Parvovirus B19

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

Indications for Testing

  • Rash or arthritis in pregnant females
  • Development of aplastic anemia in immunocompromised patient

Laboratory Testing

  • Antibody testing
    • IgM antibodies
      • Response occurs 7-14 days after onset of disease
      • Remain detectable 2-3 months after infection
    • IgG antibodies
      • IgG elevations ~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
    • Retest exposed pregnant females who are initially nonimmune in 3-4 weeks
  • Polymerase chain reaction (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 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 – peaks 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 are asymptomatic, particularly in children
  • Erythema infectiosum or fifth disease
    • Classically presents in school-age children
    • Benign, self-limited, febrile illness associated with "slapped cheek" appearance on face and lacy or reticular rash on trunk and limbs (sparing of palms and soles)
      • Rash may wax and wane for up to 3 weeks
  • Severe anemia
    • Major complication due to virus's predilection for red cell precursors in 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, but may persist for years (rare)
  • In pregnant females
    • Risk of transplacental infection
    • Risk of fetal loss, primarily if infection occurs in the first trimester and early second trimester
    • Hydrops fetalis – represents 10-20% of all cases of nonimmune hydrops
    • Fetal condition frequently necessitates early delivery
    • ​Severe neonatal anemia, thrombocytopenia, and meningoencephalitis (rare)
  • Associated with onset of autoimmune disorders
  • Transient aplastic crisis
  • Chronic bone marrow failure and pure red cell aplasia (PRCA)
    • May become persistent in patients unable to mount efficient immune response
    • 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

Parvovirus B19 by Qualitative PCR 0060043
Method: Qualitative Polymerase Chain Reaction

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: Aug 2017]

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: September 2017