What is the treatment for parvovirus B19 infection?

Treatment of Parvovirus B19 Infection

For immunocompetent patients with parvovirus B19 infection, treatment is supportive care only with antipyretics and analgesics; for patients with hemolytic disorders experiencing aplastic crisis, red blood cell transfusions are required; for immunocompromised patients with persistent infection, intravenous immunoglobulin (IVIG) is the treatment of choice; and for pregnant women with fetal hydrops, intrauterine transfusion is indicated. 1

Immunocompetent Patients

• Supportive care is the mainstay of treatment, including antipyretics for fever and analgesics for joint pain and discomfort in patients with erythema infectiosum (Fifth disease). 1
• No antiviral therapy is indicated or beneficial in healthy individuals with normal immune systems. 1
• Isolation from high-risk individuals (pregnant women, immunocompromised patients, and those with hemolytic disorders) is recommended to prevent transmission. 1

Patients with Hemolytic Disorders

• Transient aplastic crisis requires prompt recognition and red blood cell transfusions to manage severe anemia in patients with sickle cell disease and other hemolytic disorders. 1
• Monitor siblings and close contacts with hemolytic disorders for concurrent or subsequent aplastic crisis. 1
• The clinical presentation typically includes severe anemia with reticulocytopenia and absence of red cell precursors on bone marrow examination. 2

Immunocompromised Patients

• Intravenous immunoglobulin (IVIG) is the only FDA-approved antiviral treatment for parvovirus B19 infection, particularly for chronic anemia and pure red cell aplasia in immunocompromised hosts. 3, 2
• Diagnosis should be established by detecting B19 DNA in serum in the absence of IgG antibody to B19, or when IgG is present but non-neutralizing. 2
• Treatment approach includes: red cell transfusion for symptomatic anemia, adjustment of immunosuppressive medications when possible to restore immune function, and administration of IVIG. 2
• Close monitoring is essential following treatment—if hematocrit trends downward and parvovirus DNA trends upward, repeat IVIG therapy is indicated. 2
• In refractory cases, monthly maintenance IVIG may be necessary. 2
• For persistent infection refractory to standard IVIG treatment, pegylated interferon alfa-2a has shown success in achieving viral clearance, though long-term follow-up and potentially repeated treatment may be required. 4

Pregnant Women with Fetal Complications

• Intrauterine transfusion is indicated for cases of fetal hydrops or severe fetal anemia detected by ultrasound and middle cerebral artery Doppler studies. 1
• Close monitoring with serial ultrasounds and Doppler studies is essential to detect fetal anemia early, as accurate identification and treatment of affected fetuses improves perinatal outcomes. 5
• Vertical transmission occurs in 33% to 51% of maternal infections, with fetal complications including anemia, heart failure, and non-immune hydrops. 5

Important Caveats

• Corticosteroids are not recommended for parvovirus B19 infection, as they may worsen the condition through further immunosuppression. 1
• Be aware that B19 variants can be missed or under-quantitated by some real-time PCR methods, which may complicate diagnosis and monitoring. 2
• Despite IVIG being the only FDA-approved treatment, it has limited efficacy and high cost, and there are still no virus-specific therapeutics clinically available. 3
• Parvovirus B19 should be suspected in compromised hosts with unexplained or severe anemia and reticulocytopenia, or when bone marrow shows giant pronormoblasts or absence of red cell precursors. 2