Treatment of Parvovirus B19 Infection
For immunocompetent patients with parvovirus B19 infection, treatment is supportive care only with antipyretics and analgesics; for immunocompromised patients with chronic anemia, intravenous immunoglobulin (IVIG) is the primary treatment; and for patients with hemolytic disorders experiencing aplastic crisis, red blood cell transfusions are required. 1
Immunocompetent Patients
- Supportive care is the standard approach, including antipyretics for fever and analgesics for joint pain and discomfort in patients with erythema infectiosum (Fifth disease). 1
- No antiviral therapy is indicated as infections are typically self-limiting and resolve with development of specific immune response. 2
- Isolation from pregnant women, immunocompromised patients, and those with hemolytic disorders is recommended to prevent transmission. 1
Immunocompromised Patients with Chronic Anemia
- IVIG is the primary treatment for immunocompromised hosts with pure red-cell aplasia and chronic anemia due to parvovirus B19. 2
- Diagnosis should be established by detecting B19 DNA in serum in the absence of neutralizing IgG antibody before initiating treatment. 2
- Therapy includes red-cell transfusion as needed, adjustment of immunosuppressive medications to restore immune function, and administration of IVIG. 2
- Close monitoring is essential following treatment, especially if immunosuppression remains unchanged—if hematocrit trends downward and parvovirus DNA trends upward, repeat IVIG therapy. 2
- Monthly maintenance IVIG may be indicated in select cases where immunosuppression cannot be reduced. 2
Patients with Hemolytic Disorders (Sickle Cell Disease)
- Transient aplastic crisis requires prompt recognition and red blood cell transfusions to manage severe anemia. 1
- Monitor siblings and close contacts with hemolytic disorders for concurrent or subsequent aplastic crisis. 1
Pregnant Patients with Fetal Complications
- Intrauterine transfusion is recommended for fetal hydrops or severe fetal anemia. 1
- Close monitoring with ultrasound and middle cerebral artery Doppler studies should be performed to detect fetal anemia. 1
- Treatable causes like parvovirus B19 infection have better prognosis when identified early. 3
Important Caveats
- Corticosteroids are contraindicated in parvovirus B19 infection as they may worsen viral replication and prolong infection. 3
- Some patients may have detectable IgG antibody that is non-neutralizing, requiring DNA testing for accurate diagnosis. 2
- Parvovirus B19 variants can be missed by some PCR methods, so clinical suspicion should remain high despite negative testing. 2
- Long-term neurological outcomes may be abnormal in survivors of fetal hydrops following intrauterine transfusion, though causality is unclear. 3