Parvovirus B19 Infection Treatment & Management
- Author: David J Cennimo, MD, FAAP, FACP, AAHIVS; Chief Editor: Russell W Steele, MD more...
Treatment may include the following:
- Acetaminophen or ibuprofen is effective for treating fever in patients with parvovirus B19 (B19V) infection. Fever does not always require treatment with antipyretics; however, consider antipyretics if a patient appears clinically uncomfortable.
- Resolution of infection depends on the presence of immunoglobulins against parvovirus B19. Intravenous immunoglobulin (IVIG) has been used with good results for patients suffering pure red cell aplasia (PRCA). Patients should be monitored for relapsed viremia.[8, 2, 25]
- Patients in aplastic crisis require packed RBC transfusions. In some studies, more than 80% of patients with sickle cell disease in transient aplastic crisis (TAC) have required transfusion. IVIG is not recommended for TAC.
- In patients receiving immunosuppressive agents, temporarily decreasing the dose of immunosuppressive agents usually enables the immune system to produce sufficient immunoglobulin G (IgG) to eradicate the infection and confer lifelong protection. In some individuals with human immunodeficiency virus (HIV) infection, highly active antiretroviral therapy restores immune function, enabling resolution of chronic parvovirus B19 infection.
- Although its use is controversial and carries many risks, intrauterine blood transfusions may be helpful in cases of hydrops fetalis.[2, 35, 13, 20, 23]
Consultations may include the following:
- Hematologist: Patients who present with aplastic crisis require intensive monitoring and RBC transfusions to prevent death and should be evaluated by a hematologist.
- Pediatric infectious disease specialist or immunologist: Patients with long-term or unusual parvovirus B19 infections can benefit from consultation with a pediatric subspecialist in infectious diseases or immunology. These patients may benefit from treatment with IVIG.
No dietary restrictions are necessary.
Patients with classic erythema infectiosum are no longer contagious after the rash has appeared.
Patients with aplastic crisis, papular-purpuric "gloves and socks" syndrome (PPGSS), or immunosuppression and chronic parvovirus B19 infection with anemia should be isolated with droplet and standard precautions due to ongoing viremia.
Patients with TAC should have precautions maintained for 7 days, whereas those with chronic infection should be isolated for the duration of their stay.
Pregnant staff should be alerted to the potential risks of parvovirus B19 infection when caring for these patients.
Cossart YE, Field AM, Cant B et al. Parvovirus-like particles in human sera. Lancet. 1975. 1:72.
Young NS, Brown KE. Parvovirus B19. N Engl J Med. 2004 Feb 5. 350(6):586-97. [Medline].
Pattison JR,Jones SE, Hodgson J et al. Parvovirus infections and hypoplastic crisis in sickle cell anaemia. Lancet. 1981. 1:664.
Serjeant GR, Topley JM, Mason K, Serjeant BE, Pattison JR, Jones SE, et al. Outbreak of aplastic crises in sickle cell anaemia associated with parvovirus-like agent. Lancet. 1981 Sep 19. 2(8247):595-7.
Cherry JD, Schulte DJ. Human Parvovirus B19. Feigin RD, Cherry JD, Demmler-Harrison GJ, Kaplan SL, eds. Feigin & Cherry's Textbook of Pediatric Infectious Diseases. 6th ed. Philadelphia, PA: Saunders Elsevier; 2009. Vol 2: 1902-1920.
Servey JT, Reamy BV, Hodge J. Clinical presentations of parvovirus B19 infection. Am Fam Physician. 2007 Feb 1. 75(3):373-6. [Medline].
Anderson LJ, Hurwitz ES. Human parvovirus B19 and pregnancy. Clin Perinatol. 1988. 15:273.
Brown KE. Parvovirus B19. Mandell GL, Bennet JE, Dolin R. Mandell, Douglas and Bennett's Principals and Practice of Infectious Diseases. 6th ed. Philadelphia, PA: Churchill Livingstone Elsevier; 2005. Vol 2: 1891-1902.
American Academy of Pediatrics Committee on Infectious Diseases. Parvovirus B19. Pickering LK, Baker CJ, Kimberlin DW, Long SS, eds. 2009 Red Book: Report of the Committee on Infectious Diseases. 28th ed. Elk Grove Village, IL: American Academy of Peiatrics; 2009. 491-493.
Brown KE. Human Parvoviruses. Long SS, Pickering LK, Prober CG, eds. Principles and Practice of Pediatric Infectious Diseases. 3rd ed. Philadelphia, PA: Churchill Livingstone Elsevier; 2008. 1072-1076.
Burns K, Parish CR. Parvoviridae. Knipe DM, Howley PM, eds. Fields Virology. 5th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2007. Vol 2: 65.
Mustafa MM, McClain KL. Diverse hematologic effects of parvovirus B19 infection. Pediatr Clin North Am. 1996 Jun. 43(3):809-21. [Medline].
Ergaz Z, Ornoy A. Parvovirus B19 in pregnancy. Reprod Toxicol. 2006 May. 21(4):421-35. [Medline].
Luzzi GA, Kurtz JB. Human parvovirus arthropathy and rheumatoid factor(Letter). Lancet. 1985. 1:1218.
Conrad ME, Studdard H et al. Case report: aplastic crisis in sickle cell disorders: bone marrow necrosis and human parvovirus infection. Am J Med Sci. 1988. 295:212.
Eid AJ, Brown RA, Patel R, Razonable RR. Parvovirus B19 infection after transplantation: a review of 98 cases. Clin Infect Dis. 2006 Jul 1. 43(1):40-8. [Medline].
Lindblom A, Heyman M, Gustafsson I, Norbeck O, Kaldensjo T, Vernby A. Parvovirus B19 infection in children with acute lymphoblastic leukemia is associated with cytopenia resulting in prolonged interruptions of chemotherapy. Clin Infect Dis. 2008 Feb 15. 46(4):528-36. [Medline].
Young NS. Hematologic and hematopoietic consequences of B19 parvovirus infection. Semin Hematol. 1988. 25:159.
Mendelson E, Aboudy Y, Smetana Z, Tepperberg M, Grossman Z. Laboratory assessment and diagnosis of congenital viral infections:Rubella, cytomegalovirus (CMV), varicella-zoster virus (VZV),herpes simplex virus (HSV), parvovirus B19 andhuman immunodeficiency virus (HIV). Reprod Toxicol. 2006. 21:350-382.
Adler SP, Koch WC. Human Parvovirus Infections. Remington JS, Klein JO, Wilson CB, Baker CJ. Infectious Diseases of the Fetus and Newborn Infant. 6th ed. Philadelphia, PA: Saunders Elsevier; 2006. 868-892.
Tolfvenstam T, Broliden K. Parvovirus B19 infection. Semin Fetal Neonatal Med. 2009 Aug. 14(4):218-21. [Medline].
Simms RA, Liebling RE, Patel RR, et al. Management and outcome of pregnancies with parvovirus B19 infection over seven years in a tertiary fetal medicine unit. Fetal Diagn Ther. 2009. 25(4):373-8. [Medline].
Infections. Cunningham FG, Leveno KL, Bloom SL, Hauth JC, Gilstrap III LC, Wenstrom KD, eds. Williams Obstetrics. 22nd Ed. USA: McGraw-Hill; 2001. chap 58.
Crane J, Mundle W, Boucoiran I, Gagnon R, Bujold E, Basso M, et al. Parvovirus B19 infection in pregnancy. J Obstet Gynaecol Can. 2014 Dec. 36(12):1107-16. [Medline].
Broliden K, Tolfvenstam T, Norbeck O. Clinical aspects of parvovirus B19 infection. Jrnl Internal Med. 2006. 260:285-304.
Grilli R, Izquierdo MJ, Farina MC, et al. Papular-purpuric "gloves and socks" syndrome: polymerase chain reaction demonstration of parvovirus B19 DNA in cutaneous lesions and sera. J Am Acad Dermatol. 1999 Nov. 41(5 Pt 1):793-6. [Medline].
Fretzayas A, Douros K, Moustaki M, Nicolaidou P. Papular-purpuric gloves and socks syndrome in children and adolescents. Pediatr Infect Dis J. 2009 Mar. 28(3):250-2. [Medline].
Tschope C, Bock CT, Kasner M, Noutsias M, Westermann D, Schwimmbeck PL. High prevalence of cardiac parvovirus B19 infection in patients with isolated left ventricular diastolic dysfunction. Circulation. 2005 Feb 22. 111(7):879-86. [Medline].
Douvoyiannis M, Litman N, Goldman DL. Neurologic manifestations associated with parvovirus B19 infection. Clin Infect Dis. 2009 Jun 15. 48(12):1713-23. [Medline].
Kleinman SH, Glynn SA, Lee TH, et al. A linked donor-recipient study to evaluate parvovirus B19 transmission by blood component transfusion. Blood. 2009 Oct 22. 114(17):3677-83. [Medline]. [Full Text].
Bredl S, Plentz A, Wenzel JJ, Pfister H, Möst J, Modrow S. False-negative serology in patients with acute parvovirus B19 infection. J Clin Virol. 2011 Jun. 51(2):115-20. [Medline].
Soderlund-Venermo M, Hokynar K, Nieminen J et al. Undefined. Persistence of human parvovirus B 19 in human tissues. 2002. 50;:307-316.
Musiani M, Zerbini M et al.Gentilomi G et al. Parvovirus B19 clearance from peripheral blood after acute infection. J Infect Dis. 1995. 172:1360-1363.
Anderson MJ, Higgins PG, Davis LR, Willman JS, Jones SE, Kidd IM. Experimental parvoviral infection in humans. J Infect Dis. 1985 Aug. 152(2):257-65. [Medline].
Failey CK, Smoleniec JS et al. Observational study of effect of intrauterine transfusions on outcome of fetal hydrops after parvovirus B 19 infection. Lancet. 1995. 346:1335-1337.
[Guideline] Center for Disease control and Prevention. Risk associated with human parvovirus infection. MMWR. 1989. 38:81.
de Jong EP, Walther FJ, Kroes AC, Oepkes D. Parvovirus B19 infection in pregnancy: new insights and management. Prenat Diagn. 2011 May. 31(5):419-25. [Medline].