clinique, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Linda Feghoul
- Université de Paris, Inserm U976, Insight team, F-75010, Paris France Unité Virologie et greffes, Département des agents infectieux, Hôpital Saint-Louis, APHP, Paris, France
| | - Alienor Xhaard
- Service d'hématologie-greffe, Hôpital Saint-Louis, Université Paris Cité, Paris, France
| | - Nathalie Dhedin
- Service d'hématologie Adolescents et Jeunes Adultes, Hôpital Saint Louis, AP-HP, Paris, France
| | - Marie Robin
- Service d'hématologie-greffe, Hôpital Saint-Louis, Université Paris Cité, Paris, France
| | - David Michonneau
- Service d'hématologie-greffe, Hôpital Saint-Louis, Université Paris Cité, Paris, France
- Université de Paris Cité, Paris, France
| | - Michael Loschi
- Service d'Hématologie Clinique, Centre Hospitalier Universitaire de Nice, Nice, France
- INSERM U1065, Centre de Médecine Moléculaire Méditerranéen, Université Nice Cote d'Azur, Nice, France
| | - Jerome Legoff
- Université de Paris, Inserm U976, Insight team, F-75010, Paris France Unité Virologie et greffes, Département des agents infectieux, Hôpital Saint-Louis, APHP, Paris, France
| | - Regis de Peffault de Latour
- Service d'hématologie-greffe, Hôpital Saint-Louis, Université Paris Cité, Paris, France
- Université de Paris Cité, Paris, France
- Centre Français de Référence de l'Aplasie Médullaire et de l'Hémoglobinurie Paroxystique Nocturne, Paris, France
| | - Flore de Sicre de Fontbrune
- Service d'hématologie-greffe, Hôpital Saint-Louis, Université Paris Cité, Paris, France
- Centre Français de Référence de l'Aplasie Médullaire et de l'Hémoglobinurie Paroxystique Nocturne, Paris, France
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13
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Kinsella PM, Yong MK, Slavin MA, Hall VG. Parvovirus B19 in stem cell transplantation. Transpl Infect Dis 2023; 25:e14138. [PMID: 37610327 DOI: 10.1111/tid.14138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 08/14/2023] [Accepted: 08/16/2023] [Indexed: 08/24/2023]
Affiliation(s)
- Paul M Kinsella
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Department of Infectious Diseases, University of Melbourne, Parkville, Victoria, Australia
| | - Michelle K Yong
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
- Department of Infectious Diseases, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Monica A Slavin
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
- Department of Infectious Diseases, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Victoria G Hall
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
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14
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Yaghoubi F, Dalil D, Tavakoli F, Hosseini SM. Relapsing anemia associated with parvovirus B19 infection in a kidney transplant recipient: A case report and review of the literature. Clin Case Rep 2023; 11:e7906. [PMID: 37692152 PMCID: PMC10485237 DOI: 10.1002/ccr3.7906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/25/2023] [Accepted: 08/28/2023] [Indexed: 09/12/2023] Open
Abstract
Key clinical message PB19 infection should be considered an uncommon cause of posttransplant anemia in renal transplant recipients, particularly those whose anemia is not associated with common etiologies. IVIG treatment and reduced immunosuppression could be beneficial. Abstract Parvovirus B19-associated relapsing anemia is rare in kidney transplant recipients. Herein, we report a case of relapsed anemia due to parvovirus B19 infection in a 53-year-old woman 18 months after kidney transplantation. The patient presented with palpitations, shortness of breath, dizziness, weakness, and lethargy. Early laboratory findings showed a WBC count of 6.000/μL, RBC count of 1.89/μL, hemoglobin (Hb) 3.5 g/dL, hematocrit (Hct) 15%, platelet count 266.000/μL, MCV 89, reticulocyte count 0.8%, and serum iron 221 μg/dL. Upon further evaluation, the RT-PCR test for BK polyomavirus and cytomegalovirus (CMV) was negative, while the parvovirus B19 RT-PCR was positive. The patient was treated with blood transfusion and IVIG 25 g daily for 5 days. Two months after discharge, the patient presented, complaining of palpitation, shortness of breath, and dizziness, with RBC 2.7/μL, Hb 6.5 g/dL, Hct 25%, and MCV 85. Again, the CMV RT-PCR was negative, while the parvovirus B19 RT-PCR was positive. Tacrolimus and mycophenolic acid were stopped, and IVIG 25 g daily for 5 days was administered. Consequently, her Hb level increased to 9 g/dL, and the patient was discharged with prednisolone 5 mg daily and cyclosporine 50 mg daily instead of tacrolimus. Viral infection, particularly PB19 infection, should be considered in the differential diagnosis of posttransplantation anemia in KTRs. IVIG treatment and modification of immunosuppressive medications are suggested standard therapies for such patients. The function of transplanted kidneys should be carefully monitored during treatment.
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Affiliation(s)
- Fatemeh Yaghoubi
- Nephrology Research Center, Shariati HospitalTehran University of Medical SciencesTehranIran
| | - Davood Dalil
- Student Research Committee, Faculty of MedicineShahed UniversityTehranIran
| | - Farnaz Tavakoli
- Nephrology Research Center, Shariati HospitalTehran University of Medical SciencesTehranIran
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Bertazza Partigiani N, Negrisolo S, Carraro A, Marzenta D, Manaresi E, Gallinella G, Barzon L, Benetti E. Pre-Existing Intrarenal Parvovirus B19 Infection May Relate to Antibody-Mediated Rejection in Pediatric Kidney Transplant Patients. Int J Mol Sci 2023; 24:ijms24119147. [PMID: 37298109 DOI: 10.3390/ijms24119147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/01/2023] [Accepted: 05/20/2023] [Indexed: 06/12/2023] Open
Abstract
Viral infections can lead to transplant dysfunction, and their possible role in rejection is described. In total, 218 protocol biopsies performed in 106 children at 6, 12 and 24 months after transplantation were analyzed according to Banff '15. RT-PCR for cytomegalovirus, Epstein-Barr virus, BK virus and Parvovirus B19 was performed on blood and bioptic samples at the time of transplant and each protocol biopsy. The prevalence of intrarenal viral infection increases between 6 and 12 months after transplantation (24% vs. 44%, p = 0.007). Intrarenal Parvovirus B19 infection is also associated with antibody-mediated rejection (ABMR) (50% ABMR vs. 19% T-cell-mediated rejection, p = 0.04). Moreover, Parvovirus infection is higher at 12 months of follow-up and it decreases at 48 months (40.4% vs. 14%, p = 0.02), while in 24% of grafts, Parvovirus is already detectable at the moment of transplantation. Intrarenal Parvovirus B19 infection seems to be related to ABMR in pediatric kidney recipients. The graft itself may be the way of transmission for Parvovirus, so performance of a PCR test for Parvovirus B19 should be considered to identify high-risk patients. Intrarenal Parvovirus infection presents mainly during the first-year post-transplantation; thus, we recommend an active surveillance of donor-specific antibodies (DSA) in patients with intrarenal Parvovirus B19 infection during this period. Indeed, it should be considered a treatment with intravenous immunoglobulins in patients with intrarenal Parvovirus B19 infection and DSA positivity, even in the absence of ABMR criteria for kidney biopsy.
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Affiliation(s)
- Nicola Bertazza Partigiani
- Pediatric Nephrology, Department of Women's and Children's Health, University Hospital of Padua, 35128 Padua, Italy
- Department of Women's and Children's Health, University of Padua, 35128 Padua, Italy
| | - Susanna Negrisolo
- Laboratory of Immunopathology and Molecular Biology of the Kidney, Department of Women's and Children's Health, University of Padova, 35127 Padua, Italy
- Pediatric Research Institute "IRP Città della Speranza", 35127 Padua, Italy
| | - Andrea Carraro
- Laboratory of Immunopathology and Molecular Biology of the Kidney, Department of Women's and Children's Health, University of Padova, 35127 Padua, Italy
| | - Diana Marzenta
- Pediatric Nephrology, Department of Women's and Children's Health, University Hospital of Padua, 35128 Padua, Italy
- Laboratory of Immunopathology and Molecular Biology of the Kidney, Department of Women's and Children's Health, University of Padova, 35127 Padua, Italy
| | - Elisabetta Manaresi
- Department of Pharmacy and Biotechnology, University of Bologna, 40138 Bologna, Italy
| | - Giorgio Gallinella
- Department of Pharmacy and Biotechnology, University of Bologna, 40138 Bologna, Italy
| | - Luisa Barzon
- Department of Molecular Medicine, University of Padua, 35121 Padua, Italy
| | - Elisa Benetti
- Pediatric Nephrology, Department of Women's and Children's Health, University Hospital of Padua, 35128 Padua, Italy
- Laboratory of Immunopathology and Molecular Biology of the Kidney, Department of Women's and Children's Health, University of Padova, 35127 Padua, Italy
- Pediatric Research Institute "IRP Città della Speranza", 35127 Padua, Italy
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Holterhus M, Hennies M, Hillmann H, Thorer H, Rossig C, Burkhardt B, Groll AH. Parvovirus B19 infection in pediatric allogeneic hematopoietic cell transplantation - Single-center experience and review. Transpl Infect Dis 2023; 25:e14028. [PMID: 36748962 DOI: 10.1111/tid.14028] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 01/06/2023] [Accepted: 01/17/2023] [Indexed: 02/08/2023]
Abstract
BACKGROUND Parvovirus B19 (B19V) infection following pediatric hematopoietic cell transplantation (HCT) is a rare complication and available data is scarce. Therefore, we present the experience with B19V Infection in allogeneic pediatric HCT recipients at our transplant center together with a systematic review of the literature. METHODS Pediatric HCT patients with Parvovirus B19 infection treated at the University Children's Hospital Münster between 1999 and 2021 were retrospectively identified and clinical data were analyzed. Additionally, a systematic MEDLINE search to identify relevant articles was performed. RESULTS We identified three out of 445 patients (0.6%) with B19V infection post-transplantation. B19V infection occurred in combination with other complications like Graft-versus-Host disease, additional infections, or autoimmune-mediated hemolysis potentially triggered by B19V. In one patient these complications lead to a fatal outcome. The review of the literature showed considerable morbidity of B19V infection with the potential for life-threatening complications. Most patients were treated by red blood cell transfusion and intravenous immunoglobulins (IVIG) with a high succession rate. CONCLUSION Symptomatic B19V infection following HCT remains a rare but potentially challenging complication. A causal antiviral therapy does not exist as well as general recommendations on dosage and duration of IVIG therapy. Despite this, most patients are treated successfully with these measures. Additionally, transmission via blood or stem cell products is also rare and no general recommendations on B19V screenings exist.
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Affiliation(s)
- Malcolm Holterhus
- Department of Pediatric Hematology and Oncology, University Children's Hospital Munster, Munster, Germany
| | - Marc Hennies
- Department for Clinical Virology, Institute of Virology, University Hospital Munster, Munster, Germany
| | - Hartmut Hillmann
- Department of Transfusion Medicine and Cellular Therapy, University Hospital Munster, Munster, Germany
| | - Heike Thorer
- Department of Pediatric Hematology and Oncology, University Children's Hospital Munster, Munster, Germany
| | - Claudia Rossig
- Department of Pediatric Hematology and Oncology, University Children's Hospital Munster, Munster, Germany
| | - Birgit Burkhardt
- Department of Pediatric Hematology and Oncology, University Children's Hospital Munster, Munster, Germany
| | - Andreas H Groll
- Department of Pediatric Hematology and Oncology, University Children's Hospital Munster, Munster, Germany.,Department of Pediatric Hematology and Oncology, Infectious Disease Research Program, Center for Bone Marrow Transplantation, University Children's Hospital Münster, Munster, Germany
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Rajesh C, Mishra U, Valsan A, John EE, Eapen JJ, Thomas A, Yusuf S, Alexander S, David VG, Varughese S. Treating Parvovirus Triggered Refractory Hemolytic Anemia with Rituximab in Renal Transplant Recipients - A Report of Two Cases. INDIAN JOURNAL OF TRANSPLANTATION 2023; 17:139-142. [PMID: 38689694 PMCID: PMC7615908 DOI: 10.4103/ijot.ijot_34_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
Parvovirus B19 is a small (26 nm), nonenveloped, single-stranded DNA (5.6-kb) virus. The only known host for parvovirus B19 is humans. Parvovirus B19 is directly cytotoxic to erythroid precursor cells of the colony- and burst-forming units. Human parvovirus B19 is the etiologic agent of erythema infectiosum and chronic pure red cell aplasia in immunocompromised individuals. Acute parvovirus B19 infection should be suspected in immunocompromised patients, who present with reticulocytopenic hemolytic anemia and thrombocytopenia. Intravenous immunoglobulin (IVIg) is the standard treatment for parvovirus-induced cytopenias. We report two cases of postrenal transplant who presented with reticulocytopenic anemia and were found to have parvovirus infection. They did not respond to conventional treatment with intravenous gamma globulin. Both patients were treated with rituximab with which they had improvement in clinical and hematological parameters. There was no previous documentation of using rituximab in the treatment of parvovirus-triggered autoimmune hemolytic anemia postrenal transplant patients. This article illustrates how rituximab will be helpful in this setting, of course, it is a new thought but requires further studies and validation.
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Affiliation(s)
- Chilaka Rajesh
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Utkarsh Mishra
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Anna Valsan
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Jeethu Joseph Eapen
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Athul Thomas
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sabina Yusuf
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Suceena Alexander
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Vinoi George David
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Santosh Varughese
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India
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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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19
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Ma Y, Man J, Niu J, Yang L. Progress of research on human parvovirus B19 infection after renal transplantation. Transplant Rev (Orlando) 2022; 36:100730. [DOI: 10.1016/j.trre.2022.100730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 11/03/2022] [Accepted: 11/03/2022] [Indexed: 11/07/2022]
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20
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Zhang QQ, Zhang WJ, Wang F, Chen S, Chang S. Clinical utility of immune function based on IFN-γ monitoring of lymphocyte subsets for parvovirus B19 infection in renal recipients. INFECTION, GENETICS AND EVOLUTION : JOURNAL OF MOLECULAR EPIDEMIOLOGY AND EVOLUTIONARY GENETICS IN INFECTIOUS DISEASES 2022; 103:105307. [PMID: 35738549 DOI: 10.1016/j.meegid.2022.105307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 05/12/2022] [Accepted: 05/20/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND There should be a heightened index of suspicion for Parvovirus B19 (PVB19)-related anemia in organ transplant recipients. Thus far, there is no consensus or recommendation for clinical routine monitoring methods of PVB19 recipients to allow tailoring of immunosuppression. METHODS We conducted a retrospective study to evaluate the utility of the function (represented by the abilities to secrete IFN-γ) and numbers of lymphocyte subsets in monitoring PVB19 infections in renal recipients posttransplant. The enrolled 109 patients were split into 2 groups according to whether the recipients had an occurrence of PVB19 infection: 37 (33.94%) recipients developed PVB19 infection and 72 (66.06%) immune-stable recipients. RESULTS The PVB19 infected group had significantly lower absolute counts and functions of different lymphocyte subsets compared with immune-stable recipients. We showed that the frequencies of IFN-γ + CD4 + T cells, IFN-γ + CD8 + T cells, and IFN-γ + NK cells increased markedly after treatment when compared to the occurrence in patients with timepoint before therapy, especially the percentages of IFN-γ + CD4 + T cells were significantly higher. Receiver operating characteristic (ROC) analysis showed that the optimal infection indicator was IFN-γ + NK cells frequency, with an auROC curve of 0.925. Concomitantly, Cox regression analysis indicated that the post-therapy increasing level of IFN-γ secreting function was significantly predictive of recurrent infections (P < 0.001). CONCLUSIONS We recommend prospective risk stratification for the high-risk population at risk of early-onset PVB19 infection and its recurrence involves screening strategies of immune-based surveillance with the sensitive IFN-γ + secreting monitoring for antiviral prophylaxis and preemptive therapy goal. Clinical Trial Notation: clinical trial registration number: chiCTR-ROC-17010756.
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Affiliation(s)
- Qian-Qian Zhang
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Key Laboratory of Organ Transplantation, Ministry of Education NHC Key Laboratory of Organ Transplantation Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan, China
| | - Wei-Jie Zhang
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Key Laboratory of Organ Transplantation, Ministry of Education NHC Key Laboratory of Organ Transplantation Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan, China
| | - Feng Wang
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Song Chen
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Key Laboratory of Organ Transplantation, Ministry of Education NHC Key Laboratory of Organ Transplantation Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan, China
| | - Sheng Chang
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Key Laboratory of Organ Transplantation, Ministry of Education NHC Key Laboratory of Organ Transplantation Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan, China.
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Huang Q, Wang Y, Chen R, Zhao Y, Wang H, Ma X, Li D, Liu Q, Chen X, He L, Zhang M, Li M. Parvovirus B19 infection in kidney transplant recipients: A prospective study in a teaching hospital in Shanghai, China. Transpl Immunol 2022; 74:101667. [PMID: 35835294 DOI: 10.1016/j.trim.2022.101667] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 07/05/2022] [Accepted: 07/07/2022] [Indexed: 12/19/2022]
Abstract
BACKGROUND There is a lack of epidemiological studies on the course and clinical characteristics of Parvovirus B19 (B19V) infections in kidney transplant (KT) recipients. This study was undertaken to provide recommendations for clinical B19V infection diagnosis and treatment. METHODS Serum samples of KT recipients were regularly collected and tested for B19V-DNA copies, B19V-IgG/IgM levels, as well as hematological parameters and functions of kidney and liver. The course of B19V infection was described according to the results of serology and DNA testing, and the clinical and epidemiological data were combined for analysis. RESULTS 75% B19V infections occurred within 2 weeks after KT(n = 9). The infection rate of B19V in KT recipients was high, namely 10.17% (n = 12). The number of 10 patients IgM antibodies against B19V (IgM+) and theDNA B19V (DNA+), whereas 2 patients were IgM negative (IgM-) but DNA+. The B19V infected KT patients showed several symptoms, including anemia (100%), reduction of platelets (8.33%), and damage to liver (75%) and kidney function (16.67%) Patients with progressive anemia in the first two weeks after KT, which combined with the decrease of reticulocytes, are more likely to have B19V infection. Associations of four main therapeutic risk factors for B19V infections in KT patients have been analyzed. B19V infection was associated with use of basiliximab (OR = 1.19; 95%- CI: 1.08-1.32; P = 0.003) and use of thymoglobulins (OR = 0.84; 95%-CI: 0.76-0.93; P = 0.003). CONCLUSIONS Doctors should be alert to B19V infection, especially in the immunodeficient patients within the first two weeks after transplantation.
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Affiliation(s)
- Qian Huang
- Department of Laboratory Medicine, Ren Ji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
| | - Yanan Wang
- Department of Laboratory Medicine, Ren Ji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
| | - Ruoyang Chen
- Department of Urology, Ren Ji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
| | - Yanan Zhao
- Faculty of medical laboratory science, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
| | - Hua Wang
- Department of Laboratory Medicine, Ren Ji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
| | - Xiaowei Ma
- Department of Laboratory Medicine, Ren Ji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
| | - Dawei Li
- Department of Urology, Ren Ji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
| | - Qian Liu
- Department of Laboratory Medicine, Ren Ji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
| | - Xiaoying Chen
- Department of Laboratory Medicine, Ren Ji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
| | - Lei He
- Department of Laboratory Medicine, Ren Ji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
| | - Ming Zhang
- Department of Urology, Ren Ji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China.
| | - Min Li
- Department of Laboratory Medicine, Ren Ji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China; Faculty of medical laboratory science, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China.
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22
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Hu X, Jia C, Wu J, Zhang J, Jiang Z, Ma K. Towards the Antiviral Agents and Nanotechnology-Enabled Approaches Against Parvovirus B19. Front Cell Infect Microbiol 2022; 12:916012. [PMID: 35795188 PMCID: PMC9250997 DOI: 10.3389/fcimb.2022.916012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 05/24/2022] [Indexed: 11/13/2022] Open
Abstract
Parvovirus B19 (B19V) as a human pathogenic virus, would cause a wide range of clinical manifestations. Besides the supportive and symptomatic treatments, the only FDA-approved antiviral drug for the treatment of B19V is intravenous immunoglobulins, which however, have limited efficacy and high cost. By far, there are still no virus-specific therapeutics clinically available to treat B19V infection. Therefore, exploiting the potential targets with a deep understanding of the life cycle of B19V, are pivotal to the development of B19V-tailored effective antiviral approaches. This review will introduce antiviral agents via blocking viral invasion, inhibiting the enzymes or regulatory proteins involved in DNA synthesis, and so on. Moreover, nanotechnology-enabled approaches against B19V will also be outlined and discussed through a multidisciplinary perspective involving virology, nanotechnology, medicine, pharmaceutics, chemistry, materials science, and other fields. Lastly, the prospects of the antiviral agents and nanosystems in terms of fabrication, clinical translation and potential breakthroughs will be briefly discussed.
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Affiliation(s)
- Xi Hu
- Department of Clinical Pharmacy, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Zhejiang Provincial Key Laboratory for Drug Evaluation and Clinical Research, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chen Jia
- Department of Clinical Pharmacy, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Department of Pharmacy, Lanzhou University Second Hospital, Lanzhou, China
| | - Jianyong Wu
- Kidney Disease Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jian Zhang
- Kidney Disease Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhijie Jiang
- Department of Clinical Pharmacy, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Zhejiang Provincial Key Laboratory for Drug Evaluation and Clinical Research, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Kuifen Ma
- Department of Clinical Pharmacy, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Zhejiang Provincial Key Laboratory for Drug Evaluation and Clinical Research, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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23
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Arino H, Muramae N, Okano M, Mori K, Otsui K, Sakaguchi K. Acute Onset of Remitting Seronegative Symmetrical Synovitis With Pitting Edema (RS3PE) Two Weeks After COVID-19 Vaccination With mRNA-1273 With Possible Activation of Parvovirus B19: A Case Report With Literature Review. Cureus 2022; 14:e24952. [PMID: 35706724 PMCID: PMC9187273 DOI: 10.7759/cureus.24952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2022] [Indexed: 11/18/2022] Open
Abstract
Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) is a rare clinical entity characterized by “remitting,” “seronegative,” and “symmetrical” synovitis with pitting edema on the dorsum of the hands and feet. Although rheumatic or malignant diseases are diseases that are known to coexist with RS3PE, other factors such as medication, infection, and vaccination have been reported to be associated with RS3PE. Here, we present a case of RS3PE syndrome that satisfied all four diagnostic criteria of RS3PE (pitting edema in the limbs, acute onset, age ≥ 50 years, and/or rheumatoid factor negativity) after mRNA-1273 SARS-CoV-2 vaccination.
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24
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Wang F, Zhan Q, Yu SP, Feng HT, Hu P, Zhong ZF, Qu TT. Environmental Monitoring of Parvovirus B19 in the Kidney Transplantation Ward of a Chinese Teaching Hospital. Infect Drug Resist 2022; 15:1903-1910. [PMID: 35465250 PMCID: PMC9030386 DOI: 10.2147/idr.s356174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/26/2022] [Indexed: 01/04/2023] Open
Abstract
Purpose Parvovirus B19 (B19V) infection is a viral threat after kidney transplantation. It is mainly transmitted by close-contact inhalation of aerosolized viral particles. The risk of nosocomial spread of B19V in the transplantation ward is quite high. This study aimed to evaluate the quality of routine disinfection and the effectiveness of isolation measures in the wards of B19V-infected kidney transplant recipients. Patients and Methods Throat swab samples of 19 kidney transplant recipients admitted to the isolation ward and three healthcare workers (HCWs) were collected for viral DNA detection. Routine disinfection procedures were performed twice a day in general and B19V isolation wards. Environmental surface and air samples were collected for viral DNA detection before and after disinfection. Results A total of four patients were diagnosed with B19V infection and transferred to the B19V isolation ward, of which only two had positive throat swab samples. The other 15 patients and all HCWs tested negative for B19V. A total of 88 environmental surface and air samples were collected. Eight of the environmental samples collected in the B19V isolation ward before disinfection tested positive for B19V, while one sample tested positive after disinfection. In the general wards, all environmental samples collected before disinfection tested negative for B19V. All 24 samples collected from ambient air, whether in B19V isolation or general wards, before or after disinfection, tested negative for B19V. Conclusion Existing methods of routine or terminal disinfection for air and object surfaces were effective in eliminating B19V from object surfaces and ambient air in the isolation and general wards. Material surfaces that are exposed to high frequency and easily contaminated by blood, body fluids, and indoor air were the focus of cleaning and disinfection. Nosocomial cross-infection of other immunocompromised patients and HCWs can be avoided if appropriate prevention and control measures are taken.
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Affiliation(s)
- Fang Wang
- Infection Control Department, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, People’s Republic of China
| | - Qing Zhan
- Infection Control Department, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, People’s Republic of China
| | - Shi-Ping Yu
- Kidney Disease Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, People’s Republic of China
| | - Hai-Ting Feng
- Infection Control Department, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, People’s Republic of China
| | - Ping Hu
- Kidney Disease Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, People’s Republic of China
| | - Zi-Feng Zhong
- Infection Control Department, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, People’s Republic of China
| | - Ting-Ting Qu
- Infection Control Department, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, People’s Republic of China
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, People’s Republic of China
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25
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Zhou X, Jiang P, Gao L, Yang J, Cai Y, Tong Y, Qiu H, Huang C, Zhou K, Xu X, Niu J, Xia X, Zhang Y, Shen C, Wei Y, Shao J, Song X, Wan L. Immune reconstitution and survival of patients with parvovirus B19 related pure red cell aplasia after haplo-PBSCT. Ann Hematol 2022; 101:1333-1342. [PMID: 35396950 PMCID: PMC9072482 DOI: 10.1007/s00277-022-04831-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 03/29/2022] [Indexed: 11/24/2022]
Abstract
Parvovirus B19 (PvB19) infection and PvB19 related pure red cell aplasia (PRCA) in recipients with allogeneic hematopoietic stem cell transplantation have been reported sporadically. However, clinical studies with large sample sizes are lacking, especially in patients undergoing HLA-haploidentical peripheral blood stem cell transplantation (haplo-PBSCT). In addition, clinical features, immune reconstitution, and outcomes of these patients are not clear. We conducted a retrospective analysis of 164 patients who received haplo-PBSCT with low-dose anti-thymocyte globulin (ATG) plus low-dose posttransplant cyclophosphamide (PTCy)-based regimen as graft-versus-host disease (GVHD) prophylaxis. We analyzed the incidence of PvB19 related PRCA and compared the clinical characteristics, immune reconstitution, incidence of GVHD, relapse rate, and survival between patients with and without PvB19 related PRCA. A total of 14 (8.5%) recipients developed PvB19 related PRCA after a median of 5.3 months after haplo-PBSCT. These patients with PvB19 related PRCA had slower immune reconstitution, but similar incidences of GVHD, relapse rate, and overall survival compared with recipients without PvB19 related PRCA. PvB19 related PRCA indicated relative delayed and poor immune reconstitution of the recipients early after haplo-PBSCT. PvB19 related PRCA had no effects on GVHD, relapse, and survival.
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Affiliation(s)
- Xiao Zhou
- Department of Hematology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Shanghai, 200080, China.,Engineering Technology Research Center of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee (STCSM), No. 100 Haining Road, Shanghai, 200080, China
| | - Peiyao Jiang
- Department of Hematology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Shanghai, 200080, China.,Engineering Technology Research Center of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee (STCSM), No. 100 Haining Road, Shanghai, 200080, China
| | - Lu Gao
- Department of Hematology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Shanghai, 200080, China.,Engineering Technology Research Center of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee (STCSM), No. 100 Haining Road, Shanghai, 200080, China
| | - Jun Yang
- Department of Hematology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Shanghai, 200080, China.,Engineering Technology Research Center of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee (STCSM), No. 100 Haining Road, Shanghai, 200080, China
| | - Yu Cai
- Department of Hematology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Shanghai, 200080, China.,Engineering Technology Research Center of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee (STCSM), No. 100 Haining Road, Shanghai, 200080, China
| | - Yin Tong
- Department of Hematology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Shanghai, 200080, China.,Engineering Technology Research Center of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee (STCSM), No. 100 Haining Road, Shanghai, 200080, China
| | - Huiying Qiu
- Department of Hematology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Shanghai, 200080, China.,Engineering Technology Research Center of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee (STCSM), No. 100 Haining Road, Shanghai, 200080, China
| | - Chongmei Huang
- Department of Hematology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Shanghai, 200080, China.,Engineering Technology Research Center of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee (STCSM), No. 100 Haining Road, Shanghai, 200080, China
| | - Kun Zhou
- Department of Hematology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Shanghai, 200080, China.,Engineering Technology Research Center of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee (STCSM), No. 100 Haining Road, Shanghai, 200080, China
| | - Xiaowei Xu
- Department of Hematology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Shanghai, 200080, China.,Engineering Technology Research Center of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee (STCSM), No. 100 Haining Road, Shanghai, 200080, China
| | - Jiahua Niu
- Department of Hematology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Shanghai, 200080, China.,Engineering Technology Research Center of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee (STCSM), No. 100 Haining Road, Shanghai, 200080, China
| | - Xinxin Xia
- Department of Hematology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Shanghai, 200080, China.,Engineering Technology Research Center of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee (STCSM), No. 100 Haining Road, Shanghai, 200080, China
| | - Ying Zhang
- Department of Hematology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Shanghai, 200080, China.,Engineering Technology Research Center of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee (STCSM), No. 100 Haining Road, Shanghai, 200080, China
| | - Chang Shen
- Department of Hematology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Shanghai, 200080, China.,Engineering Technology Research Center of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee (STCSM), No. 100 Haining Road, Shanghai, 200080, China
| | - Yu Wei
- Department of Hematology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Shanghai, 200080, China.,Engineering Technology Research Center of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee (STCSM), No. 100 Haining Road, Shanghai, 200080, China
| | - Jie Shao
- Department of Hematology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Shanghai, 200080, China.,Engineering Technology Research Center of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee (STCSM), No. 100 Haining Road, Shanghai, 200080, China
| | - Xianmin Song
- Department of Hematology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Shanghai, 200080, China. .,Engineering Technology Research Center of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee (STCSM), No. 100 Haining Road, Shanghai, 200080, China.
| | - Liping Wan
- Department of Hematology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Shanghai, 200080, China. .,Engineering Technology Research Center of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee (STCSM), No. 100 Haining Road, Shanghai, 200080, China.
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26
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Lindahl JP, Barlinn R, Abrahamsen IW, Spetalen S, Midtvedt K, Jenssen T. Case Report: Pure Red Cell Aplasia Caused by Refractory Parvovirus B19 Infection After Pancreas Transplantation Alone. Front Med (Lausanne) 2022; 9:849783. [PMID: 35372384 PMCID: PMC8966125 DOI: 10.3389/fmed.2022.849783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 02/22/2022] [Indexed: 11/25/2022] Open
Abstract
A multidisciplinary team of doctors is in charge or is involved in the follow-up of patients who undergo solid organ transplantation (SOT). Immunosuppressive drugs are required after SOT, some potential unwanted side effects can be difficult to detect, and physicians must be aware of potential pitfalls. We report a case of a recipient with brittle type 1 diabetes who experienced severe and refractory anemia after pancreas transplantation alone (PTA). Despite a broad diagnostic approach for anemia, the diagnosis was delayed. The patient had normocytic normochromic anemia with severe reticulocytopenia and marked reduction or absence of erythroid precursors in the bone marrow, compatible with pure red cell aplasia (PRCA). Analyses of serological parvovirus B19 anti-IgM and anti-IgG antibodies, including PCR, were initially inconclusive/negative. The diagnosis of parvovirus B19 infection was confirmed after bone marrow biopsy with immunohistochemical staining for parvovirus B19. A retrospective analysis revealed an early post-transplant primary parvovirus B19 infection. The patient was successfully treated with intravenous immunoglobulin (IVIg) therapy. There is a risk of diagnostic delay for the less common types of anemia following SOT. Parvovirus B19 infection-associated PRCA is curable in SOT recipients and should be actively considered in patients with persistent anemia and low reticulocytes.
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Affiliation(s)
- Jørn Petter Lindahl
- Department of Transplantation Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Regine Barlinn
- Department of Microbiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | | | - Signe Spetalen
- Department of Pathology, Oslo University Hospital, Radiumhospitalet, Oslo, Norway
| | - Karsten Midtvedt
- Department of Transplantation Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Trond Jenssen
- Department of Transplantation Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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27
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Bircher C, Bieri J, Assaraf R, Leisi R, Ros C. A Conserved Receptor-Binding Domain in the VP1u of Primate Erythroparvoviruses Determines the Marked Tropism for Erythroid Cells. Viruses 2022; 14:v14020420. [PMID: 35216013 PMCID: PMC8879732 DOI: 10.3390/v14020420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/06/2022] [Accepted: 02/15/2022] [Indexed: 01/27/2023] Open
Abstract
Parvovirus B19 (B19V) is a human pathogen with a marked tropism for erythroid progenitor cells (EPCs). The N-terminal of the VP1 unique region (VP1u) contains a receptor-binding domain (RBD), which mediates virus uptake through interaction with an as-yet-unknown receptor (VP1uR). Considering the central role of VP1uR in the virus tropism, we sought to investigate its expression profile in multiple cell types. To this end, we established a PP7 bacteriophage-VP1u bioconjugate, sharing the size and VP1u composition of native B19V capsids. The suitability of the PP7-VP1u construct as a specific and sensitive VP1uR expression marker was validated in competition assays with B19V and recombinant VP1u. VP1uR expression was exclusively detected in erythroid cells and cells reprogrammed towards the erythroid lineage. Sequence alignment and in silico protein structure prediction of the N-terminal of VP1u (N-VP1u) from B19V and other primate erythroparvoviruses (simian, rhesus, and pig-tailed) revealed a similar structure characterized by a fold of three or four α-helices. Functional studies with simian parvovirus confirmed the presence of a conserved RBD in the N-VP1u, mediating virus internalization into human erythroid cells. In summary, this study confirms the exclusive association of VP1uR expression with cells of the erythroid lineage. The presence of an analogous RBD in the VP1u from non-human primate erythroparvoviruses emphasizes their parallel evolutionary trait and zoonotic potential.
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Affiliation(s)
- Cornelia Bircher
- Department of Chemistry, Biochemistry and Pharmaceutical Sciences, University of Bern, 3012 Bern, Switzerland; (C.B.); (J.B.); (R.A.); (R.L.)
| | - Jan Bieri
- Department of Chemistry, Biochemistry and Pharmaceutical Sciences, University of Bern, 3012 Bern, Switzerland; (C.B.); (J.B.); (R.A.); (R.L.)
| | - Ruben Assaraf
- Department of Chemistry, Biochemistry and Pharmaceutical Sciences, University of Bern, 3012 Bern, Switzerland; (C.B.); (J.B.); (R.A.); (R.L.)
| | - Remo Leisi
- Department of Chemistry, Biochemistry and Pharmaceutical Sciences, University of Bern, 3012 Bern, Switzerland; (C.B.); (J.B.); (R.A.); (R.L.)
- CSL Behring AG, 3000 Bern, Switzerland
| | - Carlos Ros
- Department of Chemistry, Biochemistry and Pharmaceutical Sciences, University of Bern, 3012 Bern, Switzerland; (C.B.); (J.B.); (R.A.); (R.L.)
- Correspondence:
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28
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Munting A, Manuel O. Viral infections in lung transplantation. J Thorac Dis 2022; 13:6673-6694. [PMID: 34992844 PMCID: PMC8662465 DOI: 10.21037/jtd-2021-24] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/21/2021] [Indexed: 12/15/2022]
Abstract
Viral infections account for up to 30% of all infectious complications in lung transplant recipients, remaining a significant cause of morbidity and even mortality. Impact of viral infections is not only due to the direct effects of viral replication, but also to immunologically-mediated lung injury that may lead to acute rejection and chronic lung allograft dysfunction. This has particularly been seen in infections caused by herpesviruses and respiratory viruses. The implementation of universal preventive measures against cytomegalovirus (CMV) and influenza (by means of antiviral prophylaxis and vaccination, respectively) and administration of early antiviral treatment have reduced the burden of these diseases and potentially their role in affecting allograft outcomes. New antivirals against CMV for prophylaxis and for treatment of antiviral-resistant CMV infection are currently being evaluated in transplant recipients, and may continue to improve the management of CMV in lung transplant recipients. However, new therapeutic and preventive strategies are highly needed for other viruses such as respiratory syncytial virus (RSV) or parainfluenza virus (PIV), including new antivirals and vaccines. This is particularly important in the advent of the COVID-19 pandemic, for which several unanswered questions remain, in particular on the best antiviral and immunomodulatory regimen for decreasing mortality specifically in lung transplant recipients. In conclusion, the appropriate management of viral complications after transplantation remain an essential step to continue improving survival and quality of life of lung transplant recipients.
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Affiliation(s)
- Aline Munting
- Infectious Diseases Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Oriol Manuel
- Infectious Diseases Service, Lausanne University Hospital, Lausanne, Switzerland.,Transplantation Center, Lausanne University Hospital, Lausanne, Switzerland
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29
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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: 1.0] [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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Xu B, Zhang W, Qian X, Wang S, He F. Parvovirus B19-induced severe anemia in heart transplant recipient: A case report. Medicine (Baltimore) 2021; 100:e28387. [PMID: 34941171 PMCID: PMC8702246 DOI: 10.1097/md.0000000000028387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 12/02/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Human parvovirus B19 (B19V) is a non-enveloped single-stranded DNA virus associated with a variety of human diseases. Reports of B19V infection after cardiac transplantation are relatively rare. PATIENT CONCERNS We report a case of a 48-year-old women who underwent orthotopic heart transplant for dilated cardiomyopathy. She developed an anemia after cardiac transplantation. Anemia was most severe 2 months after surgery, with a decrease in reticulocyte count. Serological DNA test for parvovirus B19V was performed and the result was positive. DIAGNOSES B19V infection. INTERVENTIONS AND OUTCOMES Intravenous immunoglobulin administration resulted in a resolution of the anemia. The patient's blood test results showed a normal hemoglobin and reticulocyte count 1 year after surgery. LESSONS Patients with parvovirus B19V infection may develop severe anemia after heart transplantation. The diagnosis mainly relies on viral DNA detection. Intravenous immunoglobulin is an effective treatment for viral infection.
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Parvovirus B19 Infection due to over Immunosuppression in Kidney Transplant Recipients: Case Reports and Literature Review. Case Rep Transplant 2021; 2021:7651488. [PMID: 34881070 PMCID: PMC8648477 DOI: 10.1155/2021/7651488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 11/09/2021] [Indexed: 11/30/2022] Open
Abstract
Parvovirus B19 (PB19) is a single-stranded DNA virus that belongs to the Erythrovirus genus within the Parvoviridae family. Clinical presentations associated with PB19 infection vary greatly, depending on the infected individual's age and hematologic and immunologic status. The limited data available regarding consensus on screening algorithms and indications in donors and recipients prior to kidney transplantation makes diagnosis and management challenging. We presented 3 cases of pure red cell aplasia due to parvovirus B19 after kidney transplant. These patients were diagnosed with severe normocytic, normochromic anemia (hemoglobin below 60 g/L) in the 1st 6 months posttransplant. A complete anemia work-up revealed low reticulocyte count and was otherwise inconclusive. All patients were diagnosed with pure red cell aplasia due to parvovirus B19. Two patients improved after receiving intravenous immunoglobulin 2 gm/kg given over 4 doses. Unfortunately, they relapse after few weeks and required additional doses of intravenous immunoglobulin in conjugation with reduction of their immunosuppressive medication. The third patient improved after holding mycophenolate mofetil (MMF) and did not require intravenous immunoglobulin. Whereas PB19 infection is typically self-limiting and associated with positive IgM serology in immunocompetent hosts, these cases highlight the importance of considering PB19 infection in the differential diagnosis of persistent anemia in immunocompromised patients and the challenges in confirming the diagnosis. Intravenous immunoglobulin (IVIG) can be an effective treatment in immunocompromised patients with primary or relapsed PB19 infection in conjunction with minimizing immunosuppressive medication. Further research and consideration are required to determine appropriate and targeted screening in donors and recipients in the peritransplantation period.
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Vilibic-Cavlek T, Tabain I, Kolaric B, Mihulja K, Blazevic L, Bogdanic M, Navolan D, Beader N, Mrzljak A. Parvovirus B19 in Croatia: A Large-Scale Seroprevalence Study. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57111279. [PMID: 34833497 PMCID: PMC8617724 DOI: 10.3390/medicina57111279] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 02/07/2023]
Abstract
Background and Objectives: Seroepidemiological studies indicate that parvovirus B19 circulates in all areas of the world, although with some differences. The aim of this study is to analyze the seroprevalence of parvovirus B19 in the Croatian population. Materials and Methods: From 2010 to 2021, 1538 serum samples from different populations were tested for the presence of parvovirus B19 IgM/IgG antibodies. Serological tests were performed using a commercial enzyme-linked immunosorbent assay. Results: IgG antibodies were detected in 986/64.1% of participants with differences (p < 0.001) among the following population groups: 42.4% of children and adolescents, 67.1% of the adult general population, 66.7% of hemodialysis patients, and 65.6% of liver transplant recipients. Seroprevalence increased with age, from 30.0% in the 6 months-9 years age group to 69.0% in the 40-49 years age group, and remained stable thereafter (68.8-73.3%). There was no difference in the seropositivity among males (66.1%) and females (63.1%), as well as the place of residence (suburban/rural 63.9%, urban 64.1%). IgM antibodies (current/recent infection) were found in 61/4.0% of participants with the highest seropositivity in the youngest age group (11.1%). In pregnant women, seroprevalence was higher in women with an unfavorable obstetric history compared with a normal pregnancy (IgG 71.0% vs. 62.6%; IgM 6.5% vs. 2.4%), but these differences were not significant. Logistic regression showed that the adult population had almost three times higher risk of IgG seropositivity compared to children/adolescents (general population OR = 2.777, 95% CI = 2.023-3.812; hemodialysis patients OR = 2.586, 95% CI = 1.531-4.367; and transplant patients OR = 2.717, 95% CI = 1.604-4.603). A one-year increase in age increased the risk of IgG seroprevalence (OR = 1.017; 95% CI = 1.011-1.022). Conclusions: Older age was the main risk factor for IgG seropositivity. Hemodialysis and organ transplantation seem unrelated to the increased parvovirus B19 seroprevalence. The role of parvovirus B19 in the etiology of TORCH infections needs to be studied further.
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Affiliation(s)
- Tatjana Vilibic-Cavlek
- Department of Virology, Croatian Institute of Public Health, 10000 Zagreb, Croatia; (I.T.); (M.B.)
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia; (N.B.); (A.M.)
- Correspondence: ; Tel.: +385-1-4863-238
| | - Irena Tabain
- Department of Virology, Croatian Institute of Public Health, 10000 Zagreb, Croatia; (I.T.); (M.B.)
| | - Branko Kolaric
- Department of Public Health Gerontology, Andrija Stampar Teaching Institute of Public Health, 10000 Zagreb, Croatia;
- Department of Epidemiology, Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia
| | - Klara Mihulja
- Zagreb County Family Medicine Division, 10380 Sveti Ivan Zelina, Croatia;
| | - Lana Blazevic
- Department of Epidemiology, Croatian Institute of Public Health, 10000 Zagreb, Croatia;
| | - Maja Bogdanic
- Department of Virology, Croatian Institute of Public Health, 10000 Zagreb, Croatia; (I.T.); (M.B.)
| | - Dan Navolan
- Department of Obstetrics-Gynecology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Natasa Beader
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia; (N.B.); (A.M.)
- Department of Clinical and Molecular Microbiology, University Hospital Center, 10000 Zagreb, Croatia
| | - Anna Mrzljak
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia; (N.B.); (A.M.)
- Department of Gastroenterology and Hepatology, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
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Yu Y, Wei C, Lyu J, Wu X, Wang R, Huang H, Wu J, Chen J, Peng W. Donor-Derived Human Parvovirus B19 Infection in Kidney Transplantation. Front Cell Infect Microbiol 2021; 11:753970. [PMID: 34722340 PMCID: PMC8554309 DOI: 10.3389/fcimb.2021.753970] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 09/23/2021] [Indexed: 12/22/2022] Open
Abstract
Background Donor-derived human parvovirus B19 (B19V) infections are rarely reported. Thus, its incidence in kidney transplantation is still unknown due to lack of surveillance studies. Similarly, whether the donor needs to be routinely screened for B19V and whether the kidneys from those with B19V DNAemia could be accepted also remain unknown. Methods This retrospective study aims to evaluate the donor-derived B19V infections occurring in 823 living and 1,225 deceased donor kidney transplantations from January 2016 to December 2020. The serum viral load of living donors and their corresponding recipients was evaluated before and after transplantation. Meanwhile, for the deceased donor kidney transplantation, the serum viral load of recipients was only tested after transplantation; if recipients of a deceased donor subsequently developed B19V infection, the serum viral load of recipients and their corresponding donors before transplantation would then be further traced. Results A total of 15 living donors were B19V DNAemia positive before the donation, of which B19V DNAemia occurred in three corresponding recipients. In deceased donor kidney transplantation, DNAemia occurred simultaneously in 18 recipients and their corresponding nine donors. A progressive decline in hemoglobin and reticulocyte count could be observed in one living donor recipient and other 11 deceased donor recipients, which were all well controlled by treatment eventually. Conclusion The incidence of donor-derived B19V infection was 0.4% and 1.5% in living and deceased kidney transplantations, respectively. B19V was seemingly unnecessary to be routinely screened for the donor. Moreover, kidneys of the donors with B19V infection were acceptable.
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Affiliation(s)
- Yedong Yu
- Kidney Disease Center, the First Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Chunchun Wei
- Kidney Disease Center, the First Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China.,Kidney Disease Immunology Laboratory, State Administration of Traditional Chinese Medicine of China, Hangzhou, China.,Key Laboratory of Multiple Organ Transplantation, Ministry of Health of China, Hangzhou, China.,Institute of Nephrology, Zhejiang University, Hangzhou, China.,Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, Hangzhou, China
| | - Junhao Lyu
- Kidney Disease Center, the First Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China.,Kidney Disease Immunology Laboratory, State Administration of Traditional Chinese Medicine of China, Hangzhou, China.,Key Laboratory of Multiple Organ Transplantation, Ministry of Health of China, Hangzhou, China.,Institute of Nephrology, Zhejiang University, Hangzhou, China.,Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, Hangzhou, China
| | - Xiaoliang Wu
- Department of Intensive Care Medicine, the First Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Rending Wang
- Kidney Disease Center, the First Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China.,Kidney Disease Immunology Laboratory, State Administration of Traditional Chinese Medicine of China, Hangzhou, China.,Key Laboratory of Multiple Organ Transplantation, Ministry of Health of China, Hangzhou, China.,Institute of Nephrology, Zhejiang University, Hangzhou, China.,Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, Hangzhou, China
| | - Hongfeng Huang
- Kidney Disease Center, the First Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China.,Kidney Disease Immunology Laboratory, State Administration of Traditional Chinese Medicine of China, Hangzhou, China.,Key Laboratory of Multiple Organ Transplantation, Ministry of Health of China, Hangzhou, China.,Institute of Nephrology, Zhejiang University, Hangzhou, China.,Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, Hangzhou, China
| | - Jianyong Wu
- Kidney Disease Center, the First Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China.,Kidney Disease Immunology Laboratory, State Administration of Traditional Chinese Medicine of China, Hangzhou, China.,Key Laboratory of Multiple Organ Transplantation, Ministry of Health of China, Hangzhou, China.,Institute of Nephrology, Zhejiang University, Hangzhou, China.,Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, Hangzhou, China
| | - Jianghua Chen
- Kidney Disease Center, the First Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China.,Kidney Disease Immunology Laboratory, State Administration of Traditional Chinese Medicine of China, Hangzhou, China.,Key Laboratory of Multiple Organ Transplantation, Ministry of Health of China, Hangzhou, China.,Institute of Nephrology, Zhejiang University, Hangzhou, China.,Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, Hangzhou, China
| | - Wenhan Peng
- Kidney Disease Center, the First Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China.,Kidney Disease Immunology Laboratory, State Administration of Traditional Chinese Medicine of China, Hangzhou, China.,Key Laboratory of Multiple Organ Transplantation, Ministry of Health of China, Hangzhou, China.,Institute of Nephrology, Zhejiang University, Hangzhou, China.,Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, Hangzhou, China
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Zhang LY, Liu F, Chen X, Zhang XY, Ren YY, Zhang RR, Yang WY, Guo Y. [The hematological diversity of human parvovirus B19 infection after allo-hematopoietic stem cell transplantation in pediatric patients]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2021; 42:654-659. [PMID: 34547871 PMCID: PMC8501274 DOI: 10.3760/cma.j.issn.0253-2727.2021.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
目的 探讨异基因造血干细胞移植（allo-HSCT）患儿造血重建后人类细小病毒B19（HPV-B19）感染的血液学表现。 方法 对9例allo-HSCT后合并HPV-B19感染的患儿进行回顾性分析。 结果 9例患儿占同期接受allo-HSCT患儿的8.04％（9/112），男8例，女1例，中位年龄9（3～13）岁，均采取清髓性预处理方案。HPV-B19感染中位时间为移植后61（36～114）d。allo-HSCT并发HPV-B19感染患儿血液学表现具有异质性，9例患儿以血红蛋白伴网织红细胞下降为主要特点，7 d内网织红细胞比例、绝对值下降幅度中位数分别为90.4％（24.7％～98.7％）、90.7％（18.6％～99.0％）。除常见红系造血停滞表现外，allo-HSCT后合并HPV-B19感染的患儿还具有非红系的血象及骨髓变化：5例患儿外周血出现中性粒细胞下降，但骨髓涂片未见粒系增生受抑；6例患儿骨髓涂片查见巨核系增生减低，其中5例患儿外周血血小板下降。同时，allo-HSCT造血重建后合并HPV-B19感染的患儿骨髓红系受抑并非必要表现，9例患儿虽然均出现血红蛋白下降，但仅5例患儿骨髓红系增生减低。 结论 血液病患儿allo-HSCT造血重建后合并HPV-B19感染的血液学表现具有异质性，血红蛋白伴网织红细胞下降对HPV-B19感染早期诊断可能具有重要意义。
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Affiliation(s)
- L Y Zhang
- State Key Laboratory of Experimental Hematology; National Clinical Research Center for Blood Diseases; Children's Blood Disease Diagnosis and Treatment Center, Institute of Hematology & Blood Disease Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
| | - F Liu
- State Key Laboratory of Experimental Hematology; National Clinical Research Center for Blood Diseases; Children's Blood Disease Diagnosis and Treatment Center, Institute of Hematology & Blood Disease Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
| | - X Chen
- State Key Laboratory of Experimental Hematology; National Clinical Research Center for Blood Diseases; Children's Blood Disease Diagnosis and Treatment Center, Institute of Hematology & Blood Disease Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
| | - X Y Zhang
- State Key Laboratory of Experimental Hematology; National Clinical Research Center for Blood Diseases; Children's Blood Disease Diagnosis and Treatment Center, Institute of Hematology & Blood Disease Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
| | - Y Y Ren
- State Key Laboratory of Experimental Hematology; National Clinical Research Center for Blood Diseases; Children's Blood Disease Diagnosis and Treatment Center, Institute of Hematology & Blood Disease Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
| | - R R Zhang
- State Key Laboratory of Experimental Hematology; National Clinical Research Center for Blood Diseases; Children's Blood Disease Diagnosis and Treatment Center, Institute of Hematology & Blood Disease Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
| | - W Y Yang
- State Key Laboratory of Experimental Hematology; National Clinical Research Center for Blood Diseases; Children's Blood Disease Diagnosis and Treatment Center, Institute of Hematology & Blood Disease Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
| | - Y Guo
- State Key Laboratory of Experimental Hematology; National Clinical Research Center for Blood Diseases; Children's Blood Disease Diagnosis and Treatment Center, Institute of Hematology & Blood Disease Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
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Yu Y, Bao R, Lyu J, Wu J, Chen J, Peng W. Foscarnet Therapy for Pure Red Cell Aplasia Related to Human Parvovirus B19 Infection in Kidney Transplant Recipients: A Preliminary Exploration. Infect Drug Resist 2021; 14:2911-2923. [PMID: 34349526 PMCID: PMC8326942 DOI: 10.2147/idr.s321936] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 07/21/2021] [Indexed: 12/22/2022] Open
Abstract
Background Parvovirus B19-associated pure red cell aplasia (PVB19-PRCA) is an uncommon but serious complication after kidney transplantation. Currently, intravenous immunoglobulin (IVIG) is preferred as the first-line treatment for PVB19-PRCA, but presents with disadvantages of disease recurrence and expensive cost. In this context, we propose that foscarnet therapy for kidney transplantation recipients (KTR) with PVB19-PRCA may be an alternative scenario. No related study has been reported, and we performed this study to assess the efficacy and safety of foscarnet for PVB19-associated PRCA in KTR. Methods We conducted a retrospective review of PVB19-PRCA in KTR at our center over 9-year period. The data on therapy and outcomes in all cases treated with foscarnet are detailed records and summarized. Results Among our 68 patients, PVB19-PRCA was confirmed in 50 based on inclusion/exclusion criteria. All patients presented with refractory anemia and low reticulocyte percentage (<0.5%), the mean hemoglobin of patients was 79.8±12.6g/L at the time of PVB19-PRCA was identified. The median serum genome copy number of parvovirus B19 at diagnosis was 9.6 log10 copies per milliliter. A total of 11 patients received foscarnet therapy, of 10 patients responded well to the treatment and maintained no recurrence. But 1 patient had a poor response to foscarnet therapy. Except for this patient, the mean hemoglobin level gradually increased from 68.5±9.3 g/L to 73.2±8.8 g/L, and the mean percentage of reticulocytes steadily increased from 0.1±0.0% to 7.6±2.9% after foscarnet therapy. The median serum genome copy number of parvovirus B19 decreased from 9.8 log10 to 6.1 log10 copies per milliliter. There was no significant difference (P=0.61, 0.60) in serum creatinine and glomerular filtration rate before and after foscarnet treatment. At the latest follow-up, the mean hemoglobin was 131.5±12.5 g/L and the hemoglobin correction occurred in all patients. Conclusion Foscarnet therapy doesn't seem to be worse than IVIG for PVB19-PRCA in KTR, and it can be an alternative option.
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Affiliation(s)
- Yedong Yu
- Department of Kidney Disease Center, The First Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Ruijie Bao
- Department of Kidney Disease Center, The First Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Junhao Lyu
- Department of Kidney Disease Center, The First Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, People's Republic of China.,Department of Kidney Disease Immunology Laboratory, State Administration of Traditional Chinese Medicine of China, Hangzhou, People's Republic of China.,Department of Key Laboratory of Multiple Organ Transplantation, Ministry of Health of China, Hangzhou, People's Republic of China.,Institute of Nephropathy, Zhejiang University, Hangzhou, People's Republic of China
| | - Jianyong Wu
- Department of Kidney Disease Center, The First Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, People's Republic of China.,Department of Kidney Disease Immunology Laboratory, State Administration of Traditional Chinese Medicine of China, Hangzhou, People's Republic of China.,Department of Key Laboratory of Multiple Organ Transplantation, Ministry of Health of China, Hangzhou, People's Republic of China.,Institute of Nephropathy, Zhejiang University, Hangzhou, People's Republic of China
| | - Jianghua Chen
- Department of Kidney Disease Center, The First Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, People's Republic of China.,Department of Kidney Disease Immunology Laboratory, State Administration of Traditional Chinese Medicine of China, Hangzhou, People's Republic of China.,Department of Key Laboratory of Multiple Organ Transplantation, Ministry of Health of China, Hangzhou, People's Republic of China.,Institute of Nephropathy, Zhejiang University, Hangzhou, People's Republic of China
| | - Wenhan Peng
- Department of Kidney Disease Center, The First Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, People's Republic of China.,Department of Kidney Disease Immunology Laboratory, State Administration of Traditional Chinese Medicine of China, Hangzhou, People's Republic of China.,Department of Key Laboratory of Multiple Organ Transplantation, Ministry of Health of China, Hangzhou, People's Republic of China.,Institute of Nephropathy, Zhejiang University, Hangzhou, People's Republic of China
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36
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Parvovirus: Uncommon Causes of Anemia and Kidney Failure in a Kidney Transplant Patient. Nephrourol Mon 2021. [DOI: 10.5812/numonthly.112713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
: Parvovirus is one of the uncommon causes of anemia in a kidney transplant patient. We reported a kidney transplant patient with parvovirus infection who developed severe anemia three weeks after kidney transplantation. Suspicion of infections increased due to the decrease in erythrocyte level. The patient's anemia became normal with a decrease in the amount of immunosuppressant and treatment with intravenous immunoglobulin (IVIG). Parvovirus B19 infection should be considered in all patients with persistent anemia with or without graft failure after renal transplant.
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Večerić-Haler Ž, Kojc N, Sever M, Zver S, Švajger U, Poženel P, Hartman K, Urdih T, Mlinšek G, Oblak M, Aleš Rigler A, Ihan A, Buturović Ponikvar J, Halloran PP, Arnol M. Case Report: Capillary Leak Syndrome With Kidney Transplant Failure Following Autologous Mesenchymal Stem Cell Therapy. Front Med (Lausanne) 2021; 8:708744. [PMID: 34368198 PMCID: PMC8334176 DOI: 10.3389/fmed.2021.708744] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 06/24/2021] [Indexed: 12/12/2022] Open
Abstract
Mesenchymal stem cells (MSCs) have attracted great interest in the field of kidney transplantation due to their immunomodulatory and reparative properties. In registered clinical trials, MSCs have been used before, at the time of, or early after transplantation and have been reported to be well-tolerated with no serious safety concerns. No results are available on the use of MSCs in the late post-transplant period. Here, we present a case report of a severe systemic complication mimicking capillary leak syndrome with ultimate kidney transplant failure after autologous transplantation of MSCs used as rescue treatment of late antibody-mediated kidney allograft rejection.
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Affiliation(s)
- Željka Večerić-Haler
- Department of Nephrology, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Nika Kojc
- Institute of Pathology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Matjaž Sever
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.,Department of Haematology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Samo Zver
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.,Department of Haematology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Urban Švajger
- Division for Cells and Tissue, Blood Transfusion Centre of Slovenia, Ljubljana, Slovenia
| | - Primož Poženel
- Division for Cells and Tissue, Blood Transfusion Centre of Slovenia, Ljubljana, Slovenia
| | - Katrina Hartman
- Division for Cells and Tissue, Blood Transfusion Centre of Slovenia, Ljubljana, Slovenia
| | - Tereza Urdih
- Department of Haematology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Gregor Mlinšek
- Department of Nephrology, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Manca Oblak
- Department of Nephrology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Andreja Aleš Rigler
- Department of Nephrology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Alojz Ihan
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Jadranka Buturović Ponikvar
- Department of Nephrology, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Philip P Halloran
- Division of Nephrology and Transplant Immunology, University of Alberta, Alberta Transplant Applied Genomics Centre, Edmonton, AB, Canada
| | - Miha Arnol
- Department of Nephrology, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Russcher A, Verdonschot J, Molenaar-de Backer MWA, Heymans SRB, Kroes ACM, Zaaijer HL. Parvovirus B19 DNA detectable in hearts of patients with dilated cardiomyopathy, but absent or inactive in blood. ESC Heart Fail 2021; 8:2723-2730. [PMID: 33931945 PMCID: PMC8318422 DOI: 10.1002/ehf2.13341] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 03/24/2021] [Accepted: 03/26/2021] [Indexed: 01/14/2023] Open
Abstract
Aims Parvovirus B19 (B19V) is often assumed to be a cause of dilated cardiomyopathy (DCM), based on the quantification of B19V DNA in endomyocardial biopsies (EMB). Whether the presence of B19V DNA correlates with active infection is still debated. Application of the enzyme endonuclease to blood samples results in degradation of B19V DNA remnants but leaves viral particles intact, which enables differentiation between active and past infection. In this study, the susceptibility to degradation by endonuclease of B19V DNA in blood was compared between DCM patients and a control group of recent B19V infections. Methods and results Twenty blood samples from 20 adult patients with DCM, who previously tested positive for B19V DNA in EMB and/or blood, were tested with B19V PCR before and after application of endonuclease to the samples. Six blood samples tested positive for B19V DNA with a mean viral load of 2.3 × 104 IU/mL. In five samples, B19V DNA became undetectable after endonuclease (100% load reduction); in one sample DNA load showed a 23% log load reduction (viral load before endonuclease: 9.1 × 104 IU/mL; after: 6.5 × 103 IU/mL). Presence of cardiac inflammation did not differ between patients with B19V DNAemia (1/4) and patients without B19V DNAemia (6/14) (P value = 1.0). In all 18 control samples of proven recent B19V infections, DNA remained detectable after application of endonuclease, showing only a mean log load reduction of 2.3% (mean viral load before endonuclease: 8.1 × 1011 IU/mL; after: 8.0 × 1011 IU/mL). Load reduction differed significantly between the DCM group and the control group; indicating the presence of intact viral particles in the control group with proven active infection and the presence of DNA remnants in the DCM group (P value = 0.000). Conclusion During recent B19V infection, viral DNA levels in blood were unaffected by endonuclease. In contrast, B19V DNA in blood in patients with DCM became undetectable or strongly reduced after application of endonuclease. Circulating viral DNA in this subset of patients with presumed parvovirus‐associated DCM does not consist of intact viral particles. Viral replicative activity cannot be assumed from demonstrating B19V DNA in cardiac tissue or in blood in DCM patients.
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Affiliation(s)
- Anne Russcher
- Department of Medical Microbiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, E4P 9600, Leiden, 2300 RC, The Netherlands
| | - Job Verdonschot
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Marijke W A Molenaar-de Backer
- Department of Blood-borne Infections, Donor Medicine Research, Sanquin Blood Supply Foundation, Amsterdam, The Netherlands
| | - Stephane R B Heymans
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Aloys C M Kroes
- Department of Medical Microbiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, E4P 9600, Leiden, 2300 RC, The Netherlands
| | - Hans L Zaaijer
- Department of Blood-borne Infections, Donor Medicine Research, Sanquin Blood Supply Foundation, Amsterdam, The Netherlands
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Rattani N, Matheny C, Eckrich MJ, Madden LM, Quigg TC. Parvovirus B19-associated graft failure after allogeneic hematopoietic stem cell transplantation. Cancer Rep (Hoboken) 2021; 5:e1403. [PMID: 33932151 PMCID: PMC8789606 DOI: 10.1002/cnr2.1403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/25/2021] [Accepted: 03/30/2021] [Indexed: 01/06/2023] Open
Abstract
Background Parvovirus B19 (PVB19) infection has been implicated in allograft failure or dysfunction in solid organ transplantation (SOT) and allogeneic hematopoietic stem cell transplantation (allo‐HSCT), but the literature is limited. Case Two pediatric patients were diagnosed with PVB19 infection around the time of allo‐HSCT graft failure. Both cases were secondary graft failure and required second allo‐HSCT. Conclusion There are many risk factors and potential confounders in determining the exact etiology of graft failure after allo‐HSCT. These two cases highlight the importance of including PVB19 in the diagnostic evaluation for graft failure. PVB19 infection may be an important risk factor for allo‐HSCT graft failure.
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Affiliation(s)
- Nabila Rattani
- Pediatric Blood and Marrow Transplantation Program, Texas Transplant Institute, Methodist Children's Hospital, San Antonio, Texas, USA
| | - Christina Matheny
- Pediatric Blood and Marrow Transplantation Program, Texas Transplant Institute, Methodist Children's Hospital, San Antonio, Texas, USA
| | - Michael J Eckrich
- Pediatric Blood and Marrow Transplantation Program, Texas Transplant Institute, Methodist Children's Hospital, San Antonio, Texas, USA
| | - Lisa M Madden
- Pediatric Blood and Marrow Transplantation Program, Texas Transplant Institute, Methodist Children's Hospital, San Antonio, Texas, USA
| | - Troy C Quigg
- Pediatric Blood and Marrow Transplantation Program, Texas Transplant Institute, Methodist Children's Hospital, San Antonio, Texas, USA
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40
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Wang H, Fu YX, Song WL, Wang Z, Feng G, Zhao J, Nian YQ, Cao Y. Human parvovirus B19-associated early postoperative acquired pure red cell aplasia in simultaneous pancreas-kidney transplantation: A case report. World J Clin Cases 2021; 9:1968-1975. [PMID: 33748248 PMCID: PMC7953402 DOI: 10.12998/wjcc.v9.i8.1968] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 12/30/2020] [Accepted: 01/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Acquired pure red cell aplasia (aPRCA) related to human parvovirus B19 (HPV B19) is rarely reported in simultaneous pancreas-kidney transplantation (SPKT) recipients; there has yet to be a case report of early postoperative infection. In this current study, we report the case of a Chinese patient who experienced the disease in the early postoperative period.
CASE SUMMARY A 63-year-old man, with type 2 diabetes and end-stage renal disease, received a brain dead donor-derived SPKT. Immunosuppression treatment consisted of tacrolimus, prednisone, enteric-coated mycophenolate sodium (EC-MPS), and thymoglobulin combined with methylprednisolone as induction. The hemoglobin (Hb) level declined due to melena at postoperative day (POD) 3, erythropoietin-resistant anemia persisted, and reticulocytopenia was diagnosed at POD 20. The bone marrow aspirate showed decreased erythropoiesis and the presence of giant pronormoblasts at POD 43. Metagenomic next-generation sequencing (mNGS) of a blood sample identified HPV B19 infection at POD 66. EC-MPS was withdrawn; three cycles of intravenous immunoglobulin (IVIG) infusion therapy were administered; and tacrolimus was switched to cyclosporine. The HPV B19-associated aPRCA resolved completely and did not relapse within the 1-year follow-up period. The diminution in mNGS reads was correlated with Hb and reticulocyte count improvements.
CONCLUSION HPV B19-associated aPRCA can occur at an early period after SPKT. An effective therapy regimen includes IVIG infusion and adjustment of the immuno-suppressive regimen. Moreover, mNGS can be used for the diagnosis and to reflect disease progression.
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Affiliation(s)
- Hui Wang
- Department of Kidney and Pancreas Transplant, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin 300192, China
| | - Ying-Xin Fu
- Department of Kidney and Pancreas Transplant, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin 300192, China
| | - Wen-Li Song
- Department of Kidney and Pancreas Transplant, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin 300192, China
| | - Zhen Wang
- Department of Kidney and Pancreas Transplant, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin 300192, China
| | - Gang Feng
- Department of Kidney and Pancreas Transplant, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin 300192, China
| | - Jie Zhao
- Department of Kidney and Pancreas Transplant, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin 300192, China
| | - Ye-Qi Nian
- Department of Kidney and Pancreas Transplant, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin 300192, China
| | - Yu Cao
- Department of Kidney and Pancreas Transplant, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin 300192, China
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Abstract
Parvovirus B19 infection is s new viral threat in post-kidney transplantation. It is a viral infection often acquired from the donor, occurring in young transplant patients during the first post-kidney transplantation months, and with a non-specific clinico-biological picture. The hallmark symptom is regenerative anaemia which may be severe, requiring blood transfusion. The C3 and C4 complement fractions are reduced and constitute an early and inexpensive diagnostic marker. Diagnosis is often delayed due to the non-specific clinico-biological picture. However, severe anaemia and hypocomplementemia are early and suggestive signs of parvovirus B19 infection. Levels of parvovirus B19 DNA, as determined by real time-polymerase chain reaction (RT-PCR), are often very high and tend to decrease slowly over several months. Treatment is based on adaptive reduction of immunosuppression, adequate in the forms with few symptoms, discontinuation of antiproliferative agents, or a switch to other molecules associated with intravenous immunoglobulins in the severe and highly symptomatic forms. Screening for other concomitant viral infections, particularly for cytomegalovirus, Epstein Barr virus, and BK virus is systematic. Relapses are quite frequent during the first-year post-transplantation. Clinical-biological follow-up aims to detect any recurrence of the parvovirus B19 infection, the occurrence of parvovirus B19-related glomerulopathy, and acute rejection. Parvovirus B19 infection is a new viral threat in post-kidney transplantation and requires broader and/or randomised studies to better establish the diagnostic and therapeutic approach.
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Affiliation(s)
- Yassamine Bentata
- Nephrology, Dialysis, and Kidney Transplantation Unit, University Hospital Mohammed VI, Oujda, University Mohammed First, Oujda, Morocco.,Laboratory of Epidemiology, Clinical Research, and Public Health, Medical School, University Mohammed Premier, Oujda, Morocco
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42
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Schröder C, Roeles J, Schwarzer A, Heuser M, Retzlaff J, Hiß M. [Treatment-refractory anaemia in a 35-year-old heart transplant recipient on chronic hemodialysis]. Internist (Berl) 2021; 62:768-771. [PMID: 33580307 PMCID: PMC8260535 DOI: 10.1007/s00108-021-00955-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2021] [Indexed: 11/25/2022]
Abstract
Es wird über einen 35-jährigen Dialysepatienten nach Herztransplantation berichtet, der eine „pure red cell aplasia“ aufwies. Serologisch fand sich ein positiver Parvovirus-B19-Immunglobulin-M-Titer, im Direktnachweis mittels Polymerase-Kettenreaktion zeigten sich 80 Mrd. IU/ml. In der zytologischen Untersuchung des Knochenmarks gelang der Nachweis von Riesenproerythroblasten, pathognomonisch für eine Parvovirus-B19-Infektion. Zur Therapie erfolgte die hoch dosierte Gabe von Immunglobulinen über 5 Tage. Bei Wiedervorstellung nach vier Wochen zeigte sich die Anämie deutlich gebessert. Bei Patienten nach Organtransplantation mit hyporegenerativer Anämie sollte eine Parvovirus-B19-Infektion stets ausgeschlossen werden.
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Affiliation(s)
- Christoph Schröder
- Klinik für Nieren- und Hochdruckerkrankungen, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland.
| | - Johannes Roeles
- Klinik für Nieren- und Hochdruckerkrankungen, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland
| | - Adrian Schwarzer
- Klinik für Hämatologie, Hämostaseologie, Onkologie und Stammzelltransplantation, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Michael Heuser
- Klinik für Hämatologie, Hämostaseologie, Onkologie und Stammzelltransplantation, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Jennifer Retzlaff
- Klinik für Nieren- und Hochdruckerkrankungen, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland
| | - Marcus Hiß
- Klinik für Nieren- und Hochdruckerkrankungen, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland
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Rezahosseini O, Ekenberg C, Møller DL, Sørensen SS, Wareham NE, Perch M, Gustafsson F, Rasmussen A, Kirkby N, Reekie J, Lundgren J, Nielsen SD. Incidence and impact of parvovirus B19 infection in seronegative solid organ transplant recipients. J Infect Dis 2021; 224:865-869. [PMID: 33458766 DOI: 10.1093/infdis/jiab024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 01/13/2021] [Indexed: 12/22/2022] Open
Abstract
Routine monitoring of Parvovirus B19 (B19V) the first six months post-transplantation was performed in 241 seronegative solid organ transplant (SOT) recipients. Incidence rates (IR) during the 1st month and the 2nd to 6th months post-transplantation were 1.2 (95% CI, 0.33-3.2) and 0.21 (95% CI, 0.06-0.57) per 100 recipients per-month, respectively. Of the 6 SOT recipients with positive B19V PCR, 3 (50%) were admitted to hospital and 2 (33%) were treated with intravenous immunoglobulin. Thus, routine monitoring of B19V in seronegative SOT recipients may not be necessary. Targeted screening one-month post-transplantation and screening upon clinical suspicion could be an alternative strategy.
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Affiliation(s)
- Omid Rezahosseini
- Viro-immunology Research Unit, Department of Infectious Diseases 8632, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Christina Ekenberg
- Centre of Excellence for Health, Immunity, and Infections, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Dina Leth Møller
- Viro-immunology Research Unit, Department of Infectious Diseases 8632, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Søren Schwartz Sørensen
- Department of Nephrology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Neval Ete Wareham
- Centre of Excellence for Health, Immunity, and Infections, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Michael Perch
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Cardiology, Section for Lung Transplantation, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Finn Gustafsson
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Allan Rasmussen
- Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Nikolai Kirkby
- Department of Clinical Microbiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Joanne Reekie
- Centre of Excellence for Health, Immunity, and Infections, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jens Lundgren
- Centre of Excellence for Health, Immunity, and Infections, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Susanne Dam Nielsen
- Viro-immunology Research Unit, Department of Infectious Diseases 8632, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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44
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Fuji S. Parvovirus B19 as a Possible Cause of Skin Rash after Allogeneic Transplantation? Acta Haematol 2020; 144:122-123. [PMID: 33348335 DOI: 10.1159/000510155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 07/11/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Shigeo Fuji
- Department of Hematology, Osaka International Cancer Institute, Osaka, Japan,
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45
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Heng WL, Wang QW, Sornarajah R, Tremblay J, Putri NM, Hamid SSA, Pungrasmi P, Wang HJ, Kim DC, Saito D, Nguyen NL, Sulaiman WAW, Wardhana A, Puri V, Matsumura H, Dai NT, Ahuja RB, Luo G, He W, Chong SJ, Chua AWC. A Review of Skin Banking Guidelines and Standards Worldwide: Towards the Harmonization of Guidelines for Skin Banking in Therapeutic Applications for the Regions under the Asia Pacific Burn Association (APBA). BURNS & TRAUMA 2020; 8:tkaa019. [PMID: 33123605 PMCID: PMC7573737 DOI: 10.1093/burnst/tkaa019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 02/16/2020] [Indexed: 11/14/2022]
Abstract
Currently, there are no harmonized guidelines which govern skin banking in the Asia Pacific region. Therefore, skin banks are either unregulated or rely on their nation's legislation or international accreditation to uphold their quality standards. A new set of skin banking guidelines was developed through a comprehensive review and collation of best international practices for the Asia Pacific Burn Association (APBA) members, from donor screening and testing, to skin recovery, processing, storage and distribution, and quality assurance. National regulatory requirements reviewed include the European directives, Australia's Therapeutic Goods Administration and Singapore's tissue banking standards. Further technical and quality management recommendations are referenced from the American Association of Tissue Banks (AATB), the United States Food and Drug Administration standards and guidance documents, various relevant European guides, Japanese Society of Tissue Transplantation guidelines and the Asia Pacific Association of Surgical Tissue Banking. Adapted mainly from the AATB standards, the new Asia Pacific Burn Association Guidelines for Skin Banking in Therapeutic Applications offer a comprehensive manual, addressing: governance and contracts; staff responsibilities; quality management; facilities, equipment and supplies management; donor consent and testing; and recommendations of good practices pertaining to skin recovery, processing, storage and distribution. Besides complementing current generic regulations, they provide technical specifications of major aspects unaddressed in most legislations. This inaugural set of new regional skin banking guidelines would be a start for regional members of the APBA to adopt, and will hopefully culminate in a set of standards so that, in the long run, skin allografts from this region can be of similar quality, which can simplify import process and facilitate the exchange of allografts between members.
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Affiliation(s)
- Wee Ling Heng
- Transplant Tissue Centre, Singhealth Duke-NUS Transplant Centre, Singapore
| | - Qi Wei Wang
- Transplant Tissue Centre, Singhealth Duke-NUS Transplant Centre, Singapore
| | - Renuka Sornarajah
- Heart Valve and Tissue Bank, Lady Ridgeway Hospital for Children, Dr Danister De Silva Mawatha, Colombo, Sri Lanka
| | | | - Nandita Melati Putri
- Burn Unit, Faculty of Medicine, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Suzina Sheikh Ab Hamid
- Otorhinolaryngology-Head and Neck Surgery, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Pornthep Pungrasmi
- Plastic and Reconstructive Surgery Division, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Hsian-Jenn Wang
- Plastic and Reconstructive Surgery, Taipei Medical University, Taipei, Chinese Taipei
| | - Dong Chul Kim
- Plastic and Reconstructive Surgery, Bundang Jesaeng Hospital, Seongnam, South Korea
| | - Daizo Saito
- Division of Traumatology, Research Institute, National Defence Medical College, Saitama, Japan
| | | | - Wan Azman Wan Sulaiman
- Reconstructive Sciences Programme, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Aditya Wardhana
- Burn Unit, Faculty of Medicine, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Vinita Puri
- Department of Plastic Surgery, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, India
| | - Hajime Matsumura
- Department of Plastic and Reconstructive Surgery, Tokyo Medical University, Tokyo, Japan
| | - Niann-Tzyy Dai
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei
| | - Rajeev B Ahuja
- Plastic and Aesthetic Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Gaoxing Luo
- Institute of Burn Research, Southwest Hospital, Army Medical University, Chongqing, China
| | - Weifeng He
- Institute of Burn Research, Southwest Hospital, Army Medical University, Chongqing, China
| | - Si Jack Chong
- Transplant Tissue Centre, Singhealth Duke-NUS Transplant Centre, Singapore
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore
| | - Alvin Wen Choong Chua
- Transplant Tissue Centre, Singhealth Duke-NUS Transplant Centre, Singapore
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore
- Musculoskeletal Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore
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46
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Gang S, Park S, Min SI, Hong J, Chang YH, Ha J, Yang J. Recurrent parvovirus B19 infection-associated pure red cell aplasia in a kidney transplant patient. KOREAN JOURNAL OF TRANSPLANTATION 2020; 34:199-203. [PMID: 35769066 PMCID: PMC9186813 DOI: 10.4285/kjt.2020.34.3.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 11/04/2022] Open
Affiliation(s)
- Sujin Gang
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
| | - Sooyong Park
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sang-il Min
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
- Transplantation Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Joonshik Hong
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Yoon Hwan Chang
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jongwon Ha
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
- Transplantation Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jaeseok Yang
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
- Transplantation Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Transplantation Center, Seoul National University Hospital, Seoul, Korea
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47
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Escobar-Sevilla J, Bustos Merlo A, Garcia Martínez C, Mediavilla Garcia JD. Severe Refractory Anaemia and Fever of Unknow Origin: Human Parvovirus B19 Reactivation. Eur J Case Rep Intern Med 2020; 7:001596. [PMID: 32908820 DOI: 10.12890/2020_001596] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 05/14/2020] [Indexed: 11/05/2022] Open
Abstract
Reactivation of human parvovirus B19 is exceptional and characteristic of immunosuppression, with anaemia being the predominant manifestation although pancytopenia and thrombotic microangiopathy may also occur. We describe a patient with a history of diffuse large B-cell lymphoma with pure erythrocyte aplasia due to reactivation of parvovirus B19, who was treated with corticosteroids and immunoglobulins. LEARNING POINTS Infection with human parvovirus B19 is identified by polymerase chain reaction (PCR) testing of blood and the presence of typical giant proerythroblasts in the bone marrow.Cytomegalovirus infection should be considered in immunosuppressed patients with fever and non-specific symptoms with haematological changes.The treatment of persistent infection in immunosuppressed patients is based on the administration of IV immunoglobulins at high doses.
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48
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Weber T, Schmidberger A, Ligeti K, Bauer M, Rosenwald A, Müller LP. Presence of Parvovirus B19 but Not Herpesvirus Genome in Acute Skin Rash after Allogeneic Stem Cell Transplantation Correlates with Outcome. Acta Haematol 2020; 144:202-211. [PMID: 32906131 DOI: 10.1159/000509739] [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: 03/03/2020] [Accepted: 06/20/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Skin rash is a first symptom of acute graft-versus-host disease (GvHD) after allogeneic stem cell transplantation (ASCT) but can also be caused by viruses. The relevance of virus DNA analyses in skin rash for diagnosis and clinical outcome is unknown. OBJECTIVES To record the frequencies of detection of herpes and parvovirus B19 (ParvoB19) DNA in skin rash within 100 days after ASCT and to analyze their relevance for diagnosis, clinical course, and non-relapse mortality (NRM). METHODS We retrospectively identified 55 patients with virus DNA analysis for CMV, EBV, HHV6, HHV8, HSV, VZV, or ParvoB19. We assessed the rate of virus DNA detection and studied associations with histological diagnosis, virus DNA from concomitantly analyzed blood, clinical presentation, exanthema treatment, and NRM. RESULTS CMV, EBV, HHV6, HHV8, HSV, VZV and ParvoB19 DNA were detected in 12.5, 11.8, 10, 0, 0, 2.9, and 26.7% of exanthemas. Histopathological diagnosis was not associated with virus polymerase chain reaction (PCR) results. Detection of CMV, EBV, or HHV6 DNA but not ParvoB19 in skin and blood was associated with PCR results (p = 0.016; p < 0.001; p = 0.067; p = n.a.). Detection of CMV, EBV, HHV6, or ParvoB19 DNA in the skin was not significantly associated with patient, ASCT, or GvHD characteristics. Detection of ParvoB19 but not herpes virus DNA was associated with less immunosuppressive treatment (p = 0.015) and lower NRM (p = 0.041). In multivariate analyses, detection of ParvoB19 was associated with a lower NRM. CONCLUSIONS Detection of ParvoB19 DNA in exanthema after ASCT might be associated with lower NRM.
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Affiliation(s)
- Thomas Weber
- Department of Hematology and Oncology, University Hospital Halle (Saale), Martin Luther University Halle-Wittenberg, Halle (Saale), Germany,
| | - Andreas Schmidberger
- Department of Hematology and Oncology, University Hospital Halle (Saale), Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Kinga Ligeti
- Department of Hematology and Oncology, University Hospital Halle (Saale), Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Marcus Bauer
- Institute of Pathology, University Hospital Halle (Saale), Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Andreas Rosenwald
- Institute of Pathology, University Hospital Würzburg, Würzburg, Germany
| | - Lutz P Müller
- Department of Hematology and Oncology, University Hospital Halle (Saale), Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
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49
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Inoue D, Oda T, Iwama S, Uchida T, Kojima T, Tomiyasu T, Yoshikawa N, Yamada M, Okihara M, Akashi I, Kihara Y, Konno O, Iwase M, Iwamoto H. Development of pure red cell aplasia by transmission and persistent infection of parvovirus B19 through a kidney allograft. Transpl Infect Dis 2020; 23:e13462. [PMID: 32897628 DOI: 10.1111/tid.13462] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 08/25/2020] [Accepted: 08/28/2020] [Indexed: 11/28/2022]
Abstract
We report a case of pure red cell aplasia (PRCA) caused by parvovirus B19 (PVB19) infection, which was transmitted through a kidney allograft. The patient underwent a living-donor kidney transplant from his wife at the age of 60. Despite successful engraftment with a normal creatinine level, he developed severe anemia that required frequent blood transfusions 2 months after transplantation. Renal anemia was unlikely as his serum erythropoietin level was extremely high. A bone marrow aspiration test demonstrated the existence of large proerythroblasts. Although anti-PVB19 IgM antibody levels were not increased, polymerase chain reaction (PCR) detected PVB19 DNA in his serum. Thus, he was diagnosed as having PRCA induced by PVB19 infection. PCR analysis of total DNA isolated from 0-hour biopsy sections showed the existence of PVB19 DNA. Furthermore, PVB19 proteins was detected on renal tubules of 0-hour allograft by immunoperoxidase staining. Thus, transmission of PVB19 through the allograft was confirmed. A single course of intravenous immunoglobulin (IVIG) therapy resulted in substantial improvement; however, the effect was limited, and severe anemia relapsed after 5-6 months. Several courses of IVIG with adjustment of immunosuppressive drugs resulted in long-term remission. Our case demonstrates that donor-transmitted PVB19 infection should be suspected in kidney transplant recipients who develop refractory anemia during the early post-operative phase.
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Affiliation(s)
- Dan Inoue
- Kidney Disease Center, Department of Nephrology and Blood Purification, Tokyo Medical University Hachioji Medical Center, Hachioji, Tokyo, Japan
| | - Takashi Oda
- Kidney Disease Center, Department of Nephrology and Blood Purification, Tokyo Medical University Hachioji Medical Center, Hachioji, Tokyo, Japan
| | - Sachiko Iwama
- Kidney Disease Center, Department of Nephrology and Blood Purification, Tokyo Medical University Hachioji Medical Center, Hachioji, Tokyo, Japan
| | - Takahiro Uchida
- Kidney Disease Center, Department of Nephrology and Blood Purification, Tokyo Medical University Hachioji Medical Center, Hachioji, Tokyo, Japan
| | - Tadasu Kojima
- Kidney Disease Center, Department of Nephrology and Blood Purification, Tokyo Medical University Hachioji Medical Center, Hachioji, Tokyo, Japan
| | - Tomohiro Tomiyasu
- Kidney Disease Center, Department of Nephrology and Blood Purification, Tokyo Medical University Hachioji Medical Center, Hachioji, Tokyo, Japan
| | - Noriko Yoshikawa
- Kidney Disease Center, Department of Nephrology and Blood Purification, Tokyo Medical University Hachioji Medical Center, Hachioji, Tokyo, Japan
| | - Muneharu Yamada
- Kidney Disease Center, Department of Nephrology and Blood Purification, Tokyo Medical University Hachioji Medical Center, Hachioji, Tokyo, Japan
| | - Masaaki Okihara
- Kidney Disease Center, Department of Kidney Surgery and Transplantation, Tokyo Medical University Hachioji Medical Center, Hachioji, Tokyo, Japan
| | - Isao Akashi
- Kidney Disease Center, Department of Kidney Surgery and Transplantation, Tokyo Medical University Hachioji Medical Center, Hachioji, Tokyo, Japan
| | - Yu Kihara
- Kidney Disease Center, Department of Kidney Surgery and Transplantation, Tokyo Medical University Hachioji Medical Center, Hachioji, Tokyo, Japan
| | - Osamu Konno
- Kidney Disease Center, Department of Kidney Surgery and Transplantation, Tokyo Medical University Hachioji Medical Center, Hachioji, Tokyo, Japan
| | - Makoto Iwase
- Department of Hematology, Tokyo Medical University Hachioji Medical Center, Hachioji, Tokyo, Japan
| | - Hitoshi Iwamoto
- Kidney Disease Center, Department of Kidney Surgery and Transplantation, Tokyo Medical University Hachioji Medical Center, Hachioji, Tokyo, Japan
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Beyond Cytomegalovirus and Epstein-Barr Virus: a Review of Viruses Composing the Blood Virome of Solid Organ Transplant and Hematopoietic Stem Cell Transplant Recipients. Clin Microbiol Rev 2020; 33:33/4/e00027-20. [PMID: 32847820 DOI: 10.1128/cmr.00027-20] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Viral primary infections and reactivations are common complications in patients after solid organ transplantation (SOT) and hematopoietic stem cell transplantation (HSCT) and are associated with high morbidity and mortality. Among these patients, viral infections are frequently associated with viremia. Beyond the usual well-known viruses that are part of the routine clinical management of transplant recipients, numerous other viral signatures or genomes can be identified in the blood of these patients. The identification of novel viral species and variants by metagenomic next-generation sequencing has opened up a new field of investigation and new paradigms. Thus, there is a need to thoroughly describe the state of knowledge in this field with a review of all viral infections that should be scrutinized in high-risk populations. Here, we review the eukaryotic DNA and RNA viruses identified in blood, plasma, or serum samples of pediatric and adult SOT/HSCT recipients and the prevalence of their detection, with a particular focus on recently identified viruses and those for which their potential association with disease remains to be investigated, such as members of the Polyomaviridae, Anelloviridae, Flaviviridae, and Astroviridae families. Current knowledge of the clinical significance of these viral infections with associated viremia among transplant recipients is also discussed. To ensure a comprehensive description in these two populations, individuals described as healthy (mostly blood donors) are considered for comparative purposes. The list of viruses that should be on the clinicians' radar is certainly incomplete and will expand, but the challenge is to identify those of possible clinical significance.
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