Parvovirus B19 infection during pregnancy
- Laura E Riley, MD
Laura E Riley, MD
- Assistant Professor of Obstetrics, Gynecology and Reproductive Biology
- Harvard Medical School
- Caraciolo J Fernandes, MD
Caraciolo J Fernandes, MD
- Associate Professor of Pediatrics
- Baylor College of Medicine
- Section Editors
- Martin S Hirsch, MD
Martin S Hirsch, MD
- Editor-in-Chief — Infectious Diseases
- Section Editor — Viral Infections
- Professor of Medicine
- Harvard Medical School
- Morven S Edwards, MD
Morven S Edwards, MD
- Section Editor — Pediatric Infectious Diseases
- Professor of Pediatrics
- Baylor College of Medicine
- Leonard E Weisman, MD
Leonard E Weisman, MD
- Section Editor — Neonatology
- Professor of Pediatrics
- Baylor College of Medicine
- Charles J Lockwood, MD, MHCM
Charles J Lockwood, MD, MHCM
- Section Editor — Obstetrics
- Senior Vice President, USF Health
- Dean, Morsani College of Medicine
- Professor, Obstetrics and Gynecology
- University of South Florida
Parvovirus B19 infection is a common childhood illness. Asymptomatic or mild infection occurs most often when B19 affects immunocompetent adults. Rarely, acute infection in pregnancy may lead to fetal loss or hydrops fetalis. The issues surrounding B19 infection during pregnancy are reviewed here.
The Parvoviruses were discovered in 1975 by electron microscopy during evaluation of tests for hepatitis B surface antigen . Parvoviridae are small, non-enveloped DNA viruses that infect a variety of animals, usually in a species-specific fashion. Two parvoviruses have been isolated from humans, the adeno-associated parvoviruses (genus Dependovirus) and human parvovirus B19 (B19) (genus Erythrovirus). Only B19 is known to cause disease in humans. (See "Clinical manifestations and diagnosis of parvovirus B19 infection".)
Parvovirus B19 has a single-stranded DNA genome containing approximately 5,000 nucleotides. It encodes at least two major structural proteins and one nonstructural protein and serves as the template for its own replication.
Parvovirus B19 preferentially infects rapidly dividing cells and is cytotoxic for erythroid progenitor cells [2,3]. B19 also may stimulate a cellular process initiating apoptosis (programmed cell death) . The latter may account for the minimal inflammatory response noted in tissues infected with B19.
Antibodies to B19 are found in 30 to 60 percent of adults [5-7]. The secondary attack rate for household contacts may be as high as 50 percent; a susceptible individual exposed in a classroom has a 20 to 30 percent risk of infection . (See "Microbiology, epidemiology, and pathogenesis of parvovirus B19 infection".)
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- CLINICAL FEATURES
- Maternal-fetal effects
- - Fetal loss
- - Transient effusions
- - Fetal hydrops
- - Neonatal and developmental considerations
- Maternal parvovirus infection
- Fetal parvovirus infection
- Other methods
- APPROACH TO THE PATIENT EXPOSED TO B19
- Past infection
- Acute infection
- Susceptible host
- - No history of exposure
- - Recent history of exposure
- MANAGEMENT OF ANEMIA AND HYDROPS
- Intrauterine blood transfusion
- Immune globulin
- Delivery room and postnatal management of the hydropic infant
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS