Miron Dan, Luder Anthony, Horovitz Yoseph, Izkovitz Andrey, Shizgreen Irena, Ben David Eliel, Ohnona Frederic S, Schlesinger Yechiel
Department of Pediatrics A, HaEmek Medical Center, Afula, Israel.
Pediatr Infect Dis J. 2006 Oct;25(10):898-901. doi: 10.1097/01.inf.0000237865.01251.d2.
The extent and clinical manifestations of acute human parvovirus B19 (B19) infection were assessed in previously healthy hospitalized children admitted with clinical syndromes potentially associated the virus.
The study was prospective and was conducted between October 2002 and August 2004 in the pediatric departments of 3 hospitals in Israel. The survey included previously healthy children who were hospitalized with 1 or more of the following acute diseases: acute nonallergic exanthema, fever for >1 week, aplastic anemia or pancytopenia, acute nonbacterial arthropathy, immune thrombocytopenic purpura (ITP), Henoch-Schönlein purpura (HSP) and aseptic meningitis. A control group of children with a proven, non-B19 infection was also studied. Serum samples obtained from each child on admission were tested for B19 DNA by real-time PCR and B19 IgM by ELISA. Acute B19 infection was defined by the following criteria: positive serum B19-DNA and/or B19 IgM, negative serum B19 IgG, and no other proven infection.
Overall, 167 children were included in the study. The mean age was 5.5 +/- 4.6 years (range, 0.5-17), males and females equally divided. Acute B19 infection was demonstrated in 12.6% (n = 21) of the children. Both tests were performed in 19 children and were positive in 10 (53%). In 7 and 2 children, only B19-DNA or B19 IgM, respectively, was positive. Acute B19 infection was documented in 27% (10/39) of children who presented with a variety of acute exanthema diseases; 9% (5/57) of children with acute arthropathy (all 5 had transient synovitis); 10% (2/21) of children with fever >1 week, both presented as mononucleosis syndrome; and in 44% (4/9) of children with transient pancytopenia or aplastic anemia. No acute B19 infection was demonstrated in 15 children with ITP, 9 with HSP, and 6 with aseptic meningitis and among 70 children in the control group. By logistic regression analysis, manifestations significantly associated with acute B19 infection were exanthema (OR 2.9; 95% CI = 1.1-7.5), anemia (OR 6.35; 95% CI = 2.2-18.2) and leucopenia (OR 4.14; 95% CI =1.2-14.2).
Acute B19 infection was documented among 12.6% of children hospitalized with clinical syndrome potentially associated with the virus. Clinical and laboratory features associated with acute B19 infection were exanthema, anemia and leucopenia. Determination of both serum B19-DNA and serum B19 IgM should be performed for the accurate diagnosis of acute B19 infection.
对因可能与人类细小病毒B19（B19）相关的临床综合征而入院的既往健康住院儿童，评估急性B19感染的程度及临床表现。
本研究为前瞻性研究，于2002年10月至2004年8月在以色列3家医院的儿科进行。该调查纳入了因以下1种或多种急性疾病而住院的既往健康儿童：急性非过敏性皮疹、发热超过1周、再生障碍性贫血或全血细胞减少、急性非细菌性关节炎、免疫性血小板减少性紫癜（ITP）、过敏性紫癜（HSP）和无菌性脑膜炎。还对一组经证实为非B19感染的儿童进行了研究。入院时从每个儿童采集的血清样本通过实时PCR检测B19 DNA，通过酶联免疫吸附测定（ELISA）检测B19 IgM。急性B19感染依据以下标准定义：血清B19 - DNA和/或B19 IgM阳性、血清B19 IgG阴性且无其他经证实的感染。
总体而言，167名儿童纳入本研究。平均年龄为5.5±4.6岁（范围0.5 - 17岁），男女比例均等。12.6%（n = 21）的儿童证实有急性B19感染。19名儿童同时进行了两项检测，其中10名（53%）呈阳性。分别有7名和2名儿童仅B19 - DNA或B19 IgM呈阳性。在患有各种急性皮疹疾病的儿童中，27%（10/39）记录有急性B19感染；急性关节炎儿童中有9%（5/57）（所有5例均为短暂性滑膜炎）；发热超过1周的儿童中有10%（2/21），均表现为传染性单核细胞增多症综合征；短暂性全血细胞减少或再生障碍性贫血儿童中有44%（4/9）。15例ITP儿童、9例HSP儿童、6例无菌性脑膜炎儿童以及70名对照组儿童中均未证实有急性B19感染。通过逻辑回归分析，与急性B19感染显著相关的表现为皮疹（比值比[OR]2.9；95%置信区间[CI]=1.1 - 7.5）、贫血（OR 6.35；95% CI = 2.2 - 18.2）和白细胞减少（OR 4.14；95% CI =1.2 - 14.2）。
在因可能与该病毒相关的临床综合征而住院的儿童中，12.6%记录有急性B19感染。与急性B19感染相关的临床和实验室特征为皮疹、贫血和白细胞减少。为准确诊断急性B19感染，应同时检测血清B19 - DNA和血清B19 IgM。
