Parvovirus B19 Infection Treatment & Management

Updated: Dec 06, 2018
  • Author: David J Cennimo, MD, FAAP, FACP, AAHIVS; Chief Editor: Russell W Steele, MD  more...
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Treatment

Medical Care

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, 27]

  • Patients in aplastic crisis require packed RBC transfusions. [9] In some studies, more than 80% of patients with sickle cell disease in transient aplastic crisis (TAC) have required transfusion. [8] 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. [27]

  • Although its use is controversial and carries many risks, intrauterine blood transfusions may be helpful in cases of hydrops fetalis. [2, 38, 14, 21, 24]

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Consultations

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.

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Diet

No dietary restrictions are necessary.

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Activity

Patients with classic erythema infectiosum are no longer contagious after the rash has appeared. [9]

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. [9]

Maintain precaution for patients with TAC for 7 days or until the reticulocyte count rebounds to at least 2%, whereas those with chronic infection should be isolated for the duration of their stay. [9]

Pregnant staff should be alerted to the potential risks of parvovirus B19 infection when caring for these patients. [9]

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