What are the clinical manifestations and management of parvovirus B19 (Parvovirus B19) infection in adults?

Clinical Manifestations and Management of Parvovirus B19 Infection in Adults

Parvovirus B19 infection in adults commonly presents with fever, peripheral symmetric polyarthralgia, and skin rash, with potential complications including hematologic abnormalities, autoimmune phenomena, and persistent infection in immunocompromised hosts. 1

Clinical Manifestations

Common Presentations

• Fever occurs in approximately 65% of adult patients with primary parvovirus B19 infection 1
• Peripheral and symmetrical polyarthritis/polyarthralgia affects about 60% of adults, predominantly in hands and feet, typically lasting 1-3 weeks but occasionally becoming protracted 2, 1
• Skin rash (erythema infectiosum) appears in approximately 58% of adult cases, sometimes presenting as a "slapped cheek" appearance or lupus-like eruption over the cheeks 2, 1

Hematologic Manifestations

• Transient aplastic crisis in patients with underlying hemolytic disorders (such as sickle cell disease) requiring prompt recognition and often red blood cell transfusions 3
• Abnormal laboratory values commonly include increased acute phase reactants (73%), thrombocytopenia (43%), lymphopenia (38%), and elevated liver enzymes (37%) 1
• Pure red cell aplasia and chronic anemia can develop in immunocompromised hosts due to persistent B19 infection 4

Autoimmune Phenomena

• Transient production of autoantibodies including antinuclear antibodies (19%), anti-DNA (28%), anti-phospholipids (14%), and hypocomplementemia (32%) 1
• Rheumatoid factors may be produced transiently, and acute B19 infection can simulate early rheumatoid arthritis or systemic lupus erythematosus 2
• Various vasculitides affecting small, medium, and large vessels have been reported following B19 infection, though causal relationship is often difficult to establish 2

Rare Manifestations

• Neurological manifestations including cranial nerve palsy and distal paresthesia 1
• Myocarditis and potential association with dilated cardiomyopathy 1, 5
• Hepatitis with cholestatic features, particularly in immunocompromised patients 6

Diagnostic Approach

Serologic Testing

• IgM antibodies confirm recent infection and are detectable shortly after rash onset 7
• IgG antibodies typically become detectable shortly after rash onset, peak approximately 7 days later, and remain detectable indefinitely 7
• False-positive IgM results may occur with certain viral infections, but IgG results are generally reliable 7

Molecular Testing

• PCR detection of viral DNA is essential for diagnosing persistent B19 infection, particularly in immunocompromised patients 6
• Dot blot hybridization may also be used for viral DNA detection 4

Management Recommendations

Immunocompetent Adults

• Supportive care is the mainstay of treatment, including antipyretics for fever and analgesics for joint pain and discomfort 3
• Most cases are self-limiting and resolve without specific intervention 4

Special Populations

• Patients with hemolytic disorders experiencing transient aplastic crisis often require red blood cell transfusions 3
• Immunocompromised patients with persistent infection benefit from intravenous immunoglobulin (IVIG) therapy, which reduces viral load and improves anemia 4, 6
• For HIV patients with B19 infection, adherence to antiretroviral therapy is crucial for viral clearance 6

Preventive Measures

• Isolation of infected individuals is recommended, particularly from pregnant women, immunocompromised patients, and those with hemolytic disorders 3
• Monitoring of siblings and other close contacts with hemolytic disorders for concurrent or subsequent aplastic crisis 3

Special Considerations

Pregnancy

• Maternal infection can lead to fetal anemia, hydrops fetalis, or fetal death in utero 4
• Intrauterine transfusion is recommended for cases of fetal hydrops or severe anemia 3
• Pregnant women with positive parvovirus B19 IgG and negative IgM are protected against new infection and require no intervention 7

Persistent Infection

• Persistent B19 infection can occur in both immunocompetent and immunocompromised individuals 5
• In immunocompromised hosts, persistent infection manifests as pure red cell aplasia and chronic anemia 4
• Treatment with immunoglobulin effectively reduces viral load and improves anemia in persistent infection 4