History

See the list below:

No distinction between confirmed, apparently isolated bocavirus-associated disease and any other nonspecific viral respiratory infection has been established.
The most consistently reported symptoms include cough, fever, and rhinorrhea.
A higher-than-expected rate of GI symptoms has been noted, with as many as 25% of patients experiencing some form of gastroenteritis. Other known pathogens were detected along with human bocavirus in 58% of stool samples in one study from Spain.^[24]HBoV2 has been detected at a high frequency (17.2%) in stool samples of children with acute gastroenteritis, but also in a significant number (8.1%) of healthy controls.^[6]
Several reports of isolated human bocavirus in patients with wheezing episodes suggest that it primarily causes obstructive respiratory disease, is a secondary inflammatory response (similar to respiratory syncytial virus), or acts as a trigger to patients who are susceptible to reactive airways, such as those with preexisting asthma.

Physical

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The physical examination findings are similar to those of a typical viral respiratory infection.
Patients with more severe lower respiratory tract disease may have wheezing, tachypnea, grunting (in younger children), and use of accessory muscles.
Children with severe gastroenteritis may show signs of dehydration: poor skin turgor, sunken eyes, lethargy. A decrease in urine output (manifesting as fewer wet diapers in young infants) and a lack of tears when crying may be noticed.

Differential Diagnoses

Guido M, Tumolo MR, Verri T, Romano A, Serio F, De Giorgi M, et al. Human bocavirus: Current knowledge and future challenges. World J Gastroenterol. 2016 Oct 21. 22 (39):8684-8697. [QxMD MEDLINE Link]. [Full Text].
Allander T, Tammi MT, Eriksson M, et al. Cloning of a human parvovirus by molecular screening of respiratory tract samples. Proc Natl Acad Sci U S A. 2005 Sep 6. 102(36):12891-6. [QxMD MEDLINE Link].
Schildgen O, Müller A, Allander T, Mackay IM, Völz S, Kupfer B, et al. Human bocavirus: passenger or pathogen in acute respiratory tract infections?. Clin Microbiol Rev. 2008 Apr. 21(2):291-304, table of contents. [QxMD MEDLINE Link]. [Full Text].
Kapoor A, Slikas E, Simmonds P, Chieochansin T, Naeem A, Shaukat S, et al. A newly identified bocavirus species in human stool. J Infect Dis. 2009 Jan 15. 199(2):196-200. [QxMD MEDLINE Link]. [Full Text].
Chow BD, Ou Z, Esper FP. Newly recognized bocaviruses (HBoV, HBoV2) in children and adults with gastrointestinal illness in the United States. J Clin Virol. 2010 Feb. 47(2):143-7. [QxMD MEDLINE Link].
Arthur JL, Higgins GD, Davidson GP, Givney RC, Ratcliff RM. A novel bocavirus associated with acute gastroenteritis in Australian children. PLoS Pathog. 2009 Apr. 5(4):e1000391. [QxMD MEDLINE Link]. [Full Text].
De R, Liu L, Qian Y, Zhu R, Deng J, Wang F, et al. Risk of acute gastroenteritis associated with human bocavirus infection in children: A systematic review and meta-analysis. PLoS One. 2017. 12 (9):e0184833. [QxMD MEDLINE Link]. [Full Text].
Zhao M, Zhu R, Qian Y, Deng J, Wang F, Sun Y, et al. Prevalence and Phylogenetic Analysis of Human Bocaviruses 1-4 in Pediatric Patients with Various Infectious Diseases. PLoS One. 2016. 11 (8):e0160603. [QxMD MEDLINE Link]. [Full Text].
Dijkman R, Koekkoek SM, Molenkamp R, Schildgen O, van der Hoek L. Human bocavirus can be cultured in differentiated human airway epithelial cells. J Virol. 2009 Aug. 83(15):7739-48. [QxMD MEDLINE Link]. [Full Text].
Lassauniére R, Kresfelder T, Venter M. A novel multiplex real-time RT-PCR assay with FRET hybridization probes for the detection and quantitation of 13 respiratory viruses. J Virol Methods. 2010 Feb 11. [QxMD MEDLINE Link].
Allander T, Jartti T, Gupta S, et al. Human bocavirus and acute wheezing in children. Clin Infect Dis. 2007 Apr 1. 44(7):904-10. [QxMD MEDLINE Link].
Fry AM, Lu X, Chittaganpitch M, Peret T, et al. Human bocavirus: a novel parvovirus epidemiologically associated with pneumonia requiring hospitalization in Thailand. J Infect Dis. 2007 Apr 1. 195(7):1038-45. [QxMD MEDLINE Link].
Martin ET, Fairchok MP, Kuypers J, et al. Frequent and prolonged shedding of bocavirus in young children attending daycare. J Infect Dis. 2010 Jun 1. 201(11):1625-32. [QxMD MEDLINE Link]. [Full Text].
Lehtoranta L, Soderlund-Venermo M, Nokso-Koivisto J, et al. Human bocavirus in the nasopharynx of otitis-prone children. Int J Pediatr Otorhinolaryngol. 2012 Feb. 76(2):206-11. [QxMD MEDLINE Link].
Blessing K, Neske F, Herre U, Kreth HW, Weissbrich B. Prolonged detection of human bocavirus DNA in nasopharyngeal aspirates of children with respiratory tract disease. Pediatr Infect Dis J. 2009 Nov. 28(11):1018-9. [QxMD MEDLINE Link].
Deng Y, Gu X, Zhao X, et al. High viral load of human bocavirus correlates with duration of wheezing in children with severe lower respiratory tract infection. PLoS One. 2012. 7(3):e34353. [QxMD MEDLINE Link]. [Full Text].
Korner RW, Soderlund-Venermo M, van Koningsbruggen-Rietschel S, Kaiser R, Malecki M, Schildgen O. Severe human bocavirus infection, Germany. Emerg Infect Dis. 2011 Dec. 17(12):2303-5. [QxMD MEDLINE Link]. [Full Text].
Edner N, Castillo-Rodas P, Falk L, Hedman K, Söderlund-Venermo M, Allander T. Life-threatening respiratory tract disease with human bocavirus-1 infection in a 4-year-old child. J Clin Microbiol. 2012 Feb. 50(2):531-2. [QxMD MEDLINE Link]. [Full Text].
Mitui MT, Tabib SM, Matsumoto T, et al. Detection of human bocavirus in the cerebrospinal fluid of children with encephalitis. Clin Infect Dis. 2012 Apr. 54(7):964-7. [QxMD MEDLINE Link].
Korppi M. Polymerase chain reaction in respiratory samples alone is not a reliable marker of bocavirus infection. Pediatr Pulmonol. 2013 Oct 24. [QxMD MEDLINE Link].
Brebion A, Vanlieferinghen P, Déchelotte P, Boutry M, Peigue-Lafeuille H, Henquell C. Fatal sub-acute myocarditis associated with human bocavirus 2 in a 13-month-old child. J Clin Microbiol. 2013 Dec 26. [QxMD MEDLINE Link].
Mori D, Ranawaka U, Yamada K, Rajindrajith S, Miya K, Perera HK, et al. Human bocavirus in patients with encephalitis, Sri Lanka, 2009-2010. Emerg Infect Dis. 2013 Nov. 19(11):1859-62. [QxMD MEDLINE Link]. [Full Text].
Endo R, Ishiguro N, Kikuta H, Teramoto S, Shirkoohi R, Ma X, et al. Seroepidemiology of human bocavirus in Hokkaido prefecture, Japan. J Clin Microbiol. 2007 Oct. 45(10):3218-23. [QxMD MEDLINE Link].
Vicente D, Cilla G, Montes M, et al. Human bocavirus, a respiratory and enteric virus. Emerg Infect Dis. 2007 Apr. 13(4):636-7. [QxMD MEDLINE Link].
Ma X, Endo R, Ishiguro N, et al. Detection of human bocavirus in Japanese children with lower respiratory tract infections. J Clin Microbiol. 2006 Mar. 44(3):1132-4. [QxMD MEDLINE Link].
Volz S, Schildgen O, Klinkenberg D, et al. Prospective study of Human Bocavirus (HBoV) infection in a pediatric university hospital in Germany 2005/2006. J Clin Virol. 2007 Nov. 40(3):229-35. [QxMD MEDLINE Link].
Kapoor A, Simmonds P, Slikas E, et al. Human bocaviruses are highly diverse, dispersed, recombination prone, and prevalent in enteric infections. J Infect Dis. 2010 Jun 1. 201(11):1633-43. [QxMD MEDLINE Link].

Media Gallery

The genome of human bocavirus. The 4 genes are labeled based on their presumed function, according to homologous genes in other parvoviruses. Nonstructural protein 1 (NS1) is a DNA-binding protein involved in gene transcription. NP1 is also nonstructural and is a highly conserved protein of unknown function. The capsid proteins are viral protein 1 (VP1) and viral protein 2 (VP2).
An electron micrograph of canine parvovirus, which is closely related to human bocavirus.

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Author

Nicholas John Bennett, MBBCh, PhD, FAAP, MA(Cantab) Assistant Professor of Pediatrics, Co-Director of Antimicrobial Stewardship, Medical Director, Division of Pediatric Infectious Diseases and Immunology, Connecticut Children's Medical Center

Nicholas John Bennett, MBBCh, PhD, FAAP, MA(Cantab) is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics

Disclosure: Received research grant from: Cubist<br/>Received income in an amount equal to or greater than $250 from: Horizon Pharmaceuticals, Shire<br/>Medico legal consulting for: Various.

Coauthor(s)

Joseph Domachowske, MD Professor of Pediatrics, Microbiology and Immunology, Department of Pediatrics, Division of Infectious Diseases, State University of New York Upstate Medical University

Joseph Domachowske, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa

Disclosure: Received research grant from: Pfizer;GlaxoSmithKline;AstraZeneca;Merck;American Academy of Pediatrics, Novavax, Regeneron, Diassess, Actelion<br/>Received income in an amount equal to or greater than $250 from: Sanofi Pasteur.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Chief Editor

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, Southern Medical Association

Disclosure: Nothing to disclose.

Pediatric Bocavirus Clinical Presentation

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