Thursday, September 23, 2010

CONSULT ROUNDS: Parvovirus b19 and transplant patients

                                                                                                           Parvovirus B19 is a common human pathogen, causing erythema infectiosum in children, hydrops fetalis and transient aplastic crisis in patients with chronic hemolytic anemia.

Renal transplant recipients can develop symptomatic B19 infections as a result of primary infection acquired via the usual respiratory route or via the transplanted organ, or because of reactivation of latent or persistent viral infection. It is not something we commonly think about or screen for.

The most common manifestations of B19 infection in immunosuppressed patients are pure red cell aplasia and other cytopenias. If you have a patient with unexplained anemia, and the reticulocyte count is also low, think of Parvovirus B19 in the differential, get PCR. You shall be surprised how many you will pick up.

It can affect the kidney post transplant as well and can lead to a post Transplant Collapsing Glomerulopathy.(PTCG). Before it gets to that stage, treatment might be crucial. Thrombotic microangiopathy have been reported in association with B19 infection in renal transplant recipients, but a causal relationship has not been definitively established.  Most patients benefit from intravenous immunoglobulin therapy and/or alteration or reduction of immunosuppressive therapy.


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