Freitas Ronaldo B, Monteiro Talita A F, Silva Filho Manoel G, Linhares Alexandre C
Virology Section, Evandro Chagas Institute, National Foundation of Health, Ministry of Health, Belém, Pará, Brazil.
Rev Inst Med Trop Sao Paulo. 2002 Jan-Feb;44(1):17-22. doi: 10.1590/s0036-46652002000100004.
A total of 220 patients with arthropathy were selected in Belém, Pará between January 1994 and December 2000, and screened for the presence of human parvovirus B19 IgM and IgG antibodies by enzyme-linked immunosorbent assay (ELISA). A subgroup (n = 132) of patients with high levels of antibodies (either IgM+/IgG+ or IgM-/IgG+) were examined for the presence of DNA by polymerase chain reaction/nested PCR. Recent/active infection (detection of IgM and/or IgG-specific antibodies and presence of viral DNA) was identified in 47.7% of the 132 individuals with arthropathy. In our study, women were significantly more affected (59.7%) than men (35.4%) (P = 0.0006). The age group of 11-20 years (84.6%), among female patients, and 21-30 years (42.1%), among male, were those with the highest incidence rates. The analysis of the temporal distribution of B19-associated arthropaties showed a cyclic pattern, with peak incidence rates occuring at 3-5 year intervals. Significant diference (P = 0.01) was observed when comparing both the highest (39.0%) and the lowest (11.0%) seropositivity rates for the years of 1995 and 2000, respectively. The interfalangial joints of hands and feet were mostly affected, with 50.0% and 48.0% of cases among both women and men, respectively. In a smaller proportion, other joints such as those of knee, ankle, pulse and shoulder were affected. As for the duration, symptoms lasted 1 to 5 days in 54.0% of the individuals, whereas in 46.0% of them the disease lasted 6-10 days, if considered the subgroup (n = 63) of patients with recent/active infection by parvovirus B19. In our study, joint clinical manifestations occurred symmetrically. Our results indicate that B19 may be an important agent of arthropathies in our region, and this underscores the need for specific laboratory diagnosis when treating patients suffering from acute arthropathy, mainly pregnant women.
1994年1月至2000年12月期间，在帕拉州贝伦市共选取了220例关节病患者，通过酶联免疫吸附测定（ELISA）筛查人细小病毒B19 IgM和IgG抗体的存在情况。对抗体水平较高（IgM+/IgG+或IgM-/IgG+）的一组患者（n = 132）进行聚合酶链反应/巢式PCR检测以确定DNA的存在情况。在132例关节病患者中，47.7%被确定为近期/活动性感染（检测到IgM和/或IgG特异性抗体且存在病毒DNA）。在我们的研究中，女性受影响的比例（59.7%）显著高于男性（35.4%）（P = 0.0006）。女性患者中11 - 20岁年龄组的发病率最高（84.6%），男性患者中21 - 30岁年龄组的发病率最高（42.1%）。对与B19相关的关节病的时间分布分析显示出一种周期性模式，发病率高峰每隔3 - 5年出现一次。分别比较1995年和2000年的最高血清阳性率（39.0%）和最低血清阳性率（11.0%）时，观察到显著差异（P = 0.01）。手和脚的指间关节受影响最为常见，女性和男性患者中分别有50.0%和48.0%的病例累及该部位。较小比例的患者其他关节如膝关节、踝关节、腕关节和肩关节也受到影响。至于病程，如果考虑细小病毒B19近期/活动性感染的患者亚组（n = 63），54.0%的个体症状持续1至5天，而46.0%的个体疾病持续6 - 10天。在我们的研究中，关节临床表现呈对称性出现。我们的结果表明，B19可能是我们地区关节病的一个重要致病因素，这突出了在治疗急性关节病患者（主要是孕妇）时进行特异性实验室诊断的必要性。
