PARVOVIRUS INFECTION IN PREGNANT WOMEN: SOME ASPECTS OF CLINICAL PROGRESSION AND DIAGNOSTICS
Human parvovirus (B19V) infection is a well-known fetotropic agent that may lead to a fetal loss. Nevertheless, the routine testing for B19V is not included into antenatal or preconception screening programs, and some authors find it a reason of delay in management of pregnancies complicated by B19V. The aim of our research was to reveal practicability of B19V screening tests in pregnant women in certain population, and also to assess the proportion between asymptomatic and manifest forms of B19V infection in our population, whether some diagnostic methods and their combinations are useful in testing, and to investigate correlation between clinical symptoms in fetus and laboratory parameters of expectant mother. The observation of 129 pregnant women (patients of Perinatal Centre in Kyiv) with suggested B19V infection in different terms of gestation was conducted. Diagnostic systems used were: ELISA test (DRG) and immunoblot testing system EUROIMMUN (Germany), and DNA detection of B19V in mother’s blood samples was conducted with the use of PCR. In addition, we turned our attention to epidemiologic cyclicity of B19V infection, seasonal prevalence and other ordinary for infection processes characteristics. In observed population the incidence of B19V infection had no correlation with the terms of gestation; more significant correspondence was observed with cyclicity waves (2 years of low morbidity were followed by periods increased morbidity), seasonal prevalence, environment of pregnant women (the professional and household one). Except of apparent but nonspecific general blood changes, in 46/129 (35,6%) pregnant women the acute B19V infection was diagnosed with the use of PCR with the presence of B19V DNA in blood samples and negative or uncertain serological results. In 85,1% (40/47)cases of symptomatic fetus injury B19V DNA load was found in mother’s blood samples, and that was the difference when compared with the group of women with asymptomatic course of disease, in which the viral load was found in 32,6% (16/49) of cases. The long-term viremia in mothers was found in cases of fetal infection (B19V DNA until 120 days) associated with seroconversion. The results of this study demonstrated some certain particularities of clinical course of disease in observed population except of common features of B19V, and revealed reasonability of combined laboratory testing if suspecting B19V infection. Further achievements in B19V infection research will provide better algorithms and methods of diagnosing; will lead to effective prophylaxis as well as for the development of novel therapeutic options.
2. Flower, B. & MacMahon, E. (2017). Erythrovirus B19 infection. J. Medicine, 45, 772–776. Doi.org/10.1016/S1701-2163(15)30816-1.
3. de Jong, E. P., Walther, F. J., Kroes, A. C. & Oepkes, D. (2011). Parvovirus B19 infection in pregnancy new insights and management. Prenatal. Diagn., 31, 419–25. https://doi.org/10.1002/pd.2714.
4. Dijkmans, A. C., de Jong, E. P., Dijkmans, B. A., Loprion, E., Vosses, A., Walther, F. J. & Oepkes, D. (2012). Parvovirus B19 in pregnancy: prenatal diagnosis and management of fetal complications. Curr. Opin. Obstet. Gynecol., 24, 95–101. https://doi.org/10.1097/GCO.0b013e3283505a9d.
5. Crane, J., Mundle, W. & Boucoiran, I. (2014). Parvovirus B19 Infection in Pregnancy. J. Obstet. Gynaecol. Can., 36 (12), 1107–1116. https://doi.org/10.1016/S1701-2163(15)30390-X.
6. Chisaka, H., Ito, K., Niikura, H., Sugawara, J., Takano, T., Murakami, T. & Yaegashi, N. (2006). Clinical manifestations and outcomes of parvovirus B19 infection during pregnancy in Japan. Tohoku J. Exp. Med., 209 (4), 277–83. DOI: 10.1620/tjem.209.277.
7. Heegaard, E. D. & Brown, K. E. (2002). Human Parvovirus B19. Clin. Microbiol. Rev. 15 (3), 485–505. doi: 10.1128/CMR.15.3.485-505.2002.
8. Aysun Karabulut. Non-immune hydrops fetalis without anemia due to parvovirus B19/Aysun Karabulut, Soner Gok. [etal.] // International Jornal of GynecolObstet.– Jan. 2014; V.124. P – 82. https://doi.org/10.1016/j.ijgo.2013.07.021.
9. Quigley, J., Doyle, B., Burke, E., Culliton, M., Diaz, M. & McParland, P. (2014). Non immune hydrops due to parvovirus B19 in pregnancy: a case report. Retrieved from https://www.giveblood.ie/Clinical-Services/Red-Cell-Immunohaematology-Diagnostics/RCI-Publications/non-immune-hydrops.pdf
10. Subtil, D., Garabedian, C. & Chauvet, A. (2015). Infection à parvovirus B19 et grossesse. Parvovirus B19 infection and pregnancy. J. La Presse Medicale, 44, 647–653. Doi.org/10.1016/j.lpm.2015.04.013.
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