1. Because the fetus is capable of producing IgM by approximately 18 weeks gestation, either fetal blood or amniotic fluid can be tested for IgM. Registered users can save articles, searches, and manage email alerts. Some studies have noted that several women infected with parvovirus B19 were found to have elevated maternal serum alpha-fetoprotein (MSAFP) levels and have suggested that women with high MSAFP levels be screened for B19 infection. In studies of human volunteers, serum and respiratory secretions were positive for B19 DNA during the prodromal illness, but the specimens were negative by the time of onset of rash or arthralgia. Fifth disease is a mild rash illness caused by parvovirus B19. AWHONN Journals Article Collection on COVID-19, Racism, Disparities, and Social Determinants of Health, JOGNN Health Care Improvement and Evaluation, Diagnosis and Treatment of Herpes Simplex Infection During Pregnancy, Guide to Interpreting Parvovirus B19 IgG and IgM Serology Values. In pregnant women exposed to parvovirus B19, obtain IgG and IgM serology as soon as possible following exposure - Negative IgG and IgM results indicate that the mother is not immune and that no evidence of acute infection is noted. 2. your express consent. Log in to view full text. Parvovirus is usually diagnosed through a blood test for antibodies to the virus. Keywords: parvovirus B19, pregnancy, erythema infectiosum, hydrops fetalis Clinical features and pathogenesis The clinical features and pathogenesis of parvovirus B19 have been described in two reports.1,2 Human parvovirus B19 causes an acute, usually self-limiting, infection which is often asymptomatic. 1. Because of the low risk of fetal damage, termination of pregnancy is not recommended, nor is amniocentesis for diagnosis of asymptomatic intrauterine infection (. Several investigators have reported spontaneous resolution of nonimmune hydrops. However, there is no evidence that the rate of congenital anomalies differs from background rates (, During outbreaks of B19 infection, it is difficult to prevent the spread of infection. [email protected]. However, nonimmune fetal hydrops is rare (1 in 3,000 to 4,000 pregnancies), with B19 infection as one of the most frequent causes. The most common symptomatic presentation of infection in the fetus is nonimmune hydrops secondary to severe fetal anemia. -Psychosocial history (a client’s emotional response to pregnancy, adolescent pregnancy, spouse, support system, history of depression, domestic violence issues). Guidelines for preconceptional conseling. Parvovirus B19 is a nonenveloped DNA virus and a member of the. Elizabeth Heavey is an associate professor of nursing at the State University of New York College in Brockport, N.Y., where Roselind Bruce-Vanderpuije is a nursing student. Sore throat. Preventing falls in hospitalized older adults, Managing delirium behaviors with one-to-one sitter, International public health emergencies: Lessons learned in West Africa, Keeping children with latex allergies safe, Calling on smartphones to enhance patient care, One hospital's journey to create a sustainable sepsis program, Implementing bedside shift report: Walking the walk and talking the talk, Improving language interpretation practices, Time taping an I.V. If IgM is detected when the test is repeated (with or without IgG), there is evidence of recent infection (. This disease is usually not a problem for pregnant women and their babies. Parvovirus B19 is a common, self-limiting, usually benign childhood virus that causes erythema infectiosum, also known as fifth disease. The risk of hydrops is 3% with a mortality of 50%. Primate erythroparvovirus 1, generally referred to as B19 virus, parvovirus B19 or sometimes erythrovirus B19, was the first (and until 2005 the only) known human virus in the family Parvoviridae, genus Erythroparvovirus; it measures only 23–26 nm in diameter. Although the infection is usually mild and self-limited, three groups of people are susceptible to serious complications of infection: persons with chronic hemolytic anemia, persons with congenital or acquired immunodeficiency, and pregnant women (, Susceptible pregnant women may be exposed to the virus, and the highest infection rates occur in school-teachers, day care workers, and women with school-age children in the home. Because B19 is cytotoxic to fetal red blood cell precursors, fetal infection may cause severe anemia, high cardiac output failure, and non-immune hydrops. Susceptible pregnant women who are infected with parvovirus B19 will need supportive treatment during the illness as well as counseling about options for fetal testing. Your message has been successfully sent to your colleague. The incidence of human parvovirus B19 infection during pregnancy and its impact on perinatal outcome. Rogers BB, Singer DB, Mak SK, Gary GW, Fikrig MK, McMillan PN. We present a case of parvovirus B19 infection related to hemophagocytic lymphohistiocytosis during pregnancy. L.P., PA. Elizabeth Heavey, PhD, RN, CNM, and Roselind Bruce-Vanderpuije, SN, reply: Several viruses can cause fetal harm, including parvovirus B19 (B19), also known as erythema infectiosum or fifth disease. bag Learning by example, On Veterans Day, remember those living with mental health problems, Planning for high-risk maternity patients: A new approach. In pregnant women who are exposed to parvovirus B19, serological testing of IgG and IgM should be carried out immediately. The clinical features and pathogenesis of parvovirus B19 have been described in two reports. Current trends and risks associated with human parvovirus B19 infection. Fetal Parvovirus infection has been associated with aplastic anaemia and myocarditis that may present with hydrops fetalis and death, usually within the first 20 weeks of pregnancy although it has rarely been reported at later gestations. Therefore, MSAFP testing is not recommended for predicting fetuses at risk for parvovirus infection (. Other viral agents of perinatal importance: Varicella, parvovirus, respiratory syncytial virus and enterovirus. Török TJ. Hydrops can be diagnosed with fetal ultrasound (, If fetal hydrops is present and the pregnancy is 32 to 34 weeks gestation, consideration may be given to delivery if the fetus’s lung maturity is confirmed. Adults can get infected with parvovirus B19, too.Other much less common symptoms of parvovirus B19 infection include painful or swollen joints (polyarthropathy syndrome), which is more common in adults, and severe anemia (a condition in which the body doesn’t have enough healthy red blood cells). Parvovirus B19 most commonly causes fifth disease, a mild rash illness that usually affects children. Dr. Heavey is also a certified nurse-midwife at the Strong Midwifery Group at the University of Rochester Medical Center in Rochester, N.Y. The virus is effectively transmitted after close contact exposures, however. may email you for journal alerts and information, but is committed Parvovirus B19 infection is believed to be transmitted mainly through respiratory secretions. Fetal death as well as fetal hydrops is most likely a result of severe B19-associated anemia. Cartter ML, Farley TA, Rosengren S, et al. As a result, it can cause anemia, thrombocytopenia, and myocarditis. Isolation precautions are not indicated for most patients with erythema infectiosum because they are past the period of infectiousness at the time of clinical illness. Intrauterine infection with human parvovirus B19 (B19) has been associated with stillbirth, fetal hydrops, and fetal death (Woernle, Anderson, Tattersall, & Davison, 1987). Women who are schoolteachers or day care workers are particularly at risk because they are more likely to be exposed and have close contact with children with fifth disease. Parvovirus B19 and Pregnancy Usually there is no serious complication for a pregnant woman or her unborn baby following exposure to a person with parvovirus B19. However, if a pregnant woman is in regular contact with children aged 4 to 11 or if she has been in contact with an affected child, she must tell her doctor and have a blood test to determine immunity. APIC Text of Infection Control and Epidemiology. All registration fields are required. Acute infection in pregnancy can cause B19 infection in the fetus, leading to nonimmune fetal hydrops or fetal loss, depending on gestational age … Fetal hydrops usually resolves within 2 weeks after adequate intrauterine therapy. In situations in which there is a parvovirus B19 outbreak, it is not known whether the primary mode of transmission is direct person-to-person contact, fomites, large-particle droplets, or small-particle droplets (, Generally, diagnosis of parvovirus is based on clinical symptoms and serologic antibody testing for parvovirus immunoglobulin G and parvovirus immunoglobulin M (IgM). Some error has occurred while processing your request. Parvovirus B19 may be transmitted by blood components such as cryoprecipitate and fresh frozen plasma. Parvovirus B19 infection and its significance in pregnancy. Headache. The usual clinical manifestation is For women who are seronegative, serologic testing will offer baseline information, should they be exposed to parvovirus during the pregnancy. About half of pregnant women are immune to parvovirus B19, so they and their babies are usually protected from getting the virus and fifth disease. South Australian Perinatal Practice Guideline Parvovirus (slapped cheek syndrome) INFORMAL COPY WHEN PRINTED Page 3 of 8 Public-I 2A Parvovirus Parvovirus B19 is a single-stranded DNA virus.1 Parvovirus B19 selectively infects and lyses human erythroblasts3 and is distinguished by the mild rash illness erythema infectiosum, also known as fifth disease (the fifth, pink-red rash to be Antibodies are cells that your immune system produces in response to an infection. Acute infection in pregnancy can cause B19 infection in the fetus, leading to nonimmune fetal hydrops or fetal loss, depending on gestational age at the time of infection. All rights reserved. This is a case report of a 31-year-old primigravida who was diagnosed with an asymptomatic acute parvovirus B19 infection in the second trimester of pregnancy and its suspected association with an increased nuchal translucency (NT) measurement. Parvovirus B19 is a single-stranded DNA virus that is cytotoxic to erythroid progenitor cells, causing inhibition of erythropoiesis. Easily transmissible, parvovirus spreads slowly, allowing outbreaks to persist over months within a community. Transmission of parvovirus infection from infected patients is rare. Viral serology for parvovirus B19 was positive. However, parvovirus B19 infections during pregnancy can cause severe fetal anemia, occurring as a result of destruction of erythropoietic stem cells by the virus, which may in turn cause fetal heart failure and NIHF, and fetal death. Education about erythema infectiosum and possible methods to decrease infection can be provided to the community, schools, and parents of children who are cared for in group settings. The recommendation on seeking specialist advice if a person at increased risk of complications has confirmed parvovirus B19 infection is pragmatic and has been extrapolated from expert opinion in a review article on human parvovirus B19 [American Association of Blood Banks, 2009] and a review article on parvovirus B19 infection and people with sickle cell disease and thalassaemia [Slavov, 2011]. 2003;11(3):175-9. Parvovirus B19 infection during pregnancy. Pediatr Infect Dis J. The virus causes erythema infectiosum, also known as fifth disease. Principles and practices of infectious diseases. 6,7 The importance of contact patterns in the spread of this infection is supported by several reports of local outbreaks of erythema infectiosum in schools, 8,9 and of high attack rates among household contacts of cases of parvovirus B19 infection. However, the natural history of infection in the untreated fetus is not known, and the benefit of intrauterine blood transfusion is as yet unproven. Parvovirus infection is common throughout the world. Fifth Disease Outbreaks in the Workplace & Pregnancy. The possible fetal effects during pregnancy concern women who are exposed to this common virus. The efficacy of decontaminating toys and other environmental surfaces has not been studied. Susceptible household contacts have about a 50% attack rate. Management of parvovirus infection in pregnancy and outcomes of hydrops: A survey of members of the Society of Perinatal Obstetricians. 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