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.

Epidemiology

  • 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

Organism

  • 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

Limitations

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

Limitations

Tissues may remain positive for life with low copy numbers

Parvovirus B19 by PCR 0060043
Method: Qualitative Polymerase Chain Reaction

Limitations

Low copy numbers may be detected for months after clinical resolution

Related Tests

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 C, 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: June 2016