Parvovirus B19

  • Diagnosis
  • Background
  • Lab Tests
  • References
  • Related Topics

Indications for Testing

  • To confirm typical clinical presentation in pregnant females – either rash or arthritis
  • Development of aplastic anemia in immunocompromised patient

Laboratory Testing

  • Antibody testing
    • IgM antibody response occurs 7-14 days after the onset of disease
      • IgM antibodies remain detectable 2-3 months after infection
    • IgG antibodies
      • IgG elevations at ~2-3 weeks after onset
      • IgG antibodies remain detectable for life
    • IgM and IgG antibodies may remain negative in
      • Immunocompromised patients
      • Patients presenting with transient aplastic crisis
    • In pregnant females – retest exposed females who are initially nonimmune in 3-4 weeks
  • PCR testing
    • More sensitive than antibody testing
    • Serum samples – positive result indicates ongoing acute or persistent infection
    • Bone marrow samples – positive result indicates acute or remote infection
    • Amniotic fluid sample – positive result indicates acute or persistent infection
  • Confirmation of parvovirus infection in pregnancy mandates follow-up with testing of fetus for development of hemolytic disease
  • Congenital infection evaluation
    • Maternal IgM testing (7-10 days after infection)
    • PCR testing of mother and amniotic fluid of fetus

Differential Diagnosis

Parvovirus B19 is a member of the Erythrovirus family, so named because of its tropism for erythroid precursor cells.


  • Prevalence
    • 15% of preschool children – seropositive
    • 50% of young adults – seropositive
    • 85% of elderly – seropositive
  • Incidence – peak in late winter, early spring
  • Age – peak is 5-15 years
  • Transmission
    • Respiratory droplets
    • Blood products
    • Transplacental


  • Small, single-stranded DNA virus
  • Lacks lipid envelope – resistant to heat and detergent inactivation
  • Targets rapidly growing erythroid progenitor cells

Risk Factors

  • Immunodeficiency disorder
  • Pregnancy

Clinical Presentation

  • Many parvovirus infections asymptomatic – particularly in children
  • Erythema infectiosum (EI) or fifth disease
    • Classically presents in school-aged children
    • EI is a benign, self-limited, febrile illness associated with a "slapped cheek" appearance on the face and a lacy or reticular rash on the trunk and limbs (sparing of palms and soles)
      • Rash may wax and wane for up to 3 weeks
  • Severe anemia is the major complication due to the virus's predilection for red-cell precursors in the bone marrow
    • May cause aplastic crisis or persistent chronic anemia in immunocompromised patients
  • Migratory polyarthropathy may occur in up to 50% of adults – particularly females
    • Generally resolves within a few weeks
    • May persist for years (rare)
  • Pregnant females
    • Risk of transplacental infection
    • Risk of fetal loss, predominantly if infection occurs in the 1st trimester and early 2nd trimester
    • Hydrops fetalis
      • Represents 10-20% of all cases of nonimmune hydrops
    • ​Neonate – severe anemia, thrombocytopenia, meningoencephalitis (rare)
    • Fetal condition frequently necessitates early delivery
  • Associated with the onset of autoimmune disorders
  • Transient aplastic crisis may result in patients with increased erythropoiesis (hemoglobin disorders, hemoglobinopathies)
  • Chronic bone marrow failure and pure red-cell aplasia (PRCA) – may become persistent in patients unable to mount efficient immune response
    • PRCA or chronic anemia may result
Tests generally appear in the order most useful for common clinical situations. Click on number for test-specific information in the ARUP Laboratory Test Directory.

Parvovirus B19 Antibodies, IgG and IgM 0065120
Method: Semi-Quantitative Enzyme-Linked Immunosorbent Assay


May be negative in immunocompromised patients and patients in transient aplastic crisis (TAC)

Sensitivity 70-80%

Parvovirus B19, by PCR, Bone Marrow 0060028
Method: Qualitative Polymerase Chain Reaction


Tissues may remain positive for life with low copy numbers

Parvovirus B19 by PCR 0060043
Method: Qualitative Polymerase Chain Reaction


Low copy numbers may be detected for months after clinical resolution

Parvovirus B19 by Quantitative PCR 2012043
Method: Quantitative Polymerase Chain Reaction

General References

Brown KE. The expanding range of parvoviruses which infect humans. Rev Med Virol. 2010; 20(4): 231-44. PubMed

Center for Disease Control and Prevention. Parvovirus B19 and Fifth Disease. Center for Disease Control and Prevention. Atlanta, GA [Last updated Nov 2015; Accessed: May 2016]

Dijkmans AC, de Jong EP, Dijkmans BA, Lopriore E, Vossen A, Walther FJ, Oepkes D. Parvovirus B19 in pregnancy: prenatal diagnosis and management of fetal complications. Curr Opin Obstet Gynecol. 2012; 24(2): 95-101. PubMed

Feldman DM, Timms D, Borgida AF. Toxoplasmosis, parvovirus, and cytomegalovirus in pregnancy. Clin Lab Med. 2010; 30(3): 709-20. PubMed

Florea AV, Ionescu DN, Melhem MF. Parvovirus B19 infection in the immunocompromised host. Arch Pathol Lab Med. 2007; 131(5): 799-804. PubMed

Neu N, Duchon J, Zachariah P. TORCH infections. Clin Perinatol. 2015 Mar;42(1):77-103, viii. PubMed

O'Grady JS. Fifth and sixth diseases: more than a fever and a rash. J Fam Pract. 2014; 63(10): E1-5. PubMed

Servey JT, Reamy BV, Hodge J. Clinical presentations of parvovirus B19 infection. Am Fam Physician. 2007; 75(3): 373-6. PubMed

Tolfvenstam T, Broliden K. Parvovirus B19 infection. Semin Fetal Neonatal Med. 2009; 14(4): 218-21. PubMed

Medical Reviewers

Last Update: October 2016